Comparative analysis of the efficacy and safety of electromagnetic navigation bronchoscopy combined with x‐ray or radial endobronchial ultrasound biopsy in the diagnosis of small peripheral pulmonary nodules

OBJECTIVE: To compare the clinical value and safety of electromagnetic navigation bronchoscopy (ENB) combined with radial endobronchial ultrasound (R‐EBUS) or x‐ray in the diagnosis of small peripheral pulmonary nodules that cannot be diagnosed by conventional bronchoscopy. METHODS: Fifty‐six patients with peripheral pulmonary nodules of <3 cm in diameter who underwent bronchoscopy at the First Affiliated Hospital of Soochow University and Dushu Lake Hospital of Soochow University from February 2019 to January 2022 were selected as the study subjects, including 24 patients who underwent ENB combined with x‐ray and 32 patients who underwent ENB combined with R‐EBUS. ENB was used as the guiding method in both groups, and x‐ray group and R‐EBUS group were combined with x‐ray and R‐EBUS, respectively, to determine whether the lesion was reached. In x‐ray group, biopsy and brushing were performed under fluoroscopic guidance. Using the results of surgery, puncture pathology, or clinical follow‐up 1 year as the gold standard, the diagnostic sensitivity, specificity, negative predictive value (NPV), diagnostic yield, negative likelihood ratio (LR‐), Youden index, missed diagnosis rate, success rate, and κ value were compared between the two groups, and the occurrence of postoperative complications was also compared between the two groups. RESULTS: The negative predictive value of the R‐EBUS group was significantly better than that of the x‐ray group (p = 0.006). CONCLUSION: Even with smaller nodule diameters, the negative predictive value of ENB combined with R‐EBUS were still higher than that of the x‐ray group.