Use of the Ion Robot in the Diagnosis of Pulmonary Nodules: Fine Needle Aspiration Versus Cryobiopsy.

BACKGROUND: Robotic-assisted bronchoscopy platforms provide an innovative approach to the sampling of pulmonary nodules. As compared to other technologies, fiber-optic shape-sensing instrumentation allows for a more precise, accurate location and sampling of the target lesion with fewer complications. As FNA is a mainstay in the evaluation of pulmonary nodules, this study compares FNA diagnostic yield to cryobiopsy using the Ion robotic system. METHODS: From January 1, 2025 through June 30, 2025, the Cytopathology laboratory processed 87 FNAs with concurrent cryobiopsies from pulmonary nodules and form the basis of this study. RESULTS: Of the 87 FNAs, 45 (52%) were positive/suspicious for malignancy, 4 (5%) were positive for a neoplasm, 5 (6%) were atypical, 13 (15%) were negative and 20 (23%) were nondiagnostic. Cryobiopsies were concordant in 59 (68%) cases and discordant in 28 (32%) cases. Of the 28 discordant cases, 3 had neoplastic cells on FNA of which 2 were nondiagnostic and 1 showed atypical cells on cryobiopsy. Of the 5 FNAs with atypical cells, 5 were malignant on cryobiopsy. Of the 20 nondiagnostic FNAs, 13 were malignant and 7 were negative on cryobiopsy. FNA diagnostic yield was 71%, sensitivity 66%, and specificity 100%. The cryobiopsy diagnostic yield was 96%, sensitivity 94%, and specificity 100%. CONCLUSION: At our institution, use of the Ion robotic system for the evaluation of pulmonary nodules has led to increased diagnostic yields over standard FNA with ROSE. This technology provides an additional modality for the sampling of pulmonary nodules; in particular, those located peripherally.