{
  "abstract": "Introduction The introduction of lung screening programmes and more widespread use of CT imaging has led to a rise in the number of identified pulmonary nodules. It has been reported that 48% of baseline scans in the NELSON study had multiple nodules. 1 This raises the question about potential management of these nodules especially if there is no evidence of lymph node involvement and when multiple nodules can upstage primary lung malignancy. While CT-guided transthoracic biopsy remains the gold standard method, the role of shape-sensing robotic assisted bronchoscopy (ssRAB) in this cohort of patients has not been fully explored. We report here the diagnostic and safety outcomes for multiple nodule biopsy using ssRAB with cone-beam CT (CBCT) imaging.Methods Between April 2023 and February 2025, a retrospective analysis was performed for prospectively collected data on patients undergoing ssRAB with CBCT for two or more suspicious nodules. All patients underwent a procedure under general anaesthesia with adjunctive radial EBUS. Demographics, nodule characteristics, diagnostic and safety outcomes were collected.Results A total of 611 nodules were biopsied in 500 patients. There were 95 patients who underwent procedures for multiple nodules, of which 15 were excluded due to lesion size over 30 mm. The final analysis included 80 patients with 171 biopsied nodules. 70 patients had 2 nodules; 9 had 3 nodules and 1 had 4 nodules biopsied. 50% of the procedures were bilateral. The diagnostic yield was 92.5%. Synchronous tumours were identified in 15 patients and metastatic disease in 10 patients. There were 8 pneumothoraces (10%) with 4 (5%) requiring a chest drain.Conclusion The use of shape-sensing robotic-assisted bronchoscopy with CBCT to biopsy multiple nodules is feasible with an excellent diagnostic yield and safety profile. There is additional evidence that biopsying multiple nodules can impact management through the identification of synchronous lesions and potentially increase staging accuracy for cancer diagnoses.Reference Heuvelmans MA, Walter JE, Peters RB, Bock GH, Yousaf-Khan U, Aalst CMV, et al. Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: the NELSON study. Lung Cancer 2017;113:45–50.",
  "authors": [
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "LT Chan"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "H Trainer"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "A Tana"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "O Volhina"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "A Karir"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "ES Agaoglu"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "I Meireles"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "J Tonkin"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "JL Garner"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "CM Orton"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "Royal Brompton Hospital, London, UK"
      ],
      "name": "PL Shah"
    }
  ],
  "title": "P216 Robotic assisted bronchoscopy with cone-beam CT imaging for multiple nodules: diagnostic and safety outcomes",
  "uid": "55ee678d-94dc-56e6-a020-19dbd267dff4"
}