Role of radial endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of pulmonary nodules: Case report and literature review

The diagnosis of pulmonary nodules can be made using several methods including computed tomography (CT)-guided fine-needle aspiration (FNA), radial endobronchial ultrasound (EBUS)-guided sampling techniques (transbronchial lung biopsy [TBLB], transbronchial brush, bronchoalveolar lavage, or transbronchial needle aspiration [TBNA]), or occasionally with convex probe (CP) EBUS-TBNA. While CT-guided FNA is associated with a high (25%) rate of pneumothorax, the CP-EBUS cannot reach lesions beyond the interlobar region. Radial EBUS-guided TBLB and transbronchial brushing are excellent modalities in the evaluation of peripheral pulmonary lesions. However, these techniques cannot access lesions that are located adjacent to the proximal segmental bronchus, due to the presence of a cartilaginous wall. Herein, we describe a 58-year-old man, who presented with a lung nodule in the right middle lobe, wherein radial EBUS-guided TBNA proved to be the most appropriate diagnostic modality. We also discuss the current utility of radial EBUS-guided TBNA in day-to-day practice.