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The morphology of benign and malignant solitary pulmonary lesions sometimes overlaps, making the differentiation difficult. This research aimed to create a radiomics-based prediction model using dual-phase 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET/CT) for noninvasive classification of these lesions. A total of 132 patients with solitary pulmonary lesions were included. CT, routine PET (PET 1 ), delayed PET (PET 2 ) and clinical data were acquired. Five combinations of radiomic features (CT, CT + PET 1 , CT + PET 2 , CT + PET 1  + PET 2 , CT+(PET 2 -PET 1 )/PET 1 ) were analyzed. Feature selection used eight methods, and the top ten ranked features were retained based on their weight coefficients. Seven classifiers were used to construct models. The receiver operating characteristic (ROC) curves of the five optimal radiomics models for solitary pulmonary lesions were compared. The optimal CT+(PET 2 -PET 1 )/PET 1 model achieved the highest AUC of 0.898 (95% CI: 0.828–0.968), compared to the optimal CT (0.828, 95% confidence interval [CI]: 0.754–0.902), CT + PET 1 (0.858, 95% CI: 0.785–0.931), CT + PET 2 (0.867, 95% CI: 0.796–0.938), and CT + PET 1  + PET 2 (0.868, 95% CI: 0.798–0.939) models. Based on dual-phase 18 F-FDG PET/CT for radiomic analysis, the optimal CT+(PET 2 -PET 1 )/PET 1 model demonstrated promising diagnostic efficacy and can be a clinical diagnostic tool to distinguish between benign and malignant solitary pulmonary lesions.

Radial probe endobronchial ultrasound transbronchial lung biopsy with guide sheath (RP-EBUS-GS-TBLB) was one of the main diagnostic methods for peripheral pulmonary lesions (PPLs). The aim of this study was to develop a predictive model for the diagnostic rate of RP-EBUS-TBLB in PPLs. A total of 189 consecutive patients with PPLs who had undergone RP-EBUS-TBLB between January 2022 and October 2024 in 8th Medical Centre, Chinese PLA General Hospital were enrolled in this retrospective single-center cohort study. The LASSO regression method was used to select predictors and nomogram model was developed using multivariate logistic regression. Internal validation was performed using bootstrapping. Model performance was evaluated using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Bootstrapping method was applied for internal validation. The diagnostic rate of RP-EBUS-TBLB in PPLs was 74.07% (140/189). Six (lesion morphology in CT, number of biopsies, size, margin, echogenicity and RP-EBUS location) variables were selected by the LASSO regression analysis. We applied EBUS imaging features (size, margin, echogenicity and RP-EBUS location; model 1) separately and combined them with clinical features (lesion morphology in CT and number of Biopsies; model 2) to develop two predictive models. The AUC of model 1 was 0.889 (95% CI, 0.826–0.943), and it was 0.917 (95% CI, 0.862–0.960) in model 2. The predictive model was well calibrated and DCA indicated its potential clinical usefulness. However, there is no significant difference in AUC between the two models, which suggest that the model 1(only using EBUS imaging features) can serve as a concise and efficient predictive model and has great potential to predict the diagnostic rate of RP-EBUS-TBLB in PPLs.

Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features ( P  < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively ( P  = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone ( P  < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

Although lungs are one of the most frequent sites of metastasis for malignant tumors, little has been reported about the value of bronchoscopy for lung metastases presenting with peripheral pulmonary lesions (PPLs). This retrospective cohort study investigated the diagnostic value of bronchoscopy for peripheral metastatic lung tumors. Consecutive patients who underwent diagnostic bronchoscopy with radial endobronchial ultrasound for PPLs and were finally diagnosed with metastatic lung tumors from April 2012 to March 2019 were included. We analyzed 235 PPLs, with a median size of 18.8 mm. The overall diagnostic yield was 76.6%. In a multivariable analysis, large lesion size (>20.0 mm vs. <20.0 mm: 87.6% vs. 67.7%, p = 0.043, OR = 2.26), inner location (inner 2/3 vs. outer 1/3: 84.8% vs. 69.1%, p = 0.004, OR = 2.79), and visibility on radiography (visible vs. invisible: 83.2% vs. 56.1%, p = 0.015, OR = 3.29) significantly affected the diagnostic yield. Although a positive bronchus sign tended to have a higher yield, no significant difference was observed (81.8% vs. 70.6%, p = 0.063). Only one case of lung abscess was observed, with no serious complications. In conclusion, bronchoscopy is a valuable technique for peripheral metastatic lung tumors, with good diagnostic accuracy and safety.

