Comparison of Virtual, Electromagnetic, and Robotic-Assisted Navigational Bronchoscopy Platforms for Diagnosing Peripheral Pulmonary Lesions: A Single-Center Cohort Study

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Background: The growing demand for minimally invasive techniques highlights the need for comparative assessments of guided bronchoscopy platforms. This study evaluates the diagnostic performance of virtual navigation bronchoscopy (VNB), electromagnetic navigation bronchoscopy (EMN), and robotic-assisted bronchoscopy with integrated cone-beam computed tomography (RAB+CBCT). This retrospective cohort study analyzed PPL diagnostic yield (12-month follow-up) across three sequentially implemented platforms: VNB with 2D fluoroscopy (2021–2022), EMN with 2D fluoroscopy (2023–2024), and RAB+CBCT (2024). Results: PPL sizes were comparable across groups (VNB: n=38, median short axis 11 mm [IQR 8–13], long axis 14 mm [10–17]; EMN: n=44, median short axis 10 mm [7–18], long axis 16 mm [16–27]; RAB: n=212, median short axis 10 mm [7–14], long axis 11 mm [9–16]). RAB+CBCT achieved the highest diagnostic yield (89.3%), significantly outperforming VNB (47.4%, absolute difference 41.5% [95% CI 22.4–53.2], p<0.001) and EMN (45.5%, absolute difference 41.5% [95% CI 26.7–56.3], p<0.001). Pneumothorax rates were highest for EMN (8.5%), followed by RAB+CBCT (1.4%) and VNB (0%). Under consistent conditions and operator expertise, RAB+CBCT demonstrated a superior diagnostic yield, favorable safety profile, and high efficacy for minimally invasive diagnosis of small PPLs. erj;66/suppl_69/OA1179/F1 F1 F1

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