Comparing the effectiveness and safety of robotic-assisted bronchoscopy and computed tomography-guided transthoracic biopsy for evaluating pulmonary lung nodules: Results from the DYSTRICT study

Background Computed tomography-guided transthoracic biopsy (CTTB) and shape-sensing robotic-assisted bronchoscopy (ssRAB) are diagnostic modalities for evaluating high-risk pulmonary nodules. Previous studies have been limited by inconsistencies in defining diagnostic yield (DY). The advent of strict DY criteria enables a more accurate comparison of these modalities. The aim of this study is to compare the effectiveness and safety of ssRAB and CTTB in evaluating pulmonary nodules. Methods DYSTRICT is a retrospective cohort including patients with high-risk pulmonary nodules who underwent ssRAB or CTTB between November 2022 and December 2024. A 1:1 matched analysis was performed based on nodule characteristics. DY was assessed using strict criteria, defining diagnostic lesions as those with a specific malignant or benign diagnosis. Associations between variables were analyzed using descriptive statistics, and logistic models where appropriate. Results A total of 574 nodules were evaluated (287 in each arm). Both groups had similar baseline characteristics, including age, sex, lesion size, nodule type, and location. Strict DY was comparable between ssRAB (n=213, 74%) and CTTB (n=226, 79%) (p=0.201). However, ssRAB demonstrated a significantly safer profile, with lower rates of pneumothorax (OR 0.04, 95% CI 0.01–0.08, p<0.001) and hospitalization (OR 0.35, 95% CI 0.15–0.75, p=0.010) compared with CTTB. Conclusion ssRAB and CTTB achieved comparable strict diagnostic yield rates in pulmonary nodules with similar baseline characteristics. However, ssRAB demonstrated a higher safety profile, with significantly lower rates of pneumothorax, chest tube placement, and hospitalization compared with CTTB.