Abstract Introduction Although the incidence of lung cancer is declining, it continues to be the leading cause of cancer-related death worldwide. It is well-established that the largest factor contributing to lung cancer-related mortality is disease stage at diagnosis.1,2 With advancements in diagnostic bronchoscopy, we are able to achieve yields 90% when combining shape-sensing robotic bronchoscopy (ssRAB), radial endobronchial ultrasound (rEBUS), and transbronchial lung cryobiopsy (TBLC).3,4 There are still however new devices being employed to further increase biopsy yields. Case We present a case of a 88 year old female who is a former 15-pack year smoker with asthma and bronchiectasis who was referred to the interventional pulmonary clinic for a lung nodule biopsy. She had an incidental 7mm right upper lobe (RUL) nodule seen on CT in 2022 which was read as mucoid impaction. Repeat CT in 2024 showed the RUL nodule grew to 1.4cm in diameter and was subsequently PET-avid. She was scheduled for diagnostic bronchoscopy. In March 2025 the patient underwent ssRAB using the ION robotic bronchoscopy platform. Shape-sensing navigation was initially used to approach the RUL nodule. Subsequently we used rEBUS to localize the nodule and a concentric signal was seen. At this time a cone beam CT was performed using a Siemens Ciospin C-arm which confirmed tool-in-lesion. We then administered 2.5mg of intravenous fluorescein, inserted a 18G Bronchus biopsy needle into the target lesion, and employed needle-based confocal laser endomicroscopy (nCLE) using the Cellvizio platform and their AQ-Flex 19N confocal miniprobe. The needle position was fine-tuned and dark clumps, a pattern consistent with malignancy, were seen on nCLE imaging (figure 1). TBLC was then performed with six passes of a 1.1mm cryoprobe obtaining six samples. Surgical pathology was positive for lung adenocarcinoma with acinar features and lymph node cytology from station 4R was positive giving her a diagnosis of stage IIb lung cancer. Discussion This appears to be the first published case in which the Cellvizio nCLE platform was employed on the ION robotic bronchoscopy system. Although this nCLE device has been used previously on the Monarch robotic bronchoscopy platform, our case demonstrates that using needle-based CLE is a safe and efficacious adjunct to use for nodule biopsy on the ION robot.5 While ssRAB, rEBUS, and cone beam CT help in reaching a nodule, nCLE can help increase diagnostic yield by providing real time imaging at a cellular level. This abstract is funded by: none
Friedman et al. (Fri,) studied this question.