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Publications

Journal Article Epublish

PubMed: 42516899 DOI: 10.1183/23120541.01494-2025

The addition of radial endobronchial ultrasound to electromagnetic navigation bronchoscopy: the NEBULA study - a randomised controlled trial.

ERJ Open Res 12(4)

Authors: Amanda Dandanell Juul, Arman Arshad, Alice V Christophersen, Pernille Kristiansen, Alexis Pulga, Rana Bibi, Torben Riis Rasmussen, Ole Hilberg, Nicoline M Andersen, Christian B Laursen

Affiliations

  • Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
  • Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
  • OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
  • Centre for Advanced Lung Cancer Diagnostics (CALU), Odense University Hospital, Odense, Denmark.
  • Department of Respiratory Medicine and Infectious Disease, Bispebjerg Hospital, Copenhagen, Denmark.
  • Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark.
  • Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark.
  • Department of Internal Medicine, Vejle Hospital, Vejle, Denmark.

Abstract

BACKGROUND

Bronchoscopic biopsies are a valuable tool for diagnosing small peripheral lung lesions suspected of cancer. Electromagnetic navigation bronchoscopy (ENB) has been developed to guide the bronchoscopist to the lesion and radial endobronchial ultrasound (rEBUS) to confirm the presence lesion once reached. The combination of modalities might improve the diagnostic yield; however, only a few studies with diverting results have been published. The objective of the present study was to investigate whether the combination of rEBUS and ENB is superior to ENB alone for diagnosing peripheral lung lesions suspected of lung cancer in a pragmatic study setting representing the daily clinical practices and challenges.

METHODS

The study was conducted according to CONSORT guidelines. All patients were randomised for either ENB or ENB+rEBUS. The reference test was either a final histopathologic diagnosis or determined by 6 months of computed tomography surveillance. Analyses were performed using intention-to-treat, with only procedures with a definitive diagnosis categorised as "diagnostic".

RESULTS

Of 200 patients included from four centres, 183 were randomised and included in the final analyses. There was no difference in diagnostic yield between the two groups (43.8% versus 45.7%), nor did we find any difference in malignant yield or adverse events.

CONCLUSION

ENB+rEBUS is a safe and well-tolerated procedure, but not superior to ENB alone.

MeSH

Lung, Neoplasms, Bronchoscopy, Diagnosis, Wounds And Injuries