Transbronchial lung biopsy (TBLB) is a well-recognized diagnostic technique in diffuse
interstitial lung diseases, but it is not considered to be the first choice in investigation
of solitary pulmonary nodules (SPN). The main idea of this study was to increase
the sensitivity of bronchoscopy using multiple techniques, especially TBLB, thus to avoid
more aggressive diagnostic procedures. The objective of this prospective study was to
evaluate the efficacy and safety of TBLB in the diagnosis of SPN, in comparison with
other bronchoscopic techniques. Fifty patients with chest x-ray finding consistent with
SPN underwent bronchoscopy with bronchial washing, brushing, bronchoalveolar lavage
(BAL) and TBLB were included in this study. Thirty-one patients suffered from
malignant tumors, while 19 patients had nonmalignant lesions. TBLB achieved overall
diagnostic sensitivity of 62%, BAL of 29%, bronchial brushing of 16% and washing of
6%. Combining all techniques together, bronchoscopy had overall sensitivity of 86%. Concerning
malignant lesions, TBLB had a sensitivity of 65%, specificity of 100%, and accuracy
of 82%. TBLB had a significantly better yield for lesions with a diameter 25 mm
than for lesions of <25 mm (sensitivity of 82% and 53% respectively, p<0.05). Diagnostic
yield improved significantly with the increasing number of specimens (less than 3 specimens:
sensitivity 59%, 3 or more specimens: sensitivity 87%, p<0.05). Complications of
TBLB occurred in 2 (4%) patients: 1 incomplete pneumothorax and 1 hemorrhage. According
to the results, we conclude that TBLB is an accurate and safe technique for the
diagnosis of pulmonary solitary nodule with a diameter equal or greater than 25 mm
