Lung puncture biopsies based targeted NGS increase clinical benefit to patients with short-term progressive pulmonary lesions suspected to be benign

Objectives Identification of pathologic and microbiological features is helpful for the management of short-term progressive pulmonary lesions suspected to be benign. This study aimed to analyze the additional value of lung puncture biopsies based targeted next-generation sequencing (tNGS) for these patients. Design This was a descriptive observational study, whose endpoints were to describe the diagnostic yield regarding etiology, the rate of favored treatment change, and consistency of traditional culture with tNGS. Results Among the 81 patients enrolled, seven were diagnosed with malignancy. Of the remaining 74 benign cases, the diagnostic yield was 79.73% (59/74) when tNGS was applied to puncture biopsy specimens. This is in comparison to a yield of 13.5% (17/74) with histopathology alone and 35.1% (26/74) with histopathology combined with traditional tissue culture. Notably, without concurrent application of tNGS alongside conventional culture, microbial diagnoses would have been missed in 39.19% (29/74) of cases. Correspondingly, the combined assessment approach demonstrated a significantly higher likelihood of influencing therapeutic decisions (97.3%, 72/74) compared with histopathology alone (24.3%, 18/74) or histopathology combined with traditional culture (36.5%, 27/74). Importantly, favored therapeutic modifications guided by additional infectious or non-infectious findings from tNGS reports included initiation of antibiotic (n = 14), anti-fungal (n = 2), anti-viral (n = 2), anti-tuberculosis (n = 9), anti-nontuberculous mycobacteria (n = 2), and corticosteroid (n = 16) treatments. Furthermore, compared with traditional culture, tNGS significantly reduced the time required for microbiological identification. Conclusions Additional tNGS increases the diagnostic yield of lung puncture biopsy for short-term progressive pulmonary lesions, providing more evidence for modifying treatment, along with a shorter time to diagnosis.