Lung puncture biopsies based targeted NGS increase clinical benefit to patients with short-term progressive pulmonary lesions suspected to be benign

OBJECTIVES: Identification of pathologic and microbiological features is helpful for the management of short-term progressive pulmonary lesions suspected to be benign. This study aimed to analyze the additional value of lung puncture biopsies based targeted next-generation sequencing (tNGS) for these patients. DESIGN: This was a descriptive observational study, whose endpoints were to describe the diagnostic yield regarding etiology, the rate of favored treatment change, and consistency of traditional culture with tNGS. RESULTS: Among the 81 patients enrolled, seven were diagnosed with malignancy. Of the remaining 74 benign cases, the diagnostic yield was 79.73% (59/74) when tNGS was applied to puncture biopsy specimens. This is in comparison to a yield of 13.5% (17/74) with histopathology alone and 35.1% (26/74) with histopathology combined with traditional tissue culture. Notably, without concurrent application of tNGS alongside conventional culture, microbial diagnoses would have been missed in 39.19% (29/74) of cases. Correspondingly, the combined assessment approach demonstrated a significantly higher likelihood of influencing therapeutic decisions (97.3%, 72/74) compared with histopathology alone (24.3%, 18/74) or histopathology combined with traditional culture (36.5%, 27/74). Importantly, favored therapeutic modifications guided by additional infectious or non-infectious findings from tNGS reports included initiation of antibiotic (n = 14), anti-fungal (n = 2), anti-viral (n = 2), anti-tuberculosis (n = 9), anti-nontuberculous mycobacteria (n = 2), and corticosteroid (n = 16) treatments. Furthermore, compared with traditional culture, tNGS significantly reduced the time required for microbiological identification. CONCLUSIONS: Additional tNGS increases the diagnostic yield of lung puncture biopsy for short-term progressive pulmonary lesions, providing more evidence for modifying treatment, along with a shorter time to diagnosis.