Oct. 15, 2026
In a comparative performance study published in Lung Cancer, Mayo Clinic researchers found that shape-sensing robot-assisted bronchoscopy (ssRAB) is superior to CT-guided transthoracic biopsy (CTTB) for diagnosing peripheral pulmonary lesions. Kenneth K. Sakata, M.D., an interventional pulmonologist at Mayo Clinic in Arizona and the principal investigator of the study, explains that robotic bronchoscopy provided better results for diagnostic yield. This includes adequacy for molecular studies, with fewer complications, and reduced time from biopsy to treatment for new non-small cell lung cancer (NSCLC) diagnoses.
Robotic bronchoscopy and CT-guided transthoracic biopsy are the two nonsurgical options available for sampling lung tissue. Previous studies comparing ssRAB and CTTB have focused on diagnostic yield and complications, including pneumothorax and bleeding. A recent Mayo Clinic study went a step further by using a strict definition of diagnostic yield consistent with the American Thoracic Society and American College of Chest Physicians research statement. Researchers also evaluated additional data points, including molecular adequacy, as well as the number of days it took from nodule detection to initiation of treatment.
"Smaller studies comparing ssRAB and CTTB have been published in the past," Dr. Sakata says. "Our study is the largest to date. It shows that ssRAB performed with the Ion robotic system is at least as accurate as CTTB and far safer from a complication standpoint."
Lung cancer is responsible for roughly 1 in 5 cancer-related deaths. Lung cancer screening can reduce lung cancer mortality by 20%. According to the American Lung Association, only 18% of those who are eligible participate in lung cancer screenings, though that number is increasing.
"With the adoption of artificially intelligent nodule sniffers and a predicted rise in lung cancer screening, every hospital will need to become experienced in lung biopsy," Dr. Sakata says. "Because of these factors, pulmonologists need to understand the nuances between the different biopsy approaches, and which is best for their patients."
Fewer complications
With CT-guided biopsies, the risk of pneumothorax during the biopsy procedure ranges between 15% and 30%. The Mayo Clinic study documented the overall risk of pneumothorax from CT-guided biopsy at about 30%. The risk of pneumothorax for robotic bronchoscopy was significantly lower, at just 1.4%. Dr. Sakata explains that the lower risk is due to using the robot-assisted approach to perform biopsies, which are done from inside the lungs, leaving the lining of the lung, called the pleura, undisturbed.
The technique used during the ssRAB procedure also allows pulmonologists to biopsy multiple lung nodules and the lymph nodes during the same procedure, reducing the time to treatment by reducing the number of procedures required.
"When multiple lesions or nodules are present, sometimes we've seen two different types of cancers or where one lesion is malignant and the other is Valley fever, a dust-borne infection due to coccidioidomycosis," Dr. Sakata explains. "This has a significant impact on diagnosis and treatment decisions. The ability to biopsy multiple targets is absolutely beneficial and favors the robotic bronchoscopy approach."
Superior molecular adequacy and tumor profiling
The study also addressed molecular adequacy rates between the two nonsurgical biopsy options. Gathering sufficient viable tumor cells is critical for tumor molecular profiling, an essential step to guide treatment pathways. A higher rate of molecular adequacy was seen in the robotic bronchoscopy arm.
"With robotic bronchoscopy, we saw an approximate 10% improvement in getting enough tissue for molecular profiling when compared to CT-guided biopsy," Dr. Sakata says.
Faster time from biopsy to treatment
On average in the United States, it can take up to three months from the time a nodule is found to the start of cancer-directed treatment. Every two-week delay beyond eight weeks increases the risk of recurrence and patient mortality. Dr. Sakata and the Mayo Clinic research team found that patients who had a robotic bronchoscopy began treatment an average of 22 days faster than patients who had a CT-guided biopsy.
CT-guided biopsies can only make a diagnosis by obtaining tissue from a single target in the lung. Thus, patients who have the CTTB procedure must return for a bronchoscopy to complete lymph node sampling for staging purposes. "We can diagnose and stage in the same setting with ssRAB, reducing the need for multiple procedures and streamlining patient care," Dr. Sakata says.
Dr. Sakata says most patients can safely tolerate robotic bronchoscopy. The exception is patients with severe pulmonary hypertension because of the specific anesthesia protocols required for the procedure.
"The bottom line is that robotic bronchoscopy is more accurate. It's safer, with higher rates of molecular adequacy and a decreased need for repeat biopsies," Dr. Sakata explains. "It's a proven, faster clinical pathway for initiating therapy for NSCLC. Robotic bronchoscopy is likely here to stay and replace CT-guided biopsy."
For more information
McNierney D, et al. Comparative performance of shape-sensing robotic-assisted bronchoscopy and CT-guided transthoracic biopsy in diagnosing peripheral pulmonary lesions. Lung Cancer. 2026;218:109487.
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