Cone beam computed tomography-guided bronchoscopic sampling of peripheral pulmonary lesions: The first Indian experience.

Background: Conventional bronchoscopic approaches have a lower diagnostic yield (DY) compared to transthoracic biopsy for sampling peripheral pulmonary lesions (PPLs). Cone-beam computed tomography (CBCT)-guided bronchoscopy overcomes the limitations of conventional bronchoscopy techniques. This study evaluates DY, predictors of success, and safety of CBCT-guided bronchoscopy for PPL biopsy.

Materials and methods: This single-center retrospective study included all consecutive patients who underwent CBCT-guided biopsy for PPLs between November 2023 and November 2024. Clinico-radiologic and procedural details, tool-in-lesion (TIL) relationships, DY, factors predicting DY, and complications were assessed.

Results: Of the 183 patients who underwent bronchoscopic sampling of PPL during study period, 50 patients underwent CBCT-guided biopsy. The overall DY of CBCT biopsy was 88% (44/50). A type 1 TIL (tool within lesion) was obtained in 57% (28/49), type 2 TIL (tool touch lesion) in 35% (17/49), and a type 3 TIL (tool away from lesion) in four cases. The factors predicting DY were size of lesion and the tool-lesion relationship. DY increased with increasing size of PPL and decreased the farther the tool was from the center of the target. The DY was 100%, 82%, and 25% for lesions with type 1, type 2, and type 3 TIL, respectively ( P = 0.024). CBCT biopsy was safe with no procedural mortality, no pneumothorax, and moderate to severe bleed in seven cases.

Conclusion: CBCT-guided biopsy for peripheral pulmonary lesions is safe and has a DY of 88%. DY is higher for lesions ≥2 cm and when the tool is within the lesion (type 1 TIL) on CBCT spin.