Comparative study between medical thoracoscopic, bronchoscopic transbronchial, and ultrasound-guided transthoracic lung biopsies in diagnosis of peripheral pulmonary lesions

Background Peripheral pulmonary lesions are common clinical problems which need to be diagnosed through techniques less invasive than surgical biopsies. Objectives To compare safety and diagnostic yield of fiberoptic transbronchial, medical thoracoscopic, and ultrasound (US)-guided transthoracic lung biopsies in assessment of peripheral lung disorders. Patients and methods We recruited 45 patients with peripheral lung lesions. In 19 patients pathology was solitary and it was diffuse in 26 patients. Patients were randomly divided into three groups 15 patients each: Group A: patients underwent flexible bronchoscopy. The biopsy instrument was advanced under fluoroscopic guidance to reach the target lesion. Group B: patients underwent medical thoracoscopy and lung biopsies were taken using coagulating forceps. Group C: patients underwent US-guided transthoracic needle. Results Symptoms, investigations, findings, and hazards related to each technique were recorded. A conclusive diagnosis was achieved in 34 patients: 15 patients were diagnosed as bronchogenic carcinoma and 12 patients had metastatic lesions. Seven patients had benign pathology. Transbronchial, medical thoracoscopic, and US-guided biopsies had a sensitivity of 67.7, 87.7, and 73.7%, respectively for the diagnosis of peripheral lung disorders. Transbronchial biopsies showed less diagnostic accuracy than thoracoscopy in solitary lesions. 73.3%, of both bronchoscopy and medical thoracoscopy patients and 40% of US-guided patients had minor complications. The diagnostic performance of transbronchial lung biopsy under fluoroscopic guidance, thoracoscopic lung biopsies, and US-guided transthoracic biopsies are comparable. However, risk of potential complications makes US-guided method preferred in cases of respiratory insufficiency.