A First for Robotic Navigational Bronchoscopy and the Use of “Tele-ROSE” in diagnosing lung pathology

S. Saha*^a (Dr), S. Joshi^a (Dr), A. Ronghe^a (Dr), J. Tomaszewski^a (Dr), R. Zambrano^b (Mr)

^a University of Buffalo: School of Medicine, Buffalo, UNITED STATES ; ^b Kaleida Health System, Buffalo General Hospital, Buffalo, UNITED STATES

* sandipsa@buffalo.edu

Background:

In diagnosing malignancy or lung pathology, the adequacy of tissue specimens are ideally assesed with ROSE (rapid onsite evaluation) and a cytopathologist. When institutions are shortstaffed, we must become creative in this age of telemedicine. Telecytology, first noted by Raab et. Al (1996), utilized a Sony video camera to project images on a monitor, and examine the diagnostic accuracy in cervical smears. Bott et. al (2015) fitted a Nikon camera to a microscope, connected to another video controller, for live real time video during a mediastinal staging EBUS. Lin et. al (2019) performed ROSE on thyroid samples using the same setup as Bott et al., where images were streamed via a proprietary platform to another off-site pathologist’s workstation. We are presenting a pilot study as the first instance where telecytology is being utilized in navigation robotic bronchoscopies in identifying peripheral lung lesions.

Methodology:

38 suspected patients with targetable lung lesions were evaluated with a navigation bronchoscopy/EBUS. 11 patients utilized telecytology ROSE, 9 of which utilized a robotic navigation system. The slides were prepared and streamed in real time using a Leica Flexacam C3 with an Olympus BX43 Microscope, over the Webex video conferencing platform. A secure hospital internet connection allowed the pathologist, at an outlying facility, assess for adequacy. Our endpoint was measuring the time to calling a specimen for adequacy.

Results:

Prior to the implementation of telecytology, it took on average 18 minutes to call adequacy (n=27 patients). Using telecytology, the time to call for adequacy was 8 minutes (n=11 patients).

Conclusion:

TeleROSE may become a new standard platform for assessing adequacy of biopsies in institutions that may not have in-house pathology. This setup reduces anesthesia time, expensive licensing fees for proprietary platforms, and may help other institutions trying to develop their own thoracic oncology programs.

Disclosure of funding source(s): none