ROBOTIC-assisted bronchoscopy combined with cone-beam computed tomography (CBCT) achieved dramatically higher diagnostic yields compared with conventional bronchoscopy for peripheral pulmonary lesions, according to results presented at the European Respiratory Society (ERS) Congress 2025.
Robotic bronchoscopy with CBCT outperforms conventional approach
The investigator-initiated, single-centre randomised trial enrolled 78 patients with 127 peripheral pulmonary lesions between June and November 2024. Participants were randomised 1:1 to undergo conventional bronchoscopy with ultra-thin scopes and 2D fluoroscopy or robotic-assisted bronchoscopy using the Ion endoluminal system integrated with CBCT. Median lesion size was 11 mm, and over a quarter were pure ground-glass opacities, often challenging for traditional techniques. The primary endpoint was diagnostic yield, defined by American Thoracic Society (ATS) 2024 consensus criteria.
Diagnostic yield dramatically higher with robotic bronchoscopy
Diagnostic yield reached 84.6% with robotic-assisted bronchoscopy plus CBCT, compared with just 23.1% for conventional bronchoscopy: a 61.5% absolute difference (95% CI: 44.1–78.9%; p<0.001). Notably, 92.9% of non-diagnostic conventional cases were successfully resolved when patients underwent robotic bronchoscopy with CBCT, often during the same anaesthesia session. Across both groups, 68 cases (53.5%) were diagnosed with lung cancer, with nearly 40% identified at Stage IA. Adverse event rates were comparable, suggesting no additional safety burden from the robotic approach.
Shifting lung cancer detection to earlier stages
These findings highlight robotic-assisted bronchoscopy with CBCT as a pivotal tool for improving diagnostic accuracy in hard-to-reach pulmonary lesions, particularly small or ground-glass nodules. Investigators noted its potential to drive a “stage shift” in lung cancer diagnosis, enabling earlier intervention and improved survival outcomes. Ongoing follow-up for unresolved cases will further clarify the long-term impact.
If confirmed in larger multicentre studies, robotic bronchoscopy with CBCT could redefine diagnostic pathways for lung cancer, supporting precision medicine and earlier, more effective care.
Reference
Steinack C et al. Robotic-Assisted Bronchoscopy with Integrated Cone-Beam CT vs. Conventional Bronchoscopy for Diagnosing Peripheral Pulmonary Lesions: An Open-Label Randomized Controlled Trial. Abstract OA 1178. ERS Congress, 27 September-1 October 2025.
