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A small randomized trial presented at the CHEST annual meeting found no statistically significant improvement in lung-lesion biopsy yield when patients held their breath during robotic bronchoscopy. Researchers said dynamic imaging and confirming the biopsy tool’s position relative to the lesion may be more relevant, while cautioning that few nodules were as small as 5 or 6 mm.
A 117-patient randomized trial found that holding the breath during robotic bronchoscopy did not significantly improve the diagnostic yield of biopsies for peripheral lung lesions, compared with conventional ventilation. The results, presented by Roshen Mathew, MD, at the CHEST annual meeting, suggest that stabilizing the lung through breath holding alone may not improve the chance of obtaining a diagnosis in this setting.
Under strict American Thoracic Society and American College of Chest Physicians criteria, researchers recorded a diagnostic yield of 86.8% (46 of 53 patients) in the breath-hold group, compared with 92.2% (59 of 64) among patients receiving conventional ventilation. The difference was not statistically significant (P=0.338). Lesion localization rates were also similar: 98.1% with breath holding and 95.3% with conventional ventilation (P=0.625).
The STABLE trial randomized patients with peripheral pulmonary lesions to standardized end-inspiratory breath-hold ventilation during tissue sampling or conventional ventilation. All procedures used the Noah Galaxy robotic bronchoscopy system, with integrated augmented fluoroscopy and C-arm-based digital tomography. Average lesion size was about 1.7 centimeters; pneumothorax occurred in about 1.7% of cases. Radiation exposure was comparable between groups, averaging 5.8 minutes and approximately 38.6 mGy.
Researchers also reported diagnostic yield of 95.9% when the tool was confirmed to be inside the lesion, compared with 85.0% when it was confirmed to touch the lesion. Breath holding did not significantly improve tool-in-lesion positioning. Mathew said clinicians should dynamically reassess the tool’s position and alignment, rather than assume that holding the lung still will keep the biopsy instrument on target.
Biopsy Accuracy May Depend on Tool Position
The findings challenge the idea that breath holding by itself is a reliable way to increase biopsy yield during robotic bronchoscopy. For clinicians, the results point toward checking the instrument’s relationship to the lesion during the procedure and correcting its position when needed. That focus may matter because a tool that reaches a lesion’s area is not necessarily positioned inside the target.
The trial does not establish that dynamic imaging or tool correction improves outcomes in every patient; its findings about positioning are reported comparisons, not proof that one approach caused a higher yield. Still, the results help frame where procedural attention could be directed while researchers test ways to sample small or difficult-to-reach lung lesions. The study reported similar radiation exposure in both groups, so its comparison did not show a clear radiation difference between the ventilation approaches.
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How the STABLE Trial Compared Ventilation
Robotic bronchoscopy uses a guided instrument to reach peripheral lung lesions for tissue sampling. In this trial, the breath-hold group received end-inspiratory breath-hold ventilation during biopsy, intended to stabilize the target. The other group underwent conventional ventilation. Both groups used the same robotic platform and integrated imaging tools, making ventilation strategy the main comparison described in the report.
The system’s augmented fluoroscopy and C-arm-based tomography can show the instrument relative to the lesion and help identify divergence between the tool and target. Mathew emphasized that this dynamic assessment can support tool correction during sampling. He also said that clinicians may take a second biopsy after checking alignment, even if the lesion moves.
The results were presented at the CHEST annual meeting, hosted by the American College of Chest Physicians. Mathew described the work as a small exploratory analysis. Its average lesion size and limited representation of the smallest nodules constrain how broadly the findings can be applied.
“Breath hold after you have achieved integrated imaging with your robot really doesn’t improve diagnostic yield.”
— Roshen Mathew, MD, of WVU Medicine Camden Clark Medical Center
augmented fluoroscopy for lung biopsy
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Smallest Nodules Remain Understudied
The trial included few nodules measuring 5 or 6 millimeters, so Mathew cautioned that the findings may not apply to lesions of that size. The average lesion was about 1.7 centimeters. The report does not provide enough detail to determine whether a different ventilation method, including the apnea approach raised during the session, would change biopsy yield.
The exact duration of breath holding during each procedure was not measured, although biopsy procedures took five to seven minutes. The study was described as small and exploratory, and its results do not establish that breath holding has no possible benefit in other patient groups, lesion sizes, or procedural settings. The reported comparisons also do not establish that tool-in-lesion confirmation itself caused the higher yield.
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Larger Studies Needed for Smaller Lesions
Mathew said further study is needed before drawing broader conclusions. Future research could include more lesions at the 5- to 6-millimeter scale and measure breath-hold duration directly, addressing two limitations identified during the presentation. It could also examine whether different ventilation strategies affect tool positioning or diagnostic yield.
For now, the trial’s results support a measured conclusion: in this study, sustained breath holding did not significantly improve biopsy yield over conventional ventilation. The available report does not specify a planned follow-up trial or a timeline for additional results.
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Key Questions
Did breath holding improve lung biopsy yield in the trial?
No statistically significant improvement was found. Diagnostic yield was 86.8% with breath holding and 92.2% with conventional ventilation; the reported comparison had a P value of 0.338.
How many patients took part?
The STABLE trial included 117 patients with peripheral pulmonary lesions: 53 in the breath-hold group and 64 in the conventional-ventilation group.
What did the researchers say may help during biopsy?
Mathew emphasized using dynamic imaging to reassess the biopsy tool’s alignment with the lesion and correct its position when necessary. The trial reported higher diagnostic yield when the tool was confirmed inside the lesion than when it was confirmed to touch the lesion, but that comparison does not by itself prove causation.
Do the results apply to very small lung nodules?
That remains unclear. The study included few nodules measuring 5 or 6 millimeters, and Mathew cautioned that the findings may not generalize to lesions that small.
What happens next?
Researchers called for further study. The report does not identify a planned follow-up trial or give a timeline for additional results.
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