Peripheral pulmonary lesions (PPLs) are challenging to diagnose due to their location beyond segmental bronchi. Radial endobronchial ultrasound (rEBUS) has emerged as a promising tool, but the utility of fluoroscopy guidance remains unclear. This study aimed to compare the diagnostic yield and safety of rEBUS-guided bronchoscopic procedures with or without fluoroscopy in PPLs. This single-center prospective randomized controlled study involved 42 adult patients with PPLs, divided into two groups: rEBUS and rEBUS-F (rEBUS with fluoroscopy). Patients underwent routine bronchoscopy to rule out endobronchial abnormalities, followed by rEBUS-guided transbronchial biopsy with or without fluoroscopy guidance. Diagnostic yield, complications, and predictors of diagnostic success were evaluated. The overall diagnostic yield of rEBUS-guided bronchoscopic procedures was 59.5%, with comparable yields in the rEBUS (59.1%) and rEBUS-F (60%) arms. Positive bronchus sign adjusted odds ratio (OR): 4.92, 95% confidence interval (CI): 1.43-16.93, p=0.011 and concentric image on rEBUS (adjusted OR: 3.83, 95% CI: 1.13-12.99, p=0.031) were identified as significant predictors of diagnostic success. The overall complication rate was 14.3%, including bleeding (4.8%), desaturation (7.1%), and fever (2.4%), with no instances of pneumothorax or life-threatening complications. Omitting fluoroscopy during rEBUS procedures for PPLs may preserve diagnostic performance while reducing radiation exposure and procedural costs. Larger multicenter studies are needed to confirm these exploratory findings.
Nanda et al. (Mon,) studied this question.