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Introduction: Cystic and cavitary pulmonary lesions (PLs) frequently require histologic confirmation for an accurate diagnosis. Shape-sensing robotic-assisted bronchoscopy (ssRAB) with mobile cone beam computed tomography (mCBCT) offers a minimally invasive alternative to traditional biopsy techniques like CT-guided transthoracic biopsy. This study aimed to evaluate the diagnostic performance and safety of ssRAB in cystic and cavitary PLs., Material and Methods: A retrospective study was conducted at Mayo Clinic Florida, of patients who underwent ssRAB with mCBCT for cavitary and cystic PLs from October 2020 to February 2024. Baseline clinical, demographic, lesion characteristics, and procedure-related data were collected. Diagnostic yield, accuracy, sensitivity for malignancy and complication rates were calculated while logistic models identified associations between variables and diagnostic yield., Results: 52 patients were included, 54 nodules were sampled. ssRAB provided a diagnostic yield of 83 % and a diagnostic accuracy of 83 %, with a sensitivity for malignancy of 97 % and specificity of 58 %. Pneumothorax occurred in 4 % of cases, with one requiring chest tube insertion. Nashville bleeding scale ≥ 2 occurred in 4 % of procedures. There was no significant association between lesion size, distance to chest wall, type of lesion and diagnostic yield., Conclusion: ssRAB with mCBCT demonstrated high diagnostic yield and sensitivity for malignancy in cavitary and cystic PLs, with a low complication rate. Its ability to perform mediastinal staging in the same anesthetic event, along with its safety profile, suggests ssRAB as a valuable tool in the assessment of air-filled pulmonary lesions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Shape-sensing Robotic-assisted Bronchoscopy (ssRAB) has emerged as a promising tool for improved performance when sampling pulmonary nodules (PPN). Previous studies suggest that the 1.1 mm cryoprobe is as effective compared to fine needle aspiration (FNA), for different lesions sizes. We aim to compare the 1.1 mm cryoprobe performance to FNA for sampling PPN < 20 mm with ssRAB., Material and Methods: We conducted a retrospective cohort study from November 2022 to February 2024 of patients who underwent ssRAB with cryobiopsy for evaluation of PPN. We compared the diagnostic yield and sensitivity for malignancy of cryobiopsy and FNA for the same PPN. Descriptive statistical analysis was conducted using the McNemar's Test and Comparison of proportion. Multivariate logistic regression assessed the impact of PPN characteristics on the yield of each tool., Results: We included 256 patients, with a combined 284 procedures, and 324 nodules sampled. The median maximum and minimum nodule size was 1.6 cm (IQR 1.17-2.4) and 1.17 cm (IQR 0.86-1.7) respectively. The overall ssRAB diagnostic yield was 93.8 % and sensitivity for malignancy was 97.5 %. Cryobiopsy had a diagnostic yield of 92 % and sensitivity of 96 %, FNA had a 70.4 % and 79.29 % respectively (P < 0.001). Cryobiopsy had a significantly higher performance compared to FNA across the analyzed categories (P < 0.05), except for the sensitivity of mixed-type lesions (P = 0.11). PPN < 10 mm and ≥ 10 mm - <15 mm sampled with FNA, had lower odds of achieving a diagnosis compared to the ≥ 20 mm group (OR = 0.305 IC95%: 0.142-0.65, p < 0.001; OR = 0.497 IC95%: 0.263-0.939, p = 0.031, respectively). Complications occurred in 5.98 % (N = 17) of cases., Conclusion: Cryobiopsy demonstrates a statistically higher diagnostic yield and sensitivity for malignancy compared to FNA. Remarkably, FNA showed reduced diagnostic odds in PPN < 15 mm. ssRAB with cryobiopsy could enhance PPN diagnostic yield, leading to earlier lung cancer diagnosis and improve long-term survival rates., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)