Early Experience with Synapse 3D Virtual Bronchoscopic Navigation and Fluoroscopy-assisted R-EBUS-guided Biopsy for Peripheral Pulmonary Lesions: Diagnostic Yield and Safety

Background: Peripheral pulmonary lesions (PPLs) are difficult to sample with conventional bronchoscopy due to their small size and peripheral location.Virtual bronchoscopic navigation (VBN), radial endobronchial ultrasound (R-EBUS), and fluoroscopy offer complementary navigational and imaging support that enhances diagnostic yield.Methods: A retrospective analysis was performed in patients undergoing synapse 3D VBN-assisted, R-EBUS-guided biopsies of PPL under fluoroscopy.Results: Ten patients (mean age 56.8 years; 9 males, 1 female) underwent biopsies.The average distance from the end of VBN path to the lesion on the synapse 3D system was 2.5 mm.Overall diagnostic yield was 80%.Cryobiopsy by 1.1 mm cryoprobe achieved a higher diagnostic yield (85.7%) compared to forceps biopsy (66.7%).Complications occurred in 3 cases (minor bleeding 20%, bronchospasm 10%), all managed conservatively.No pneumothorax or major complications were reported.Conclusion: Synapse VBN combined with R-EBUS and fluoroscopy demonstrated high diagnostic accuracy and safety in PPLs.Cryobiopsy provided a superior diagnostic yield compared to forceps biopsy, with manageable complication rates.