Shape-Sensing Robotic-Assisted Bronchoscopy and Mobile Cone-Beam Computed Tomography for Pulmonary Nodules Less than 1 cm

<bold>Introduction:</bold> Shape-sensing robotic-assisted bronchoscopy (ssRAB) has optimized sampling for challenging targets such as small peripheral pulmonary nodules (PPN) less than 1cm. Nonetheless, diagnostic yield for this lesion size subgroup has been reported up to 66%. The integration of mobile cone-beam computed tomography (mCBCT) can potentially improve the diagnostic yield for small PPN, leading to enhanced early lung cancer detection and treatment. <bold>Objective:</bold> Assess diagnostic yield of ssRAB with mCBCT for PPN equal to or less than 1cm. <bold>Methods:</bold> Retrospective study of patients who underwent ssRAB with mCBCT for evaluation of pulmonary nodules equal to or less than 1cm from May 2022 to October 2023. Outcomes were diagnostic yield, PPN characteristics, and complications requiring intervention. <bold>Results:</bold> Fifty-four nodules were biopsied from 47 patients. Mean maximum and minimum diameter were 0.88 x 0.73cm (SD± 0.12; 0.14). Overall diagnostic yield was 87% (47/54), sensitivity for malignancy was 80.6% (29/36). Needle aspiration was diagnostic in 66.7% (34/54) of cases, cryobiopsy with 1.1mm cryoprobe in 83.3% (29/35). Cryobiopsy was diagnostic in 13 instances where needle aspiration was nondiagnostic. Most PPN were in the left lower lobe 29.6% (n=16), 90.7% (n=49) were solid nodules, and 42.6% (n=23) presented a positive bronchus sign. No complications requiring intervention or hospitalization were reported. <bold>Conclusion:</bold> The integration of ssRAB with mCBCT presents a high diagnostic yield for PPN equal to or less than 1 cm with a low complication rate, potentially improving early lung cancer diagnosis and management.