Evolution of Diagnostic Yield for Peripheral Lung Nodule Biopsies With Changes in Navigational Bronchoscopy Platforms, Tools, and Intraoperative Imaging Guidance

BACKGROUND: Recent growth of navigational bronchoscopy has included use of new platforms and tools, the benefit of which remains under study. RESEARCH QUESTION: Does diagnostic yield differ between: (a) electromagnetic navigation bronchoscopy versus shape-sensing robotic-assisted bronchoscopy; (b) ssRAB versus ssRAB with cone-beam CT (ssRAB-CBCT); and (c) nodule sampling with versus without cryobiopsy? METHODS: This single-center retrospective study evaluated the diagnostic performance of navigational bronchoscopy cases with acquisition of new platforms and tools at a bronchoscopy referral center between 2016 and March 2024. Diagnostic yield was evaluated for the primary procedural target, with yield defined as per ATS/ACCP guidelines. RESULTS: A total of 185 ENB cases, 371 ssRAB cases, and 54 ssRAB-CBCT cases were available for comparison. Diagnostic yield was 57% for ENB, 72% for ssRAB and 78% for ssRAB-CBCT (ENB vs. ssRAB P=0.001; ssRAB vs. ssRAB-CBCT P=0.307). Diagnostic yield was 78% for ssRAB/ssRAB-CBCT procedures that used cryobiopsy versus 69% for procedures that did not (P=0.035). Nodule size differed between procedure types: median size 27 mm (IQR 17 to 35 mm) for ENB, 21 mm (IQR 16 to 30 mm) for ssRAB (P=0.001 for ENB vs. ssRAB), and 17 mm (IQR 13 to 25) for ssRAB-CBCT (P=0.004 for ssRAB vs. ssRAB-CBCT). Differences were found between ENB and ssRAB procedures regarding nodule location in the peripheral third of lung (ENB 50% vs. ssRAB 62%, P=0.009) and presence of a bronchus sign (ENB 81% vs. ssRAB 43%, P=<0.001), whereas other nodule characteristics were similar between groups. CONCLUSION: Acquisition of new tools for navigational bronchoscopy was associated with increased diagnostic yield despite performing biopsies on increasingly difficult cases.