Abstract Introduction Robotic bronchoscopy combined with cryobiopsy is an emerging technique that enables precise sampling of peripheral pulmonary lesions in a single session, resulting in a high diagnostic yield for molecular analysis. Most lung nodules are not cancerous, but when they are, therapy might be challenging at advanced stages. Robotic-assisted bronchoscopy with cryobiopsy improves cancer detection and staging accuracy by allowing for the convenient biopsy of small peripheral lesions that previously could not be obtained by conventional techniques. This case study highlights the practical significance of robotic bronchoscopy in the identification and staging of early lung malignancies in an underserved community hospital. Case Presentation A 76-year-old Caucasian female with a 45-pack year smoking history and breast cancer was referred to pulmonology for the evaluation of two suspicious lung nodules. The patient underwent shape sensing Intuitive Ion robotic bronchoscopy, transbronchial needle aspiration, and cryobiopsy of both nodules, followed by radial endobronchial ultrasonography (EBUS) to confirm the site of each lesion. Each location yielded good concentric signals, and lung tissue samples were acquired via cryobiopsy. Histopathological examination revealed two distinct synchronous primary lung malignancies: an adenocarcinoma in the right lower lobe Figure A1-3 and a low-grade neuroendocrine tumor in the right middle lobe Figure B1-3. The patient was referred to CT surgery and oncology for a multidisciplinary evaluation. Discussion The incidence of synchronous pulmonary lung cancer (SPLC) was first underestimated, with rates reported at 0.26-1.33%. However, it was revised to 20% in the current surgical series due to the implementation of stricter histopathological criteria that can differentiate true primary lung cancers from intrapulmonary metastases. This case demonstrates the diagnostic accuracy and procedural efficiency of robotic bronchoscopy paired with cryobiopsy in assessing multiple lung lesions. Compared to standard transbronchial or percutaneous procedures, this technique allows for precise navigation through peripheral airways while obtaining sufficient tissue specimens for histological and molecular testing in a single session. It also reduces the risk of complications, reduces the need for subsequent invasive procedures, and streamlines oncologic decision-making, resulting in faster diagnosis and therapy. In some cases, it allows for both diagnostic biopsies and intervention in a single session, significantly decreasing the time to cure. Conclusion Shape-sensing robotic bronchoscopy combined with cryobiopsy allows for safe, high-yield, single-session diagnosis of synchronous primary lung cancers. This technique represents a significant advancement in the diagnosis of minimally invasive lung cancer and could potentially speed up the diagnosis-to-treatment process for multifocal pulmonary lesions. This abstract is funded by: None
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