Randomised controlled trial comparing the diagnostic yield of initial forceps biopsy vs brushings in Radial Guide Sheath Endobronchial Ultrasound lung biopsy

The radial guide sheath endobronchial ultrasound guided lung biopsies will be performed as per the usual practice at Sunshine Coast University Hospital utilising the usual equipment used for the procedure (Olympus BF190 or Olympus BF3C20 bronchoscope). - All procedures will be performed in the endoscopy unit at Sunshine Coast University. The bronchoscopist (respiratory physician or advanced trainee) will review the most recent CT Chest scan of the patient and determine the sub-segmental anatomical location of the lesions to be sampled. - Bronchoscopy will be performed under a general anaesthetic with the bronchoscope passed through a laryngeal mask airway and less commonly through an endotracheal tube, at the discretion of the anaesthetist. - The airways will be examined to segmental and sub-segmental level bilaterally. - Once the bronchoscope is in predetermined sub-segmental airway and cannot be advanced any further, the radial EBUS probe covered with the guide sheath is advanced though the working channel of the bronchoscope towards the lesion. The radial EBUS provides a high resolution 360 degree view of the surrounding lung. The usual characteristic ultrasound features of normal and abnormal lung tissue will be used to identify the lesion. Once the lesion is located, the radial EBUS probe is withdrawn while the guide sheath is left in place as an extended working channel. The sampling instruments (biopsy forceps and brush) are then advanced through the guide sheath to the lesion to obtain tissue samples. The sampling sequence will be randomly allocated prior to the procedure. The study arms are: A1) 6 forceps biopsies and 2 brushings A2) 3 forceps biopsies and 2 brushings and 3 forceps biopsies B) 2 brushings and 6 forceps biopsies. - All the collected specimens will be labelled and sent to the Sunshine Coast University Hospital laboratory for processing as per usual practice. The laboratory staff will receive the standard specimen jars: o All forceps biopsy specimens in a formalin jar o Brushings smeared on slides and the brush tip in a formalin jar o Washings in a specimen jar. - The usual procedure time is 30 minutes.