Transbronchial Approach to Peripheral Lung Lesions- How Good are the Robotic and Non-Robotic Approaches Compared with CT Guided Biopsy?

Biopsy of peripheral pulmonary lesions can be performed using transthoracic CT-guided biopsy (CTB) or peripheral bronchoscopy (PB) using a transbronchial approach. This review will focus on the diagnostic performance and complication rates of CTB, non-robotic PB, and robotic bronchoscopy (RB), the factors that influence performance and risk, and the clinical and economic considerations that may make one biopsy choice more advantageous than others.

Three RB platforms are now commercially available. A recent meta-analysis of RB reported a pooled sensitivity for malignancy of 88% with few complications.

CTB has a high diagnostic yield but is associated with a high rate of complications. Non-robotic PB has comparably lower diagnostic yield but also fewer complications. Early experience with RB suggests diagnostic performance approaching that of CTB but at high costs. Clinical and economic factors are important and may influence the choice of biopsy.