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

BACKGROUND: Electromagnetic navigational bronchoscopy has been the dominant bron-choscopic technology for targeting small peripheral lesions and now includes digital tomosynthesis-electromagnetic navigational bronchoscopy (DT-ENB), allowing near -real-time intraprocedural nodule visualization. Shape-sensing robotic-assisted bronchoscopy (ssRAB), with improved catheter stability and articulation recently became available. Although the diagnostic performance of these two methods seems higher than that of legacy systems, data remain limited. We sought to compare the diagnostic yield of these two novel platforms after their introduction at our institution.RESEARCH QUESTION: Does the diagnostic yield of ssRAB differ significantly from that of DT-ENB in patients undergoing biopsy of peripheral pulmonary lesions (PPLs)?STUDY DESIGN AND METHODS: This retrospective comparative cohort study analyzed pro-spectively collected data on consecutive procedures performed with DT-ENB and ssRAB in their first 6 months of use at our institution. Biopsies were considered diagnostic if histo-pathologic analysis revealed malignancy or specific benign features that readily explained the presence of a PPL. Nonspecific inflammation, normal lung or airway, and atypia not diag-nostic of malignancy were considered nondiagnostic.RESULTS: SSRAB was used to biopsy 143 PPLs in 133 patients and DT-ENB was used to biopsy 197 PPLs in 170 patients. Diagnostic yield was 77% for ssRAB (110 of 143 PPLs) and 80% (158 of 197 PPLs) for DT-ENB (OR, 0.8; 95% CI, 0.5-1.4; P = .4). Median lesion di-ameters were 17 and 19 mm, respectively. No difference in diagnostic yield was found 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 = .86).INTERPRETATION: SSRAB and DT-ENB showed comparable diagnostic yields and safety profiles in this comparative cohort study. CHEST 2023; 163(4):977-984

Automated summary

This study compares the diagnostic yield of shape-sensing robotic-assisted bronchoscopy (ssRAB) and digital tomosynthesis-electromagnetic navigational bronchoscopy (DT-ENB) in biopsy of peripheral pulmonary lesions. The results show that ssRAB and DT-ENB have comparable diagnostic yields and safety profiles.