Robotic Assisted Bronchoscopy: The Ultimate Solution for Peripheral Pulmonary Nodules?

Heijden, Erik H F M van der; Verhoeven, Roel L.J.

doi:10.1159/000522516

Cited by 3 publications

(5 citation statements)

References 26 publications

(39 reference statements)

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“…Several previous studies have demonstrated that, like other bronchoscopic technologies, the diagnostic yield of RAB is lower than the navigation success rate. 23,24 Similarly, this trend was observed in our current study, which may, in part, be because of CT-to-body divergence or inadequate tissue acquisition. Cone beam CT (CBCT) and needle-based confocal laser endomicroscopy (nCLE) are emerging techniques used to confirm tool-in-lesion before taking a biopsy, which may be helpful to overcome CT-tobody divergence and reduce the near-miss rate, 25,26 obtaining a high diagnostic yield.…”

Section: Discussionsupporting

confidence: 83%

Shape-sensing Robotic-assisted Bronchoscopy (SS-RAB) in Sampling Peripheral Pulmonary Nodules

Xie,

Zhang,

et al. 2024

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: The ION system is a shape-sensing robotic-assisted bronchoscopy (SS-RAB) platform developed to biopsy peripheral pulmonary nodules (PPNs). There is a lack of data describing the use of this system in the Chinese population. The study aimed to assess the feasibility and safety of using SS-RAB to diagnose PPNs across multiple centers within China. Methods: This prospective, multicenter study used SS-RAB in consecutive patients with solid or sub-solid PPNs 8 to 30 mm in largest diameter. Primary endpoints were diagnostic yield and the rates of procedure- or device-related complications. Radial endobronchial ultrasound (rEBUS) was to confirm lesion localization, followed by sampling, using the Flexision biopsy needle, biopsy forceps, and cytology brush. Subjects with nonmalignant index biopsy results were followed up to 6 months. Results: A total of 90 PPNs were biopsied from 90 subjects across 3 centers using SS-RAB. The median nodule size was 19.4 mm (IQR: 19.3, 24.6) in the largest dimension. In all (100%) cases, the catheter successfully reached the target nodule with tissue samples obtained. The diagnostic yield was 87.8% with a sensitivity for malignancy of 87.7% (71/81). In a univariate analysis, nodule lobar location, presence of bronchus sign, and rEBUS view were associated with a diagnostic sample, but only rEBUS view showed an association in a multivariate analysis. The overall pneumothorax rate was 1.1% without pneumothorax requiring intervention, and there was no periprocedural bleeding. Conclusion: As an emerging technology in the Chinese population, SS-RAB can safely biopsy PPNs with strong diagnostic performance.

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Section: Discussionsupporting

confidence: 83%

Shape-sensing Robotic-assisted Bronchoscopy (SS-RAB) in Sampling Peripheral Pulmonary Nodules

Xie,

Zhang,

et al. 2024

Journal of Bronchology &Amp; Interventional Pulmonology

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“…42,44 However, the disparity between navigational success and diagnostic yield is noticeable. 45,46 Since both robotic platforms rely on preoperative chest CT scan for navigation, this may be partly due to CT-to-body divergence. To overcome this problem, CBCT was used for tool-in-lesion confirmation before sample acquisition in two studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, the disparity between navigational success and diagnostic yield is noticeable 45,46 . Since both robotic platforms rely on preoperative chest CT scan for navigation, this may be partly due to CT‐to‐body divergence.…”

Section: Discussionmentioning

confidence: 99%

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Zhang,

Xie,

et al. 2024

Thoracic Cancer

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Robotic‐assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta‐analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta‐analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high‐quality prospective studies still need to be conducted.

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“…Although encouraging, the gap between navigational success and diagnostic yield remains suboptimal 13,14 . From a technical perspective, navigational bronchoscopy consists of three steps: navigation to the target nodule, confirmation that biopsy tools are in contact with the nodule and acquisition of adequate tissue 15 .…”

Section: Introductionmentioning

confidence: 99%

“…12 Although encouraging, the gap between navigational success and diagnostic yield remains suboptimal. 13,14 From a technical perspective, navigational bronchoscopy consists of three steps: navigation to the target nodule, confirmation that biopsy tools are in contact with the nodule and acquisition of adequate tissue. 15 Although robotic bronchoscopy demonstrated promising results in the navigation parts, these last steps-confirmation and acquisition-show room for improvement.…”

Section: Introductionmentioning

confidence: 99%

Robotic bronchoscopic needle‐based confocal laser endomicroscopy to diagnose peripheral lung nodules

et al. 2022

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Background and Objective: Robotic bronchoscopy has demonstrated high navigational success in small peripheral lung nodules but the diagnostic yield is discrepantly lower. Needle based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging at the needle tip. We aim to assess feasibility, safety and needle repositioning based on real-time nCLE-guidance during robotic bronchoscopy in small peripheral lung nodules. Methods: Patients with suspected peripheral lung cancer underwent fluoroscopy and radial EBUS assisted robotic bronchoscopy. After radial EBUS nodule identification, nCLE-imaging of the target area was performed. nCLE-malignancy and airway/lung parenchyma criteria were used to identify the optimal sampling location. In case airway was visualized, repositioning of the biopsy needle was performed. After nCLE tool-in-nodule confirmation, needle passes and biopsies were performed at the same location. Measurements and Main Results: Twenty patients were included (final diagnosis n = 17 (lung) cancer) with a median lung nodule size of 14.5 mm (range 8-28 mm). No complications occurred. In 19/20 patients, good quality nCLE-videos were obtained. In 9 patients (45%), real-time nCLE-imaging revealed inadequate positioning of the needle and repositioning was performed. After repositioning, nCLE-imaging provided tool-in-nodule-confirmation in 19/20 patients. Subsequent ROSE demonstrated representative material in 9/20 patients (45%) and overall diagnostic yield was 80% (16/20). Of the three patients with malignant nCLE-imaging but inadequate pathology, two were diagnosed with malignancy during follow-up. Conclusion: Robotic bronchoscopic nCLE-imaging is feasible and safe. nCLE-imaging in small, difficult-to-access lung nodules provided additional real-time feedback on the correct needle positioning with the potential to optimize the sampling location and diagnostic yield.

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Robotic Assisted Bronchoscopy: The Ultimate Solution for Peripheral Pulmonary Nodules?

Cited by 3 publications

References 26 publications

Shape-sensing Robotic-assisted Bronchoscopy (SS-RAB) in Sampling Peripheral Pulmonary Nodules

Shape-sensing Robotic-assisted Bronchoscopy (SS-RAB) in Sampling Peripheral Pulmonary Nodules

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Robotic bronchoscopic needle‐based confocal laser endomicroscopy to diagnose peripheral lung nodules

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