Background Diffusion-weighted imaging (DWI) can be used for quantitative tumor assessment. DWI with different models may show different aspects of tissue characteristics. Objective To investigate the diagnostic performance of parameters derived from monoexponential, biexponential, stretched exponential magnetic resonance diffusion weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in differentiating benign from malignant solitary pulmonary lesions (SPLs). Method Forty-four SPL subjects were selected according to the inclusion criteria. All patients underwent conventional and multi‑b DWI sequences. Monoexponential DWI and DKI model were fitted using least square method. Levenberg-Marquardt nonlinear fitting biexponential and stretched exponential DWI. Region of interests (ROIs) were described manually. Parameters between benign and malignant SPLs were compared using independent sample t test or the Mann-Whitney U test. Receiver operating characteristic (ROC) curves analysis was used to investigate the diagnostic performance of different DWI parameters. Correlation between all parameters were evaluated by using Spearman correlation. Result ADC, ADC slow , α, DDC and D app values were significantly lower in malignant SPL than in benign SPL ( P  < 0.001). K app was significantly higher in malignant SPL than in benign SPL ( P  < 0.001). Among all subjects, ADC slow was significantly lower than ADC ( P  < 0.05), while DDC and D app were significantly higher than ADC ( P  < 0.05). When observing the ROC curves for distinguishing benign and malignant SPL, the AUC values of ADC, ADC slow , DDC, D app , and K app were 0.904, 0.815, 0.942, 0.93, and 0.815, respectively. The DDC value has the highest area under ROC curve value. DeLong analysis showed no statistically significant difference in the area under ADC, DDC, and D app curves. There were strong correlations among ADC, ADC slow , ADC fast , f, α, DDC, D app , and K app ( P  < 0.001). Conclusion Multi‑b DWI is a promising method for differentiating benign from malignant SPLs with high diagnostic accuracy. In addition, the DDC derived from stretched‑exponential model is the most promising DWI parameter for the differentiation of benign and malignant SPLs. Trail registration This study was a clinical trail study, with study protocol published at ClinicalTrails. Retrospectively registered number ChiCTR2300074258, date of registration 02/08/2023.

Background: Serum cryptococcal antigen (CrAg) test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus (HIV) adult patients with pulmonary cryptococcosis and its clinical features. Methods: One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive (CrAg+ group) and 29 were negative (CrAg− group). It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio (OR) was used to measure correlation. Student's t- test was obtained to analyze continuous variable. Results: No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups (P > 0.05 in all). Nevertheless, diffuse extent lesion was 82.1% in CrAg+ group and 10.3% in CrAg− group (χ2 = 40.34, P < 0.001; OR = 39.87). Conclusions: Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation.

The diagnosis of peripheral pulmonary lesions (PPLs) remains a challenge for physicians. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been applied in the diagnosis of PPLs, but its diagnostic rate varies widely. The systematic review and meta-analysis was conducted to figure out the accuracy and safety of EBUS-TBNA in the diagnosis of PPLs. We searched the PubMed and Embase databases for relevant studies published from January 1, 2000 to December 30, 2021 and used PICO (Participants, Intervention, Comparison, and Outcome) to worked out the diagnostic rate of EBUS-TBNA in PPLs. Two reviewers independently performed the data extraction and assessed study quality. Statistical analysis was carried out via R software. In 7 studies of totally 510 patients of PPLs, the overall EBUS-TBNA diagnosis yield is 0.75 (95% CI 0.67–0.84) by the random effect model. EBUS-TBNA showed a higher accuracy of 0.64 (95% CI 0.53–0.74) compared to 0.46 (95% CI 0.19–0.72) of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) when EBUS probe is adjacent to lesions. In the case of malignant lesions, the diagnostic rate of EBUS-TBNA is 0.79 (95% CI 0.72–0.88). Combined EBUS-TBNA with conventional bronchoscopy procedures showed the highest diagnostic yield (0.83 (95% CI 0.79–0.87)). Collectively, EBUS-TBNA should be performed firstly in patients with PPLs suspected to lung cancer especially when the EBUS probe was adjacent to the lesions. No serious procedure-related complications were observed.

