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

Low SW et al.

Chest Volume 163, Issue 4, April 2023, Pages 977-984

What is the key question?

  • Does the diagnostic yield of shape-sensing robotic-assisted bronchoscopy (ssRAB) differ significantly from that of digital tomosynthesis-electromagnetic navigational bronchoscopy (DT-ENB) in patients undergoing biopsy of peripheral pulmonary lesions (PPLs)?

What is the bottom line?

  • The introduction of digital tomosynthesis into electromagnetic navigation bronchoscopy allowed for a near-realtime intraprocedural nodule visualization while the introduction of ssRAB into the realm of guided navigational bronchoscopy allowed for improved catheter stability, articulation and reach. The purpose of the study was to compare the diagnostic yield of these two novel platforms.
  • The is a retrospective comparative cohort study analyzing prospectively collected data on consecutive procedures performed with DT-ENB (197 PPLs in 170 patients) and ssRAB (143 PPLs in 133 patients) in their first 6 months of use at the hospital.
  • Biopsies were considered diagnostic if histopathologic analysis revealed malignancy or specific benign features that readily explained the presence of a PPL. Nonspecific inflammation, normal lung or airway, and atypia not diagnostic of malignancy were considered nondiagnostic.
  • Diagnostic yield was 77% for ssRAB (110 of 143 PPLs) and 80% (158 of 197 PPLs) for DT-ENB (P=0.4). Median lesion diameters were 17 and 19 mm, respectively.
  • There were no difference in diagnostic yield noted after adjustment for lesion size, bronchus sign, peripheral vs middle third location, and sex.
  • Pneumothorax complicated 1.5% of ssRAB and 1.8% of DT-ENB procedures (P=0.86).

Why read on?

  • This is the first study to provide a meaningful comparison of the diagnostic performance of the DT-ENB and ssRAB novel platforms using similar cohorts drawn from the same patient population, conducted by the same operators and using the same conservative definition of a diagnostic yield.