{"doi":"10.1111/resp.14438","title":"Robotic bronchoscopic needle‐based confocal laser endomicroscopy to diagnose peripheral lung nodules","abstract":"BACKGROUND AND OBJECTIVE: Robotic bronchoscopy has demonstrated high navigational success in small peripheral lung nodules but the diagnostic yield is discrepantly lower. Needle based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging at the needle tip. We aim to assess feasibility, safety and needle repositioning based on real-time nCLE-guidance during robotic bronchoscopy in small peripheral lung nodules. METHODS: Patients with suspected peripheral lung cancer underwent fluoroscopy and radial EBUS assisted robotic bronchoscopy. After radial EBUS nodule identification, nCLE-imaging of the target area was performed. nCLE-malignancy and airway/lung parenchyma criteria were used to identify the optimal sampling location. In case airway was visualized, repositioning of the biopsy needle was performed. After nCLE tool-in-nodule confirmation, needle passes and biopsies were performed at the same location. MEASUREMENTS AND MAIN RESULTS: Twenty patients were included (final diagnosis n = 17 (lung) cancer) with a median lung nodule size of 14.5 mm (range 8-28 mm). No complications occurred. In 19/20 patients, good quality nCLE-videos were obtained. In 9 patients (45%), real-time nCLE-imaging revealed inadequate positioning of the needle and repositioning was performed. After repositioning, nCLE-imaging provided tool-in-nodule-confirmation in 19/20 patients. Subsequent ROSE demonstrated representative material in 9/20 patients (45%) and overall diagnostic yield was 80% (16/20). Of the three patients with malignant nCLE-imaging but inadequate pathology, two were diagnosed with malignancy during follow-up. CONCLUSION: Robotic bronchoscopic nCLE-imaging is feasible and safe. nCLE-imaging in small, difficult-to-access lung nodules provided additional real-time feedback on the correct needle positioning with the potential to optimize the sampling location and diagnostic yield.","journal":"Respirology","year":2022,"id":254967,"datarank":0.9447187372774355,"base_score":3.091042453358316,"endowment":3.091042453358316,"self_citation_contribution":0.4636563680037475,"citation_network_contribution":0.481062369273688,"self_endowment_contribution":0.4636563680037475,"citer_contribution":0.481062369273688,"corpus_percentile":null,"corpus_rank":null,"citation_count":21,"citer_count":19,"citers_with_citation_signal":13,"citers_with_endowment":13,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9595,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04441749"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":902637,"name":"Tess Kramer","orcid":"0000-0002-2413-2329","position":1,"is_corresponding":false},{"id":730174,"name":"Rohit Kumar","orcid":"0000-0002-5815-0541","position":2,"is_corresponding":false},{"id":730175,"name":"Yulan Gong","orcid":"0000-0001-5659-9153","position":3,"is_corresponding":false},{"id":730824,"name":"Hormoz Ehya","orcid":null,"position":4,"is_corresponding":false},{"id":339896,"name":"Eric A. Ross","orcid":"0000-0002-0890-2418","position":5,"is_corresponding":false},{"id":584586,"name":"Peter I. Bonta","orcid":"0000-0002-0429-4988","position":6,"is_corresponding":false},{"id":584585,"name":"Jouke T. Annema","orcid":"0000-0001-5010-2812","position":7,"is_corresponding":false},{"id":730173,"name":"Christopher Manley","orcid":"0000-0001-8269-7240","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T00:25:12.987829Z","pmid":"36535801","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}