Traditional vs. Advanced Lung Biopsy Techniques

Lung Puncture Guidance: Is Tech Always Best?

Lena Kashyap in Health & Wellness August 2025 • 3 min read.

"A new study questions whether advanced imaging techniques improve outcomes in peripheral lung biopsies compared to traditional methods."

When it comes to diagnosing lung issues, getting a tissue sample is often crucial. For peripheral lung lesions, doctors frequently use bronchoscopy to obtain these samples. The question is, what's the best way to guide the needle to the right spot?

Traditionally, conventional bronchoscopy with fine needle aspiration has been the go-to method. However, newer technologies like endobronchial ultrasound (EBUS) and electromagnetic navigation (EMN) have emerged, promising greater precision. But do these advanced techniques really improve the odds of a successful biopsy?

A recent study, published in the American Journal of Respiratory and Critical Care Medicine, challenges the assumption that newer is always better. The researchers compared the diagnostic yield of different guidance methods in peripheral lung biopsies.

The Study: Old vs. New

Traditional vs. Advanced Lung Biopsy Techniques

The study analyzed data from 581 bronchoscopies performed on patients with unclear peripheral lung lesions. Researchers looked at how different puncture guidance techniques affected the diagnostic yield – in other words, how often the biopsy successfully provided a diagnosis.

Besides traditional bronchoscopy with fine-needle aspiration, the study also included procedures using radial EBUS (r-EBUS) and electromagnetic navigation (EMN).

r-EBUS: This technique uses ultrasound at the tip of the bronchoscope to visualize the lung tissue and guide the needle.
EMN: This method uses electromagnetic fields to create a 3D map of the lungs, allowing doctors to plan and guide the biopsy.

The study revealed some surprising results. While 63.7% of all biopsies yielded a diagnosis, the use of r-EBUS alone reduced this rate to 57%. Even more strikingly, combining bronchoscopy with EMN resulted in a diagnostic yield of only 38.5%. Combining r-EBUS with EMN fared only slightly better, at 47.1%.

The Verdict: Stick to the Basics (For Now)

The study's authors concluded that, in their retrospective analysis, electromagnetic and ultrasound-guided navigation systems didn't improve outcomes compared to traditional methods for peripheral lung biopsies.

In fact, the classic combination of bronchoscopy with fine-needle aspiration under fluoroscopic guidance (a type of X-ray imaging) still appears to be the most effective approach. The researchers suggest sticking with this technique until further prospective studies provide more nuanced insights.

It's important to remember that this study was retrospective, meaning it looked back at data that had already been collected. More research is needed to confirm these findings and explore the potential benefits of newer technologies in specific situations. But for now, the traditional approach remains a solid choice.

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Everything You Need To Know

What is conventional bronchoscopy with fine needle aspiration, and why is it considered a traditional method for peripheral lung biopsies?

In a peripheral lung biopsy, conventional bronchoscopy with fine needle aspiration is a traditional method where doctors use a bronchoscope and a needle to obtain tissue samples from lung lesions. This technique relies on the doctor's skill and experience to navigate to the lesion and collect the sample. While newer technologies like endobronchial ultrasound (EBUS) and electromagnetic navigation (EMN) have emerged, traditional bronchoscopy remains a fundamental approach in diagnosing lung issues.

What is endobronchial ultrasound (EBUS), and how does radial EBUS (r-EBUS) specifically aid in guiding peripheral lung biopsies?

Endobronchial ultrasound (EBUS) involves using an ultrasound probe at the tip of a bronchoscope to visualize lung tissue and guide a needle for biopsy. Radial EBUS (r-EBUS) is a specific type of EBUS where the ultrasound probe provides a radial view, helping doctors locate and target peripheral lung lesions. The goal of r-EBUS is to improve the accuracy of biopsies by providing real-time imaging of the lung tissue.

How does electromagnetic navigation (EMN) work in the context of lung biopsies, and what is its intended purpose?

Electromagnetic navigation (EMN) creates a 3D map of the lungs using electromagnetic fields. This map allows doctors to plan the biopsy route and guide the bronchoscope to the target lesion. EMN aims to enhance the precision of bronchoscopy by providing a virtual roadmap of the lungs, potentially improving the diagnostic yield of peripheral lung biopsies. However, its effectiveness compared to traditional methods is still under investigation.

What were the diagnostic yields observed when using radial EBUS (r-EBUS) and electromagnetic navigation (EMN) in peripheral lung biopsies, according to the study?

A recent study indicated that using radial EBUS (r-EBUS) alone actually reduced the diagnostic yield in peripheral lung biopsies to 57%. Combining bronchoscopy with electromagnetic navigation (EMN) resulted in an even lower diagnostic yield of only 38.5%. When r-EBUS was combined with EMN, the diagnostic yield only slightly improved to 47.1%. These results suggest that, in the context of the study, these advanced technologies did not outperform traditional methods.

Given the findings, what are the potential future directions for research and development regarding the use of technologies like endobronchial ultrasound (EBUS) and electromagnetic navigation (EMN) in lung biopsies?

While this study suggests that traditional methods may be sufficient for peripheral lung biopsies, advanced technologies like endobronchial ultrasound (EBUS) and electromagnetic navigation (EMN) continue to evolve. Future research should focus on refining these technologies and identifying specific patient populations or lesion characteristics for whom these advanced methods might offer a significant advantage. Additionally, improvements in training and technique may enhance the effectiveness of EBUS and EMN in the future. Further investigation may include comparison to robotic-assisted bronchoscopy and cone-beam computed tomography (CBCT).