Diagnostic Yield of Shape-Sensing Robotic-Assisted Bronchoscopy and Mobile Cone-Beam Computed Tomography for Central Pulmonary Nodules

<bold>Introduction:</bold> Bronchoscopic sampling of pulmonary nodules abutting the mediastinal pleura has been historically performed through standard flexible bronchoscopy. However, its overall diagnostic yield is reported around 50-70%. Shape-sensing robotic-assisted bronchoscopy (ssRAB) maneuvers a robotic catheter with 360°-degree rotation, standing out as a promising alternative to achieve a higher diagnostic yield for medially located pulmonary lesions (PL). <bold>Objective:</bold> Determine diagnostic yield of ssRAB with mobile cone-beam computed tomography (mCBCT) for PL abutting the mediastinal pleura. <bold>Methods:</bold> We reviewed patients who underwent ssRAB with mCBCT for evaluation of PL located in the inner third bordering the mediastinal pleura from May 2022 to October 2023. We analyzed diagnostic yield as primary outcome and PL characteristics and complications that required intervention as secondary outcomes. <bold>Results:</bold> Forty-four nodules from 44 patients were included. Mean maximum and minimum diameter were 1.70 x 1.29cm (SD± 0.64 x 0.59cm). Overall diagnostic yield was 93.2% (41/44) and sensitivity for malignancy was 96.7% (29/30). Most lesions were located in the right lower lobe (n=12), 81.8% (n=36) were solid, and 42.6% (27/44) presented a positive bronchus sign. Post-procedure two pneumothorax were reported, one requiring chest tube (2.3%). <bold>Conclusion:</bold> Shape-sensing robotic assisted bronchoscopy arises as a reliable diagnostic procedure for difficult-to-reach pulmonary lesions in the inner third of the lung abutting the mediastinal pleura, with low risk of complications.