High Diagnostic Yield in Sampling Sub-Centimeter Peripheral Pulmonary Nodules With Robotic-Assisted Bronschoscopy

Abstract

Robotic-Assisted Bronchoscopy (RAB) is a novel technique that is particularly valuable in the sampling peripheral pulmonary nodules. RAB has been reported to have a lesion localization rate of 96.2% with a diagnostic yield of 74% in patients with 1 to 5 cm peripheral pulmonary nodules. Thus far, no studies have reported the diagnostic yield of RAB in sampling subcentimeter pulmonary nodules.METHODS: This is a retrospective observational study of all RAB cases completed at a community hospital between August 2020 and March 2021. RAB was executed using the MonarchÔ platform (Auris Health, Inc., Redwood City, CA) and all cases were performed by a single operator. Only procedures performed for biopsy of a peripheral pulmonary nodule <10 mm in size were included in the study. Transbronchial biopsy for pathology and microbiology, transbronchial brushings for cytology, and transbronchial needle aspiration for cytology were performed during all cases that were included in this study. The primary outcome was diagnostic yield. A secondary outcome was incidence of procedure related complications. Baseline demographic information, nodule characteristics, and procedural outcomes were recorded.RESULTS: A total of 30 patients underwent RAB in our hospital and 3 patients were identified with a pulmonary nodule <10 mm in size. The mean nodule diameter was 5.9 mm and 66% of the sampled nodules were described as calcified. The diagnostic yield in this subset of patients was 100%. Diagnoses confirmed by biopsy were neuroendocrine tumor, cryptogenic organizing pneumonia, and Mycobacterium avium complex. No complications were reported. CONCLUSIONS:This study demonstrates high diagnostic yield with minimal complications using RAB to sample subcentimeter peripheral pulmonary nodules in a community hospital. RAB can be safely used to sample malignant and benign subcentimeter nodules. CLINICAL IMPLICATIONS:The widespread use of high-resolution CT scans for lung cancer screening has led to expedited and increased detection of peripheral pulmonary nodules. Thus, exploring the potential for earlier nodule sampling is crucial. As recent technologic advancements have made the biopsy of peripheral pulmonary nodules more feasible, clinicians can consider sampling sub-centimeter nodules concerning for malignancy. Earlier biopsy may lead to accelerated diagnosis and treatment, although these advantages must be weighed against the risk of complications.

Robotic-assisted Navigation Bronchoscopy

“…28 Twenty-three studies were included in the final analysis, including 1409 subjects and 1541 nodules (Table 1). [11][12][13][14][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]…”

“…Twenty-three studies were included in the final analysis, including 1409 subjects and 1541 nodules (Table 1). 11–14,29–47 …”

“…Reddy et al 43 Considered diagnostic if results demonstrated an etiology consistent with the clinical situation, or if follow up imaging or secondary sampling suggested benign disease -Reisenauer et al 45 Defined as conclusive when the pathology interpretation by the pathologist was consistent with the clinical history or scenario and treated by clinicians as benign disease…”