Robotic Bronchoscopy Shows 87% Malignancy Sensitivity: Michael Pritchett, DO, MPH

Shape-sensing robotic-assisted bronchoscopy (ssRAB) achieved a consensus-defined diagnostic yield of 82.1% and a sensitivity for malignancy of 87.3% in the first 750 patients with 1-year follow-up from the prospective, multicenter Ion Registry.¹ Michael Pritchett, DO, MPH, medical director of the Chest Center of the Carolinas and an advanced bronchoscopist with FirstHealth Pulmonology and Pinehurst Medical Clinic, discussed the findings with HCPLive.

Pritchett presented the late-breaking analysis at the CHEST 2026 Annual Meeting, held October 18-21, 2026, in Phoenix, Arizona. The registry enrolled patients undergoing ssRAB biopsy with no prespecified patient or nodule criteria, and this analysis included 750 of 1,301 enrolled patients across 11 sites and 22 proceduralists.¹ The data join other CHEST 2026 findings on breath-hold technique during robotic bronchoscopy.

"Sensitivity for malignancy is a much better indicator because it takes into account that longitudinal follow-up for 1 year. In this case, for the data we are presenting now, but ultimately for 2 years, and so we want to be able to tell a patient, hey, 87% of the time, if you have cancer, we are going to get you a result that is accurate," Pritchett said.

Median largest nodule diameter was 17 mm (interquartile range [IQR], 13–27), median distance to pleura was 4 mm (IQR, 0–14), and 42.6% of lesions lacked a CT bronchus sign.¹ Cone-beam CT was used in 73.1% of cases, cryobiopsy in 48.7%, and concurrent lymph node staging in 71%. Pritchett said a bronchus sign no longer drives yield with robotic navigation, noting the smallest lesion biopsied measured 4 mm.

Diagnostic yield under the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) consensus definition was 82.1% (95% CI, 79.2%–84.8%), intermediate yield was 86.3% (95% CI, 83.6%–88.7%), and sensitivity for malignancy was 87.3% (95% CI, 84.2%–90.0%).^1,2 Pritchett cautioned early yield estimates near 90% can be inflated without adequate follow-up, noting 13 patients with a specific benign result of granulomatous inflammation were later diagnosed with cancer.

Pneumothorax requiring intervention occurred in 0.9% of patients (95% CI, 0.4%–1.9%) and Nashville grade 3 or higher bleeding in 0.1% (95% CI, 0.0%–0.7%).¹ Pritchett said this safety profile allows bilateral biopsies and mediastinal staging in a single procedure, and noted the median proceduralist performed 8 cases per month. These preliminary registry data have not been peer reviewed.

Disclosures include Medtronic, Johnson & Johnson, AstraZeneca, Intuitive, BodyVision, Boston Scientific, Philips, and Biodesix.

References

1. Pritchett MA, Postigo Jasahui M, Abedi A, et al. Real-world outcomes for shape-sensing robotic-assisted bronchoscopy: diagnostic yield and sensitivity for malignancy from the prospective multicenter Ion Registry. Presented at: CHEST 2026 Annual Meeting; October 18-21, 2026; Phoenix, AZ.

2. Gonzalez AV, Silvestri GA, Korevaar DA, et al. Assessment of advanced diagnostic bronchoscopy outcomes for peripheral lung lesions: a Delphi consensus definition of diagnostic yield and recommendations for patient-centered study designs. An official American Thoracic Society/American College of Chest Physicians research statement. Am J Respir Crit Care Med. 2024;209(6):634-646.