2026-05-13T20:00:33Z https://www.peertechzpublications.org/oai-pmh

oai:www.peertechzpublications.org:10.17352/acp.000033 2025-12-31 PTZ.ACP:VOL10

Multimodal Sampling in Robotic Bronchoscopy: A Retrospective Comparative Analysis of Diagnostic Performance Using ION‑Guided FNA, Surgical Biopsy, and ROSE/Frozen Section in Lung Lesions Jennifer Lee Xuemo FanShikha Bose<p><strong>Background:</strong> Robotic-assisted bronchoscopy using the Ion™ Endoluminal Platform (ION) has emerged as a promising tool for diagnosing peripheral lung lesions. However, the comparative diagnostic performance of fine needle aspiration (FNA), surgical biopsy (SB), and their combination within this context remains underexplored.</p><p><strong>Methods:</strong> We conducted a retrospective review of 412 cases of ION-guided transbronchial FNA, and SB performed at a single institution between September 2020 and December 2022. Diagnostic yield, sensitivity, specificity, and accuracy were calculated for FNA, SB, and combined FNA+SB approaches. Additionally, we evaluated the diagnostic contribution of rapid on-site evaluation (ROSE) and frozen section (FS) in 198 cases.</p><p><strong>Results:</strong> The combined FNA+SB approach demonstrated the highest diagnostic yield (76%) and definitive diagnosis rate (67%), outperforming FNA (54%) and SB (70%) alone. Our combined approach diagnosed 81% of malignant lesions, aligning with findings from the TARGET trial. Smaller lesion size was significantly associated with non-diagnostic outcomes (p &lt; 0.0001). ROSE showed limited standalone diagnostic value, with a high non-diagnostic rate and minimal added benefit when combined with FS.</p><p><strong>Conclusion:</strong> The combination of FNA and SB provides superior diagnostic performance in ION-guided bronchoscopy and should be considered the preferred strategy when feasible. Although ROSE may offer morphological insights in select intraoperative scenarios, its routine use alongside FS may not be justified. A multimodal diagnostic approach enhances accuracy and supports optimal clinical decision-making in lung cancer care.</p><p><strong>Key points</strong></p><p>Benign lesions were more likely to yield non-diagnostic results, especially when the lesion size was small.</p><p>Malignant lesions were more accurately diagnosed using combined FNA and SB.</p><p>Multimodal sampling during robotic bronchoscopy enhances diagnostic confidence and reduces non-diagnostic outcomes.</p> Annals of Cytology and Pathology - Peertechz Publications 2025-12-31 Research Article https://doi.org/10.17352/acp.000033 en Copyright © Jennifer Lee et al.