Robotic-Assisted Bronchoscopy-Guided Transbronchial Cryobiopsy Versus Transbronchial Needle Aspiration in Peripheral Pulmonary Lesions

BACKGROUND: Transbronchial needle aspiration (TBNA) has been the gold standard for tissue sampling in peripheral pulmonary lesions, as established by the AQuIRE trial. However, advancements in robotic-assisted bronchoscopy and transbronchial cryobiopsy (TBCB) offer alternative methods with potentially superior diagnostic yields. This study aims to evaluate the diagnostic yield (DY) of TBCB and TBNA in diagnosing peripheral pulmonary lesions (PPLs) using robotic-assisted bronchoscopy. METHODS: A retrospective cohort study was conducted on 156 patients with PPLs who underwent shape-sensing robotic bronchoscopy-guided biopsy using both TBCB and TBNA at our institution from April 2023 to December 2023. Procedures were performed under general anesthesia, using a standardized approach including TBNA and TBCB. Statistical analysis was conducted using SPSS version 29, with Pearson χ2, McNemar, and multinomial logistic regression tests to assess diagnostic yield and associations with variables such as age, needle size, and lesion size. RESULTS: The median age was 68 years, with 41.7% males and 58.3% females. The median lesion size was 19 mm and the most common lesion size was 14 mm. TBCB provided a higher diagnostic yield compared with TBNA, with 41 out of 156 cases being diagnostic with TBCB but not TBNA, while 90 cases were diagnostic with both methods, and 3 cases were diagnostic with TBNA but not TBCB. Combining TBNA with TBCB increased the overall diagnostic yield from 59.62% for TBNA alone to 83.97%. The McNemar test indicated a significant diagnostic advantage for TBCB (P<0.001). Pneumothorax occurred in 4 cases (2.6%), of which only 2 (1.3%) required a chest tube. There was no grade 3 or 4 bleeding postbronchoscopy. CONCLUSION: TBCB demonstrated superior DY compared with TBNA in PPLs, independent of nodule size. In addition, our study highlights the low complication rate associated with TBCB, evidenced by the absence of grade 3 or 4 bleeding and the low incidence of pneumothorax. These findings support the use of TBCB as a primary diagnostic approach for PPLs and warrant further investigation into its broader clinical applications.