Robotic‐assisted bronchoscopy versus CT‐guided transthoracic biopsy for diagnosis of pulmonary nodules

• Published in: Respirology (Carlton, Vic.) Vol. 28; no. 1; pp. 66 - 73
• Main Authors: Yu Lee‐Mateus, Alejandra, Reisenauer, Janani, Garcia‐Saucedo, Juan C., Abia‐Trujillo, David, Buckarma, EeeLN H., Edell, Eric S., Grage, Rolf A., Bowman, Andrew W., Labarca, Gonzalo, Johnson, Margaret M., Patel, Neal M., Fernandez‐Bussy, Sebastian
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2023; Wiley Subscription Services, Inc
• Subjects: Biopsy; Bronchoscopy; Bronchoscopy - methods; Computed tomography; Humans; Image-Guided Biopsy - methods; image‐guided transthoracic biopsy; Lung - diagnostic imaging; Lung - pathology; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung nodules; Malignancy; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - pathology; pneumothorax; pulmonary nodule; Respiratory diseases; Retrospective Studies; robotic bronchoscopy; Robotic Surgical Procedures; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - pathology; Tomography, X-Ray Computed - methods; lung cancer; robotic bronchoscopy; pulmonary nodule; image-guided transthoracic biopsy; pneumothorax
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/resp.14368

Background and Objective Currently, computed tomography‐guided transthoracic biopsy (CTTB) is the most accurate diagnostic approach for pulmonary nodules suspected of malignancy. Traditional bronchoscopy has shown suboptimal diagnostic sensitivity, but the emergence of robotic‐assisted bronchoscopy (RAB) has the potential to improve diagnostic accuracy, maximize diagnostic yield and complete mediastinal and hilar staging in a single procedure. We aim to assess the efficacy and diagnostic performance of RAB compared to CTTB for diagnosing pulmonary nodules suspected of lung cancer. Methods A multicenter retrospective review of consecutive patients who underwent RAB and CTTB for evaluating pulmonary nodules from January 2019 to March 2021 at Mayo Clinic Florida and Mayo Clinic Rochester, United States. Clinical and demographic information, nodule characteristics, outcomes and complications were compared between RAB and CTTB. Results A total of 225 patients were included: 113 in the RAB group and 112 in the CTTB group. Overall diagnostic yield was 87.6% for RAB and 88.4% for CTTB. For malignant disease, RAB had a sensitivity of 82.1% and a specificity of 100%, CTTB had a sensitivity of 88.5% and a specificity of 100%. Complication rate was significantly higher for CTTB compared to RAB (17% vs. 4.4%; p = 0.002). Conclusion RAB, when available, can be as accurate as CTTB for sampling pulmonary nodules with similar or reduced complications and should be considered as a means for nodule biopsy, particularly when mediastinal staging is also clinically warranted. Robotic‐assisted bronchoscopy (RAB) has the potential improve diagnostic accuracy for pulmonary nodules. We compared diagnostic performance of RAB to CT‐guided biopsy (CTTB), the most commonly used tool for lung biopsy. We found no significant difference in diagnostic yield for RAB (87.6%) compared to CTTB (88.4%) in 225 patients. See related Editorial