This randomized crossover trial evaluated whether combining needle aspiration and forceps biopsy improves diagnostic yield compared to using a single device alone during electromagnetic navigation bronchoscopy (ENB) for peripheral pulmonary lesions. A total of 142 participants underwent both biopsy methods sequentially under moderate sedation. The primary outcome was the diagnostic yield, defined as the percentage of patients whose biopsy provided a specific diagnosis. 
 
Results showed that the combined approach yielded a diagnostic success rate of 66.9 percent, which was significantly higher than either forceps biopsy (44.4 percent) or needle aspiration (51.4 percent) alone (p<0.001 for both comparisons). The combination also increased the sensitivity for malignancy to 71.7 percent, versus 58.3 percent for needle aspiration and 47.5 percent for forceps biopsy (p<0.001). The procedure had a favorable safety profile, with a low incidence of pneumothorax (3.5 percent) and only 1.4 percent of patients requiring drainage.  
 
These findings support the use of a multimodal biopsy approach in ENB for peripheral pulmonary lesions.