In clinical practice, it is very important to diagnose pulmonary lesions at an early stage. At present, chest X-ray and CT are minimally invasive procedures used to examine pulmonary lesions [11–13]. However, these examinations can only elaborate on the imaging characteristics and cannot be used to provide conclusive diagnosis, especially in the case of diseases such as tuberculosis and tumors [14, 15]. Biopsy has become a method of choice in clinical practice, as it can quickly differentiate between the benign and malignant nature of pulmonary lesions [16, 17]. For peripheral pulmonary lesions, CT or ultrasound-guided biopsy is usually performed. Bronchoscopy biopsy is usually used for CPLs. PTNB can be used when the lesions are large. Currently, physicians prefer PTNB and TBLB for pulmonary biopsy. In this study, 110 patients were divided into two groups to analyze the accuracy of PTNB and TBLB to diagnose CPLs with a diameter ≥ 3 cm. For TBLB, we can directly observe the mucosal surface and obtain histopathological indicators, making it more commonly used in clinical practice. However, PTNB can improve the positive detection rates of pulmonary lesions and accurately and effectively locate pulmonary lesions [18]. These methods demonstrate different diagnostic values in different clinical settings. The patients who participated in this study received surgical treatment and underwent pathological examinations to compare the diagnostic accuracy between the two groups. This study aimed to determine whether TBLB had any advantages over PTNB in clinical applications to avoid relying on subjective decisions made by radiologists or clinical physicians. However, there still exists a debate about the advantages and limitations of TBLB compared with PTNB in detecting CPLs, as there is no existing recommendation for their use [19–21]. According to the latest studies, the positive rates of TBLB in diagnosing CPLs can reach 70% [22, 23], whereas the positive rate of PTNB is 80% [24, 25], which is consistent with the results of the findings of this study. In this study, we found that TBLB had similar specificity in diagnosing lung tumors as PTNB [26–28]. However, the sensitivity and accuracy of PTNB in detecting malignant lesions were much higher than TBLB (sensitivity 93.94% vs. 72.73%, accuracy 94.00% vs. 74.67%). This is consistent with the findings of the previous studies, which indicate that the sensitivity and accuracy of PTNB in diagnosing malignant tumors are significantly higher than TBLB. In addition, we found no significant difference in the malignant diagnosis rates between the two groups. However, PTNB has relatively more incidence rates of complications, such as bleeding, pneumothorax, or some other complications consistent with other studies [29–31]. However, these complications were not fatal, and PTNB is a relatively safer examination method.
Our study has some limitations. First, data collection for this study was biased and did not compare lesions with smaller diameters, and samples without final pathology were excluded because surgical pathology results were considered as the gold standard. Second, there may be some factors that affect the statistical results, such as no more samples collected and possible biases among different pathologists in pathological diagnosis. However, we believe that these limitations had little impact on the results as our study addressed multiple steps. The next round of investigation should consider these issues.
In summary, our study demonstrated that the accuracy and sensitivity of PTNB are higher than TBLB, however, PTNB has increased complication rates in diagnosing pulmonary lesions. Both PTNB and TBLB demonstrated excellent performance and should be applied under the most suitable conditions to maximize their benefits.