A Prospective Randomized Comparative Study of Three Guided Bronchoscopic Approaches for Investigating Pulmonary Nodules The PRECISION-1 Study

Yarmus Y et Al

Chest. 2020 Mar;157(3):694-701. doi: 10.1016/j.chest.2019.10.016. Epub 2019 Nov 1.;


What is the key question?

  • There are now multiple expensive modalities available to bronchoscopists to assist in the biopsy of peripheral lung nodules (PPNs).
  • At present, there is limited data regarding robotic bronchoscopy (RB) and no data comparing RB with Electromagnetic navigation bronchoscopy (ENB), ultrathin bronchoscopy (UTB) and radial probe EBUS (rEBUS).
  • The Precision-1 study was a prospective single-blinded randomized preclinical cadaveric study comparing three bronchoscopic navigational systems, RB, ENB and UTB-rEBUS.

What is the bottom line?

  • A series of cadaveric experiments were performed developing a pseudo-tumour composite of animal protein and iodinated contrast which were placed percutaneously in separate distinct lobes under fluoroscopic guidance creating “PPNs”.
  • Pre and post pseudo-tumour CT scans were performed allowing EMN planning and RB navigation
  • All three procedures were performed on mechanically ventilated cadaver model. Cone beam CT was used to verify needle position.
  • UTB-rEBUS was performed first followed randomly by RB or ENB.
  • Sixty procedures were performed targeting 20 PPNs. 80% PPNs were peripheral with a mean size of 16.5 =/- 1.5 mms (50% positive bronchus sign).
  • The rate of successful PPN localization and puncture was superior with RB when compared to EMN (80% vs. 45% p= .02) and UTB-rEBUS (80% vs. 25% (p <0.001) without a difference between EMN and UTB-rEBUS.
  • Median distance between needle and target nodule was less with RB than EMN and UTB-rEBUS.

Why read on?

  • The authors discuss further aspects of their cadaveric model including needle position in relation to lesion and needle to target miss distance.