The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endobronchial ultrasound-guided transbronchial biopsy for peripheral lung lesions.


Lung lumps are commonly investigated using a thin flexible telescope (bronchoscope) inserted into the airways of the lung via the patient’s mouth or nose. Ultrasound-guided transbronchial biopsy is intended for diagnosing patients with a lung lump that cannot be reached by conventional bronchoscopy because the lump does not protrude into the airways. With the patient under local or general anaesthetic, a bronchoscope including an ultrasound probe is used instead of a conventional bronchoscope. Ultrasound images of the lung are obtained through the bronchoscope and these help to guide the doctor to the location of the lump, to obtain samples for further tests.

Coding recommendations

E49.1 Diagnostic fibreoptic endoscopic examination of lower respiratory tract and biopsy of lesion of lower respiratory tract


Y53.2 Approach to organ under ultrasonic control 


Y76.4 Endoscopic ultrasonic approach to other body cavity

Note: The OPCS-4 code Y53.4 Approach to organ under fluoroscopic control can be assigned in addition if fluoroscopic guidance is utilised.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)