In many patients the optimal method of investigation of peripheral pulmonary lesions (PPL) is not clear. We performed a prospective randomized pragmatic trial to determine the comparative effectiveness of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) and CT-guided percutaneous needle biopsy (CT-PNB) for the investigation of PPL. Overall complication rates were higher in those undergoing CT-PNB (27% v 3%, p = 0.03), while diagnostic accuracy of EBUS-TBLB was shown to be non-inferior to that of CT-PNB. Expected diagnostic accuracy and complication rates are likely to differ for individual patients on the basis of specific complex clinicoradiologic factors, which will influence the cost-benefit analysis between EBUS-TBLB and CT-PNB for individual patients. Further studies are required to examine the effect of these factors on clinical decision-making.
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