The role of navigation bronchoscopy in the workup of lung lesions in lung transplant-eligible patients: A single-center case series.

Introduction: Lung transplantation (LTx) eligibility assessment may reveal lung lesions suspicious for malignancy. Histological evaluation of these lesions may provide clarity regarding their origin and prevent delays in transplant eligibility decisions. This single-center case series presents the outcomes of navigational bronchoscopy in patients undergoing evaluation for LTx. Methods: All patients evaluated for LTx between September 2023 and December 2025 with suspicious lung lesions amenable to navigational bronchoscopy with cone-beam CT and navigation software were included in this retrospective single-center study. Results: Out of 173 patients evaluated for lung transplantation, twelve (7%) had suspicious lung lesions. Eight patients were considered eligible for navigational bronchoscopy. The median nodule size was 12 mm (range 6-24 mm), with Herder risk scores ranging from 13% to 84% probability of malignancy. Seven patients had COPD as the underlying disease, with a median FEV₁ of 23% and DLCO of 35%. One patient had chronic lung allograft dysfunction. In all cases, the nodules were successfully reached. No complications occurred related to bronchoscopy or general anesthesia. The median procedure time was 60 min, and the median hospital stay was 7 h. In 88% of cases, the pathological results had direct clinical consequences for transplant eligibility and subsequent management. Conclusion: This series demonstrates that navigational bronchoscopy is a safe and effective diagnostic tool for evaluating suspicious lung lesions in patients undergoing assessment for lung transplantation. It can safely accelerate transplant eligibility decision-making and reduce diagnostic uncertainty.