Supplementary Material for: Streamlining Lung Cancer Diagnosis: One Procedure for Multi-Site Biopsy Using Shape-Sensing Robotic-Assisted Bronchoscopy.

Introduction: Multiple nodule sampling is a challenging scenario. While CT-guided biopsies are conventional, shape-sensing robotic-assisted bronchoscopy (ssRAB) has been proven to be safe and useful for assessing solitary nodules. However, its effectiveness in evaluating multiple pulmonary nodules remains unexplored. In this study, we aim to assess the safety and effectiveness of ssRAB for evaluating multiple pulmonary nodules. Methods: This retrospective study included patients who underwent ssRAB for multiple pulmonary nodule sampling from September 2019 to August 2024. Data on procedural time, tools, complications, and histopathological results were collected. Univariate logistic regression assessed diagnostic yield by tool and clinically relevant nodule characteristics. Results: We sampled 393 nodules in 189 patients. Overall diagnostic yield was 86.2%. The use of cryobiopsy (OR 2.23, 95% CI 1.38–3.61, p = <0.001) and upper lobe nodule location (OR 2.30, 95% CI 1.53–3.70, p < 0.001) were associated with a positive diagnostic yield. Of the cohort, 42.3% patients had malignancies in all sampled nodules, 23.3% had bilateral malignant involvement, 11.6% had multiple primary lung cancers, and 7.4% had two distinct cancer diagnoses. The overall complication rate was 5.8%, including pneumothorax (3.7%) and grade 3 bleeding (0.5%). Conclusion: Multiple nodule sampling in a single procedure using ssRAB resulted in an optimal diagnostic yield with a low complication rate and potentially benefits patient care by streamlining diagnosis, staging, and treatment in complex cases involving multiple primary lung cancers or metastatic disease.