Same yield, a quarter of the chest drains: robotic bronchoscopy against CT-guided lung biopsy

The edition in brief

Robotic-assisted bronchoscopy and CT-guided transthoracic needle biopsy both sample peripheral pulmonary lesions, and until now had not been compared directly in a review. Five retrospective studies, all from one US health system, were eligible; because four shared patients, only three mutually independent cohorts could be pooled. Strict 2024 ATS/CHEST diagnostic yield was indistinguishable — risk ratio 0.99 (95% CI 0.93 to 1.06, I² 24%) — although absolute yield fell from 88% to between 74% and 84% when the strict definition was applied. Pneumothorax requiring a chest drain or admission was about three-quarters less frequent with the robotic approach, RR 0.25 (0.14 to 0.46, I² 0%). Robotic procedures ran about 50 minutes longer where same-session staging endobronchial ultrasound was counted, and about 8 minutes longer where it was not. Certainty was low for pleural complications and very low elsewhere, no cohort stratified yield by bronchus sign or lung zone, and equivalence was never formally established. The American Society of Nuclear Cardiology has replaced its 2016 stress testing guideline with beginning-to-end practice standards covering patient selection and preparation, stress modality and protocol for each stressor, safety, and interpretation and reporting for both SPECT and PET. A prospective study has produced a five-attribute rubric — clarity, content, certainty, tone, verbosity — for deciding whether an AI-generated plain-language radiology report is safe to release, with a rule that a failing grade on any attribute except verbosity means withholding it. And BI-RADS v2025 brings non-mass lesions formally into the breast ultrasound lexicon, classified by distribution, with a malignancy rate high enough that they warrant tissue diagnosis.