Diagnostic Yield of Shape-Sensing Robotic-Assisted Bronchoscopy for Peripheral Pleural-Based and Fissure-Based Pulmonary Nodules

<bold>Introduction:</bold> Peripheral pleural-based and fissure-based pulmonary nodules are frequently biopsied through computed tomography-guided biopsy (CTTB), with a high diagnostic yield. However, CTTB is associated with a significant rate of complications including pneumothorax and bleeding of up to 33%. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has the capacity to reach the peripheral pleura and interlobar fissures for sampling lung lesions, with potentially fewer complications. <bold>Objective:</bold> Evaluate diagnostic yield of ssRAB for peripheral pleural-based and interlobar fissure-based lung nodules. <bold>Methods:</bold> Retrospective review of patients who underwent ssRAB for evaluation of peripheral pleural-based and interlobar fissure-based lung nodules from June 2020 to June 2023. Primary outcome was diagnostic yield. Secondary outcomes were lung nodules characteristics and rate of complications which required intervention. <bold>Results:</bold> We analyzed 82 nodules from 79 patients, 49 (59.8%) located in the peripheral pleura and 33 (40.2%) in interlobar fissures. Median maximum and minimum diameter were 1.90 x 1.40cm (IQR 1.56 - 2.33; 1.10 - 1.83cm). The overall diagnostic yield was 87.8% (72/82) and sensitivity for malignancy was 85.7% (48/56). When used, needle aspiration was diagnostic in 70% (39/55) and cryobiopsy with 1.1mm cryoprobe in 95% (19/20) of malignant lesions. Three pneumothorax requiring chest tube insertion (3.7%) were reported post-procedure, no associated mortality. <bold>Conclusion:</bold> For peripheral pleural-based and fissure-based nodules, ssRAB demonstrates a high diagnostic performance and safety profile.