Contrast-Enhanced Cone-Beam CT-Guided Robotic Bronchoscopic Biopsy of a Mediastinal Lymph Node Adjacent to Major Vascular Structures.

Accurate mediastinal staging is critical in lung cancer, particularly when involvement of specific nodal stations determines curative intent. Sampling high mediastinal lymph nodes adjacent to major vascular structures presents technical and safety challenges, especially when conventional endobronchial ultrasound approaches are unsuitable. We report a case of contrast-enhanced cone-beam computed tomography (CBCT)-guided robotic bronchoscopic biopsy of a high mediastinal lymph node adjacent to major vessels. Intravenous contrast during CBCT acquisition enabled clear differentiation between the target node and adjacent vascular structures, facilitating accurate segmentation, safe navigation and confirmation of tool-target contact prior to sampling. This case highlights the feasibility and role of intravenous contrast in CBCT-guided bronchoscopy to improve procedural confidence and safety during complex mediastinal biopsies.