What is the key question?

• With sensitivity around 82-99%, CT guided transthoracic biopsy (CTTB) of lung lesions remains the most accurate modality for diagnosis of peripheral lung lesions but is associated with a higher rate of complications such as pneumothorax, haemoptysis and rarely air embolism. Also a second procedure is often required to stage the underlying malignancy. This study sought to investigate the diagnostic performance of Robotic-Assisted Bronchoscopy (RAB) compared to the usual CT guided approach in the diagnosis of peripheral lung lesions.

What is the bottom line?

• Overall yield was high for both techniques (87.6% for RAB and 88.4%. for CTTB). Sensitivity and specificity was also high for both in malignancy (82.1% and 100% RAB; 88.5% and 100% CTTB). Pneumothorax rate was significantly higher for CTTB (17%) vs RAB (4.4%; p=0.002; OR 5.2). This study shows comparable diagnostic accuracy for biopsy of peripheral lung lesions from RAB compared to CTTB with safety benefits clearly demonstrated using RAB.

Why read on?

• The most obvious comment to be made in regards to the use of RAB remains the capital expense and training required to introduce a robotic device. For many centers this is likely to be prohibitive but this argument could be countered by considering the reduction in complications and the ability to perform further staging of malignancies using the RAB technique. As the technology progresses, cost is also likely to decrease.