Background Cryobiopsy is an established technique that yields larger and higher-quality samples than does a forceps biopsy. However, it remains underutilised in the diagnosis of peripheral pulmonary lesions (PPLs), mainly because of difficulties in handling conventional cryoprobes. A recently introduced single-use cryoprobe with a smaller diameter and more flexibility than conventional ones may improve its diagnostic ability for PPLs. We conducted this prospective study to evaluate the feasibility of transbronchial cryobiopsy in the diagnoses of PPLs, using a new 1.7-mm cryoprobe. Methods The study included patients with PPLs less than 30 mm in diameter scheduled to undergo bronchoscopy. All the procedures were performed using a combination of virtual bronchoscopic navigation, radial endobronchial ultrasound (R-EBUS) and X-ray fluoroscopy, and all the samples were collected using the cryoprobe alone. Thereafter, we assessed the diagnostic outcomes and safety profiles. Results A total of 50 patients were enrolled and underwent cryobiopsy. The median lesion size was 20.8 mm (range, 8.2–29.6 mm), and the negative bronchus sign was seen in 34% of lesions. The diagnostic yield was 94% (95% confidence interval, 83.5–98.8%). A positive bronchus sign had a significantly higher diagnostic yield than did a negative bronchus sign (100% vs. 82.4%; P  = 0.035). The yield was achieved regardless of other variables, including lesion size, location, and R-EBUS findings. The major complications were mild and moderate bleeding in 28% and 62% of patients, respectively. Pneumothorax was identified in one patient. Conclusion Transbronchial cryobiopsy using the new 1.7-mm cryoprobe is a feasible procedure that has the potential to increase the diagnostic accuracy for PPLs. Trial registration Japan Registry of Clinical Trials, jRCT1032200065. Registered July 8 2020, https://jrct.niph.go.jp/en-latest-detail/jRCT1032200065

Background Reports on the application of metagenomic next-generation sequencing (mNGS) to the diagnosis of peripheral pulmonary lesions (PPLs) are scarce. There have been no studies investigating the optimal specimen type for mNGS. Methods We used mNGS to detect pathogens in matched transbronchial lung biopsy (TBLB), bronchoalveolar lavage fluid (BALF), and bronchial needle brushing (BB) specimens from 39 patients suspected of having infectious PPLs. We explored differences in microbial composition and diagnostic accuracy of mNGS for the 3 specimen types. Results mNGS was more sensitive than conventional culture for detection of bacteria and fungi in TBLB, BALF, and BB specimens, with no difference in the sensitivity of mNGS across the different specimen types. mNGS showed higher sensitivity for fungi or uncategorized pulmonary pathogens in TBLB+BALF+BB compared to TBLB but not BALF or BB specimens. There were no significant differences between the 3 specimen types in the relative abundance of pathogens, or between TBLB and BB specimens in the relative abundance of 6 common lower respiratory tract commensals. Conclusions mNGS has a higher sensitivity than the conventional culture method for detecting pathogens in TBLB, BALF, or BB specimens. mNGS of BB samples is a less invasive alternative to TBLB for the diagnosis of infectious PPLs.

Background Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications. Materials and methods In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC. Results The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P  > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group ( P  = 0.017), whereas the complication rate was comparable ( P  > 0.05). Conclusion Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.