Reference: April 2026 | Issue 4 | Vol 12 | Page 8
A randomised controlled trial presented at the ERS Congress 2025 suggests robotic-assisted bronchoscopy (RAB) combined with cone-beam CT (CBCT) dramatically improves diagnostic yield compared with conventional bronchoscopy in peripheral pulmonary lesions (PPL).
The trial, conducted at University Hospital Zurich, Switzerland, compared RAB plus CBCT using the ion endoluminal system versus conventional bronchoscopy using ultra-thin bronchoscopes and 2D fluoroscopy.
A total of 78 patients with 127 PPLs were enrolled between June and November 2024. Participants were randomised 1:1 to either procedure group. The primary endpoint was diagnostic yield, defined per the American Thoracic Society (ATS) 2024 consensus criteria.
Results revealed a substantial advantage with RAB plus CBCT approach. Diagnostic yield reached 84.6 per cent compared to only 23.1 per cent with conventional bronchoscopy, an absolute difference of 61.5 per cent (95% CI 44.1-78.9%; P<0.001).
Among non-diagnostic conventional cases, 92.9 per cent were successfully diagnosed upon subsequent RAB plus CBCT, either within the same anaesthesia event or during a separate session. Median lesion diameter was 11mm, with 27.6 per cent classified as pure ground-glass opacities. Importantly, adverse event rates were similar across both groups (P=0.09).
Overall, 53.5 per cent of all lesions were diagnosed as lung cancer, with nearly 40 per cent identified at stage IA, suggesting RAB plus CBCT could potentially facilitate earlier diagnosis and improve clinical outcomes.
The authors said the “findings position robotic-assisted bronchoscopy integrated with CBCT as a transformative diagnostic tool for peripheral lung lesions. Its enhanced precision, especially for small or ground-glass lesions, could lead to significant stage shifts in lung cancer detection and management.”
They said that continued evaluation of procedural efficiency, cost-effectiveness, and training implications will be essential as RAB plus CBCT moves toward wider clinical adoption.
Reference
Steinack C, et al. Robotic-assisted bronchoscopy with integrated cone-beam CT vs conventional bronchoscopy for diagnosing peripheral pulmonary lesions: An open-label randomised controlled trial. Abstract OA 1178. European Respiratory Society Congress 27 September-1 October 2025. Amsterdam, Netherlands.
