The addition of radial endobronchial ultrasound to electromagnetic navigation bronchoscopy: the NEBULA study - a randomised controlled trial
In brief
Radial ultrasound adds no benefit to navigation bronchoscopy, yields 45% vs 44% diagnosis
In a randomized trial of 183 patients, diagnostic yield was 45.7% with ENB plus radial ultrasound versus 43.8% with ENB alone, with no difference in cancer detection or adverse events. The combined approach is safe but does not improve outcomes, so routine use of radial ultrasound may not be justified.
- Journal
- ERJ open research (Q1)
- Published
- 27 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Amanda Dandanell Juul, Arman Arshad, Alice V Christophersen, Pernille Kristiansen, Alexis Pulga, Rana Bibi, et al.
- PMID
- 42516899
- DOI
- 10.1183/23120541.01494-2025
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 29 July 2026).
Abstract
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: Of 200 patients included from four centres, 183 were randomised and included in the final analyses. There was no difference in diagnostic yield between the two groups (43.8% versus 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.