The addition of radial endobronchial ultrasound to electromagnetic navigation bronchoscopy: the NEBULA study – a randomised controlled trial

Background: Bronchoscopic biopsies are a valuable tool for diagnosing small peripheral lung lesions suspected of cancer. Electromagnetic navigation bronchoscopy (ENB) has been developed to guide the bronchoscopist to the lesion and radial endobronchial ultrasound (rEBUS) to confirm the presence lesion once reached. The combination of modalities might improve the diagnostic yield; however, only a few studies with diverting results have been published. The objective of the present study was to investigate whether the combination of rEBUS and ENB is superior to ENB alone for diagnosing peripheral lung lesions suspected of lung cancer in a pragmatic study setting representing the daily clinical practices and challenges. Methods: The study was conducted according to CONSORT guidelines. All patients were randomised for either ENB or ENB+rEBUS. The reference test was either a final histopathologic diagnosis or determined by 6 months of computed tomography surveillance. Analyses were performed using intention-to-treat, with only procedures with a definitive diagnosis categorised as "diagnostic". Results: 45.7%), nor did we find any difference in malignant yield or adverse events. Conclusion: ENB+rEBUS is a safe and well-tolerated procedure, but not superior to ENB alone.