Robotic-assisted bronchoscopy-guided cryobiopsy for the diagnosis of ground-glass opacity-predominant peripheral pulmonary nodules

BACKGROUND: The combination of shape-sensing robotic-assisted bronchoscopy (ssRAB) and cryobiopsy may improve the diagnostic yield of ground-glass opacities (GGOs). However, the literature on this approach is limited. This study aims to assess the diagnostic yield and safety of ssRAB integrated with mobile cone-beam computed tomography (CBCT)-guided cryobiopsy for GGO-predominant peripheral pulmonary nodules (PPNs). METHODS: This is a single-center retrospective study of patients suspected to have malignant GGO-predominant PPNs (consolidation-to-tumor ratio ≤ 0.5) who underwent ssRAB integrated with mobile CBCT-guided cryobiopsy between November 2024 and June 2025 at Shanghai Chest Hospital. Clinicodemographic data, nodule characteristics, procedure details, diagnostic performance, and complications were analyzed. The primary efficacy outcome was the diagnostic yield. The primary safety outcome was procedure-related and device-related complications. RESULTS: A total of 55 nodules were biopsied in 40 patients. The mean patient age was 59.2 years, and 75.0% were female. The median nodule size was 12.0 mm (interquartile range, 9.9-16.0) in the largest dimension. Thirty-six nodules were pure GGOs and 19 were mixed GGOs, with 94.5% of nodules lacking a bronchus sign. A tunnel to the target lesion was created in 74.5% of the nodules. The per-nodule diagnostic yield was 87.3%. There were no episodes of major bleeding or pneumothorax. Cryobiopsy provided specimens sufficient for assessment of programmed death-ligand 1 (PD-L1) expression in 11 (84.6%) of 13 patients tested and for genetic testing in all 16 patients (100%) in which it was attempted. CONCLUSIONS: ssRAB integrated with mobile CBCT-guided cryobiopsy had a high diagnostic yield for GGO-predominant PPNs with a favorable safety profile. CLINICAL TRIAL NUMBER: Not applicable.