Multimodal Multimodal Ultimodal Sampling in Robotic Bronchoscopy: A Retrospective Comparative Analysis of Diagnostic Performance Using ION‑Guided FNA, Surgical Biopsy, and ROSE/Frozen Section in Lung Lesions

Jennifer Lee*, Xuemo Fan and Shikha Bose

Background: Robotic-assisted bronchoscopy using the Ion™ Endoluminal Platform (ION) has emerged as a promising tool for diagnosing peripheral lung lesions. However, the comparative diagnostic performance of fine needle aspiration (FNA), surgical biopsy (SB), and their combination within this context remains underexplored.

Methods: We conducted a retrospective review of 412 cases of ION-guided transbronchial FNA, and SB performed at a single institution between September 2020 and December 2022. Diagnostic yield, sensitivity, specificity, and accuracy were calculated for FNA, SB, and combined FNA+SB approaches. Additionally, we evaluated the diagnostic contribution of rapid on-site evaluation (ROSE) and frozen section (FS) in 198 cases.

Results: The combined FNA+SB approach demonstrated the highest diagnostic yield (76%) and definitive diagnosis rate (67%), outperforming FNA (54%) and SB (70%) alone. Our combined approach diagnosed 81% of malignant lesions, aligning with findings from the TARGET trial. Smaller lesion size was significantly associated with non-diagnostic outcomes (p < 0.0001). ROSE showed limited standalone diagnostic value, with a high non-diagnostic rate and minimal added benefit when combined with FS.

Conclusion: The combination of FNA and SB provides superior diagnostic performance in ION-guided bronchoscopy and should be considered the preferred strategy when feasible. Although ROSE may offer morphological insights in select intraoperative scenarios, its routine use alongside FS may not be justified. A multimodal diagnostic approach enhances accuracy and supports optimal clinical decision-making in lung cancer care.

Key points

Benign lesions were more likely to yield non-diagnostic results, especially when the lesion size was small.

Malignant lesions were more accurately diagnosed using combined FNA and SB.

Multimodal sampling during robotic bronchoscopy enhances diagnostic confidence and reduces non-diagnostic outcomes.

Keywords:

Published on: Dec 31, 2025 Pages: 1-6

Full Text PDF Full Text HTML DOI: 10.17352/acp.000033
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat