The Diagnostic Performance of Shape Sensing Robotic-Assisted Bronchoscopy versus Digital Tomosynthesis-Corrected Electromagnetic Navigation Bronchoscopy: A Comparative Cohort Study

SW. Low*^a (Dr), R. Lentz^a (Dr), H. Chen^b (Ms), J. Katsis^c (Dr), M. Aboudara^d (Dr), O. Rickman^a (Dr), F. Maldonado^a (Prof)

^a Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, UNITED STATES ; ^b Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA, Nashville, UNITED STATES ; ^c Department of Internal Medicine, Division of Pulmonary and Critical Care, Rush University, Chicago, UNITED STATES ; ^d Division of Pulmonary and Critical Care, St. Luke's Health System, University of Missouri-Kansas City, Kansas City, UNITED STATES

* seeweilow@gmail.com

Background

The increasing incidence of indeterminate pulmonary nodules detected incidentally or via lung cancer screening highlights the need for safe and accurate biopsy modalities. Electromagnetic navigational bronchoscopy (ENB) has been the dominant bronchoscopic modality and now includes digital tomosynthesis (DT-ENB) for intra-procedure correction of computed tomography scan (CT)-body divergence. More recently, shape-sensing robotic-assisted bronchoscopy (ssRAB), with improved catheter stability and articulation but lacking DT, has become available. We sought to compare the diagnostic yield of ssRAB to DT-ENB during the first 6 months each modality was utilized at our institution.

Methods

Demographic, radiographic, and procedural data are prospectively collected on all navigational bronchoscopies at Vanderbilt University Medical Center. DT-ENB was introduced in April 2018 and ssRAB in November 2021; consecutive procedures performed six months after each introduction were identified in this database. Biopsies were considered diagnostic if histopathology revealed malignancy or specific benign features that readily explained a nodule's presence (e.g., granulomatous inflammation, robust neutrophilic inflammation/purulence, and organizing pneumonia).

Results

ssRAB was used to biopsy 137 nodules in 127 patients, and DT-ENB was used in 197 nodules in 173 patients six months after each modality was introduced. There were no baseline differences between groups. Diagnostic yield was 77% for ssRAB (110/143) and 80% (158/197) for DT-ENB (p = 0.46). Median nodule diameters were 17 and 19 mm, respectively. There was no difference in yield after adjustment for nodule size, bronchus sign, and peripheral vs. middle third location. A diagnostic biopsy was more likely with larger nodule size, concentric radial ultrasound view, and solid nodule density. Pneumothorax complicated 1.5% of ssRAB and 1.7% of DT-ENB procedures.

Conclusion

The diagnostic yields of ssRAB and DT-ENB were similar in this comparative cohort study with similar patient and nodule features using a conservative diagnostic yield definition. These results should be confirmed by randomized trials.

Disclosure of funding source(s):

F.M. reports consulting fees and research support from Medtronic.
O.R. reports consulting fees from Medtronic.
For the remaining authors there is no conflict of interest or other disclosures.