Evaluation of the efficacy of different lung biopsy modalities in solitary pulmonary nodules

Introduction: This study compared the diagnostic performance and safety of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and virtual bronchoscopic navigation (VBN)-guided transbronchial lung biopsy (TBLB) in patients with solitary pulmonary nodules (SPNs). Methods: A retrospective analysis was conducted on 204 SPN patients, divided into CT-guided (n = 102) and VBN-guided (n = 102) groups. Parameters, including diagnostic yield, procedure time, and complication rates, were compared between the two methods. Results: After applying rigorous diagnostic criteria per ATS/ACCP guidelines, the overall diagnostic yield was higher in the VBN group (64.7%, 66/102) than in the CT group (59.8%, 61/102), though the difference was not statistically significant (P = 0.472). In exploratory subgroup analyses, VBN demonstrated higher diagnostic yield for smaller nodules (8-20 mm) and those located closer to the pleura (2-3 cm) (both P < 0.05). For larger nodules (20-30 mm) or those further from the pleura (3-5 cm), diagnostic rates were comparable between groups. The VBN group had significantly shorter procedure times, including lesion localization (6.62 ± 0.93 vs. 9.27 ± 1.05 min) and total procedure duration (22.04 ± 2.36 vs. 38.16 ± 4.29 min) (P < 0.01). The complication rate was significantly lower in the VBN group (9.80% vs. 29.41%, P < 0.01), with the CT group showing higher incidences of pneumothorax, hemoptysis, and chest pain in nodules 2-3 cm from the pleura. Multivariate analysis identified several factors significantly associated with diagnostic outcomes. Additionally, the VBN group incurred lower medical costs and shorter hospital stays (P < 0.01). Conclusion: VBN-guided biopsy was associated with higher diagnostic yield, fewer complications, shorter procedure times, and lower costs compared to CT-guided biopsy. These findings warrant confirmation in prospective randomized trials.