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Shape-Sensing Robotic-Assisted Bronchoscopy with Concurrent use of Radial Endobronchial Ultrasound and Cone Beam Computed Tomography in the Evaluation of Pulmonary Lesions



Lung nodules are a common radiographic finding. Non-surgical biopsy is recommended in patients with moderate or high pretest probability for malignancy. Shape-sensing robotic-assisted bronchoscopy (ssRAB) combined with radial endobronchial ultrasound (r-EBUS) and cone beam computed tomography (CBCT) is a new approach to sample pulmonary lesions. Limited data are available regarding the diagnostic accuracy of combined ssRAB with r-EBUS and CBCT.


We conducted a retrospective analysis of the first 200 biopsy procedures of 209 lung lesions using ssRAB, r-EBUS, and CBCT at UT Southwestern Medical Center in Dallas, Texas. Outcomes were based on pathology interpretations of samples taken during ssRAB, clinical and radiographic follow-up, and/or additional sampling.


The mean largest lesion dimension was 22.6 ± 13.3 mm with a median of 19 mm (range 7 to 73 mm). The prevalence of malignancy in our data was 64.1%. The diagnostic accuracy of ssRAB combined with advanced imaging was 91.4% (CI 86.7–94.8%). Sensitivity was 87.3% (CI 80.5–92.4%) with a specificity of 98.7% (CI 92.8–100%). The negative and positive predictive values were 81.3% and 99.2%. The rate of non-diagnostic sampling was 11% (23/209 samples). The only complication was pneumothorax in 1% (2/200 procedures), with 0.5% requiring a chest tube.


Our results of the combined use of ssRAB with r-EBUS and CBCT to sample pulmonary lesions suggest a high diagnostic accuracy for malignant lesions with reasonably high sensitivity and negative predictive values. The procedure is safe with a low rate of complications.

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Authors and Affiliations



KS, M.D., AS, M.D., and MAH, M.D. contributed to procedures, data collection, analysis, literature review, preparation of the manuscript, and review of the manuscript. DP, M.D., and KM, M.D. contributed to data collection and review of the manuscript. HTC, M.D., AR, M.D., and SC, DNP, CRNA contributed to procedures and review of the manuscript. EK, M.D., and LDLC, M.D. contributed to pathology portion of the procedures and review of the manuscript.

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Correspondence to Kim Styrvoky.

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Styrvoky, K., Schwalk, A., Pham, D. et al. Shape-Sensing Robotic-Assisted Bronchoscopy with Concurrent use of Radial Endobronchial Ultrasound and Cone Beam Computed Tomography in the Evaluation of Pulmonary Lesions. Lung 200, 755–761 (2022).

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  • Robotic bronchoscopy
  • Cone beam CT
  • Radial endobronchial ultrasound
  • Shape sensing
  • Pulmonary nodule