Utility and performance of robotic-assisted bronchoscopic fine-needle aspiration compared with robotic-assisted bronchoscopic cryo-biopsy for the evaluation of pulmonary lesions.

Authors

Saroja Devi Geetha, Dianna Klippel-Almaraz, Neda Kalhor, Anthony Rowe, Saad Farooq, George Eapen, Savitri Krishnamurthy

Published in

Journal of the American Society of Cytopathology. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Few studies have compared robotic-assisted bronchoscopic (RAB) fine-needle aspiration (FNA) with RAB cryo-biopsy (CB) for the evaluation of peripheral pulmonary lesions. We compared performance between RAB-FNA and RAB-CB in the evaluation of peripheral pulmonary lesions.
From our pathology database, we identified patients who underwent RAB-FNA with rapid on-site evaluation and concurrent RAB-CB between January and December 2024. We recorded patient and lesion characteristics, RAB-CB and RAB-FNA diagnostic categorization (non-diagnostic, benign, atypical, suspicious, malignant), and specimen type used for molecular studies. RAB-FNA and RAB-CB results were compared with those of surgical resection and clinical follow-up as the gold standard. For both procedures, we evaluated diagnostic performance for establishing the diagnosis of the pulmonary lesion.
We identified 240 cases including 148 malignant, 1 neoplasm with undetermined malignant potential and 91 benign diagnoses, based on the gold standard. The male-to-female ratio was 23:25; median patient age, 69 years; and median lesion size, 1.8 cm. Touch preparation of RAB-CB was performed in 26 (11%) cases. Compared with RAB-CB, RAB-FNA had lower sensitivity for malignant tumors (89% versus 91%) but higher sensitivity for metastasis (73% versus 70%) and lymphoma (86% versus 71%), and it was used less often for molecular testing (99% versus 1%). The RAB-FNA and RAB-CB diagnoses were discordant in 44 cases (18%).
RAB-CB provided superior diagnostic performance overall compared with RAB-FNA for peripheral pulmonary lesions. However, the use of rapid on-site evaluation to evaluate RAB-FNA tissue yield guided the procurement and preservation of CB without touch preparation. Our findings support an integrated dual-sampling approach combining RAB-FNA and RAB-CB, as FNA aids in real-time confirmation of lesional targeting, thereby optimizing procedural adequacy while preserving cryobiopsy material for downstream studies.

PMID:
42680606
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.

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