Impact of Robotic-Assisted Bronchoscopy with Integrated Cone-Beam CT on Stage Shift in Peripheral Pulmonary Lesions at a Lung Cancer Centre

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Background: Robotic-assisted bronchoscopy (RAB) with integrated Cone Beam Computed Tomography (CBCT) may enhance diagnostic yield for small peripheral pulmonary lesions (PPLs). This study evaluates the first six months of RAB with CBCT. This prospective cohort included patients undergoing RAB (ION endoluminal system) with integrated CBCT (Cios Spin) and cryobiopsy. Diagnostic yield was assessed per ATS2024 criteria (intermediate definition), with a 12-month follow-up (currently ongoing). Results: A total of 141 patients (mean age 68.6±9.5 years, 57.1% male) with 213 PPLs (median short axis 10 mm [IQR 7–14], long axis 11 mm [9–16]) were included. 31 (14.6%) lesions had a positive bronchus sign and 49 (23.1%) lesions were pure ground-glass-opacities. Median procedure time per lesion was 37 minutes [IQR 26–54], requiring an average of 1.25 CBCT spins/lesion (median dose-area product 6.1 Gy·cm²). Diagnostic yield was 89.3%, with a 1.4% pneumothorax rate. In 9.3% a resection was possible during the same anesthesia-event. Follow-up of 13 lesions (6.1%) is ongoing. Compared to the prior six years, center-wide lung cancer diagnoses (incl. other diagnostic modalities) increased by +69%, and stage IA diagnoses by +291%. RAB with integrated CBCT is a safe, efficient, and highly effective technique, offering excellent diagnostic yield even for subcentimeter lesions without a bronchus sign. erj;66/suppl_69/PA1952/F1 F1 F1

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