Mobile cone-beam computed tomography combined with electromagnetic navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules

BACKGROUND: Electromagnetic navigation bronchoscopy (ENB) is widely used for diagnosing peripheral pulmonary nodules (PPNs), but its diagnostic yield remains variable. Mobile cone-beam computed tomography (mCBCT) enables intraprocedural assessment of the tool-lesion relationship and navigation correction; however, prospective data on its incremental clinical value remain limited. RESEARCH QUESTION: Clinical value of mCBCT-guided navigation correction on the tool-lesion relationship and diagnostic yield during ENB for PPNs. STUDY DESIGN AND METHODS: This prospective, single-centre, single-arm trial evaluated the diagnostic performance of mCBCT-assisted ENB for PPNs and the incremental clinical value of mCBCT-guided navigation correction. Intraoperative mCBCT assessed the tool-lesion relationship and guided correction before sampling. The primary endpoint was overall diagnostic yield after mCBCT assessment and adjustment. The key secondary endpoint was the tool-in-lesion improvement rate. RESULTS: A total of 108 patients were enrolled. Median nodule size was 21.0 (IQR, 17.0-25.0) mm, and a CT 'bronchus sign' was present in 77.8%. Nodules were peripheral (47.2%), intermediate (33.3%), or central (19.4%) and solid (83.3%), mixed ground-glass opacities (13.9%), or pure ground-glass opacities (2.8%). The overall diagnostic yield was 79.6% (86/108). Navigation correction was required in 42.6% (46/108). Following mCBCT-guided navigation correction, the tool-in-lesion rate increased from 54.6% (59/108) to 87.0% (94/108), an absolute improvement of 32.4%. Procedure-related atelectasis was identified by mCBCT in 8 (7.4%) patients. No serious adverse events occurred. CONCLUSION: mCBCT-guided navigation correction improved the tool-lesion relationship and provided incremental clinical value beyond conventional ENB, particularly for smaller lesions and those without a CT bronchus sign, while maintaining an acceptable safety profile.