Can we rely on intraoperative bronchoscopic biopsies for surgical decision making? 78 single anesthetic robotic...

To evaluate intraoperative pathologic assessment of robotic bronchoscopic biopsies and its role in altering the operative plan.

We included patients consented for robotic bronchoscopy with biopsy followed by possible pulmonary resection between April 2021 and May 2024. Cohen's kappa test was used to assess agreement between frozen section and final pathology. Diagnostic yield was calculated for strict and intermediate yields, separated into tertiles. Potentially avoidable benign resections were defined as cases in which a benign biopsy result would have excluded surgery.

A total of 107 patients consented for the procedure, with 78 patients meeting the inclusion criteria. The mean age was 67.9 ± 12.1. Patients with a final benign diagnosis were more likely to be younger (61.5 ± 15.3 years vs 69.5 ± 10.7 years; P = .018) and have a solid nodule versus a subsolid nodule (93.8% vs 59.7%; P = .023). Patients with a final malignant diagnosis were more likely to have interval growth on serial computed tomography scans (56.5% vs 6.2%; P < .001). Both strict and intermediate diagnostic yields improved from the early phase to late phase (P = .008 and .283, respectively), with a final yield of 80.8% for both. The potentially avoidable benign resection rate improved over time with each tertile (23.1% vs 15.4% vs 0%; P = .04), while there was no statistical change in the rate of benign diagnosis (26.9% vs 23.1% vs 11.5%; P = .360). Twelve cases were stopped at bronchoscopy, and all intraoperative pathology findings were confirmed by final pathology.

Intraoperative robotic bronchoscopic biopsy provides reliable pathologic information. Combining robotic bronchoscopy with possible surgical resection results in a low benign resection rate.