Technical feasibility and diagnostic yield of Archimedes-guided transbronchial needle access using the BroncTru® catheter for peripheral pulmonary lesions without a bronchus sign

Bronchoscopic transparenchymal nodule access (BTPNA) is a bronchoscopic technique for diagnosing peripheral pulmonary lesions (PPLs) without a bronchus sign. However, conventional BTPNA requires large instrumentation and long transparenchymal tunnel tracts, which may limit procedural feasibility and safety. This study aimed to evaluate the technical feasibility and diagnostic yield of Archimedes-guided transbronchial needle access using the BroncTru ® catheter in combination with a thin bronchoscope. We retrospectively reviewed consecutive patients with PPLs lacking a bronchus sign who underwent Archimedes-guided transbronchial needle aspiration (TBNA) or BTPNA using the BroncTru ® catheter between November 2024 and May 2026 at a tertiary referral university hospital. Procedural feasibility, diagnostic yield, and procedure-related complications were analyzed. A total of 25 patients were included, comprising 18 BTPNA and 7 TBNA procedures. The mean lesion size was 18.5 ± 5.4 mm. The mean tunnel length in the BTPNA group was 17.7 ± 6.5 mm. The Archimedes navigation system successfully guided the procedures to the target lesions in all cases, as confirmed by fluoroscopy and radial endobronchial ultrasound. The overall diagnostic yield was 88.0%, including 94.4% for BTPNA and 71.4% for TBNA. The diagnostic yields of cytological and histopathological analyses were 72.0% and 84.0%, respectively. No pneumothorax was detected on post-procedural chest radiographs. Minimal bleeding was observed and was successfully controlled during the procedures. Archimedes-guided transbronchial needle access using the BroncTru ® catheter and a thin bronchoscope is technically feasible for PPLs without a bronchus sign. An overall diagnostic yield of 88.0% was observed.