Abstract
<title>Abstract</title> <p>Background Virtual bronchoscopic navigation (VBN) with fused fluoroscopy and vessel mapping has expanded bronchoscopy for diagnosing peripheral pulmonary lesions (PPLs), though real-world data using strict outcome definitions remain limited. Methods We conducted a retrospective cohort study of 108 consecutive patients undergoing VBN-guided bronchoscopy with radial endobronchial ultrasound; mobile cone-beam CT (mCBCT) was used selectively. Results Mean lesion size was 14.3 ± 5.9 mm and pleural distance 12.1 ± 11.1 mm. Strict diagnostic yield was 59.3% (64/108; 95% CI 49.4–68.6%), diagnostic accuracy 82.4% (89/108; 95% CI 73.9–89.1%), and sensitivity for malignancy 84.8% (56/66; 95% CI 73.9–92.5%). Larger lesion size was associated with higher diagnostic yield, while middle or lower lobe location was associated with lower yield and accuracy. Cryo-transbronchial biopsy (cryo-TBB) demonstrated the highest yield at 78.8% (52/66; 95% CI 67.0–87.9%), compared to forceps-TBB (43.2%) and transbronchial needle aspiration (TBNA) (40.4%). The addition of mCBCT markedly improved diagnostic accuracy, achieving a negative predictive value of 95%. Safety outcomes were favorable, with pneumothorax in one case (< 1%) and grade 3 bleeding in five cases (4.6%). Conclusion VBN-guided bronchoscopy provides good diagnostic yield for small peripheral pulmonary lesions, comparable to robotic systems in real-world settings. The addition of mCBCT enhances diagnostic confidence, while biopsy tool selection significantly impacts yield.</p>