OBJECTIVES: Patients with a solitary pulmonary nodule detected in their lungs require a biopsy for a definite malignancy diagnosis. This is most frequently done by transthoracic needle aspiration (TTNA), however, TTNA is an invasive procedure associated with high complication rates of pneumothoraxes. Peripheral bronchoscopy is a minimally invasive alternative which allows samples to be taken with significantly lower complication rates, and the addition of planning software and radial endobronchial ultrasound (rEBUS) further increases its diagnostic yield. Thus, potentially more patients could have their biopsy taken endobronchially. The objective was to understand physicians´ attitudes towards peripheral bronchoscopy as alternative to TTNA and the benefits of adding rEBUS and planning software to the procedure.

METHODS: An online cross-sectional questionnaire to gather survey data was distributed among pulmonologists in Europe and Africa with experience taking bronchoscopic lung biopsies. The survey used various question-formats, including Likert-scales, numeric answers, and open- and closed-ended questions. Responses were analyzed anonymously using descriptive statistics, t-tests, and Chi-Square tests with a significance level of p<0.05.

RESULTS: The survey was completed by 50 physicians. Of the respondents, 86% (strongly) agreed that peripheral bronchoscopy in combination with planning software and rEBUS; forms a valid alternative to TTNA for sampling and 70% percent expected rEBUS to increase the diagnostic yield compared to no rEBUS. All respondents expected procedure improvements when using planning software, in particular increased localization accuracy (90%), an increase in procedural efficiency (76%), and the reduced need for secondary procedures (92% [strongly] agreed). Respondents expected that through increasing the diagnostic yield with the three techniques combined, this would lead to an average of 2.7 fewer referrals to other specialties for diagnostics.

CONCLUSIONS: A considerable majority of respondents consider peripheral bronchoscopy with planning software and rEBUS added being a valid alternative to TTNA, which may contribute to downstream resource and planning efficiencies.