Background: Lung cancer is the second most common cause of cancer with high mortality, thereby emphasizing the importance of early detection. However, the rate of new lung cancer diagnosis has remained relatively unchanged. Despite the advancements in navigational bronchoscopy, the diagnostic yield of pulmonary nodules, particularly posterior nodules, is often limited by CT-to-body divergence. Our study aims to evaluate the feasibility and safety of prone positioning during navigational bronchoscopy and its impact on the diagnostic yield of posterior pulmonary nodules. Methods: Retrospective cohort study of nine patients who underwent Ion robotic navigational bronchoscopy in prone position and 237 patients in supine position. The study period was July 2024 to December 2024 for the prone cohort and July 2020 to September 2024 for the supine cohort. Results: In the supine cohort, the diagnostic yield was 93.3%, including a malignant yield of 62.3%, and the post-operative complication rates were 1.5% for pneumothorax, 3.5% for bronchopulmonary hemorrhage, and 1.9% for respiratory failure. In the prone cohort, the diagnostic yield was 77.8% and a malignant yield of 85.7%, and the postoperative complication rates were 0% for pneumothorax, bronchopulmonary hemorrhage, and respiratory failure. Conclusions: CT-to-body divergence is a major obstacle in the diagnostic work-up of pulmonary nodules, of which a major contributor is atelectasis. Our study demonstrates that prone positioning combined with a strict anesthesia protocol is both a feasible and safe approach in the diagnostic work-up of pulmonary nodules.
Vo et al. (2026) studied this question.