Abstract Rationale Robotic-assisted bronchoscopy (RAB) promises reliable navigation to smaller and more peripheral lung lesions as well as improved diagnostic yield when sampling these lesions. The presence of a bronchus sign, defined as a bronchus leading to the target lung lesion on preprocedural computed tomography (CT), has consistently been shown to improve diagnostic yield for earlier technologies. However, studies reporting outcomes of RAB are inconsistent on whether the presence of a bronchus sign influences diagnostic yield. Prior meta-analyses on the subject also demonstrated inconsistent results and varied in the studies they include. Therefore, a dedicated meta-analysis was sought to answer this question that incorporates more recent studies with larger sample sizes. Methods We searched electronic databases and citations of search results for studies reporting diagnostic yield of RAB biopsies of lesions with presence of a bronchus sign compared to biopsies of lesions with absence of a bronchus sign. Case reports and case series with fewer than 5 patients were excluded from the review. All other study designs were included. Crude odds ratios and Wald confidence intervals were calculated for individual studies. An inverse variance weighted random-effects meta-analysis was performed to calculate a summary odds ratio. Sensitivity analyses were conducted to explore the impact of using different statistical models and of removing each individual study. Results 12 studies (n = 2856 lesions) were included in the final analysis. They comprised retrospective, prospective, single-center, and multi-center designs in both manuscript and abstract formats. Five individual studies reported a significant association between the presence of bronchus sign and diagnostic yield of RAB, including the two largest and most recently published studies. Meta-analysis yielded a summary odds ratio of 1.91 (95% CI 1.54, 2.36; P 0.001). Between-study variance and heterogeneity were not observed (τ2 = 0.00, I2 = 0%). These results remained consistent across each sensitivity analysis performed. Conclusions According to this study, the presence of a bronchus sign is a favorable predictor for diagnostic yield in biopsies of lung lesions using RAB with nearly double the odds of a diagnostic result in lesions with a bronchus sign. Despite variability across studies (e.g., platform differences, definitions of diagnostic yield, proportions of lesions with a bronchus sign), statistical measures did not indicate significant variance or heterogeneity. There is a need for additional investigation into techniques or technologies that may improve diagnostic yield for lesions that do not exhibit a bronchus sign. This abstract is funded by: None
Jang et al. (2026) studied this question.