Comparative performance of shape-sensing robotic-assisted bronchoscopy and CT-guided transthoracic biopsy in diagnosing peripheral pulmonary lesions

Nonsurgical biopsies in lung cancer are obtained by computed tomography-guided transthoracic biopsy (CTTB) or bronchoscopically. Due to previous limitations in flexible bronchoscopic techniques, the development of robotic-assisted bronchoscopy (RAB) platforms has emerged. An observational study at the Mayo Clinic (Phoenix, AZ) compared outcomes ofshape-sensing RAB (ssRAB) and CTTB using a strict diagnostic yield (DY) definition. The primary outcome was DY. A total of 638 adult patients (ssRAB n=489; CTTB n=149) were included. DY was 84.3% for ssRAB versus 80.5 for CTTB (p=0.347). Compared to CTTB, the ssRAB group had a lower incidence of pneumothorax (PTX; 1.4% versus 29.5%; p<0.001), PTX requiring a chest tube placement (1.4% versus 4.7%; p=0.039), and pulmonary hemorrhage (0.2% versus 14.1%; p<0.001). Molecular adequacy was 89.6% in ssRAB versus 79.1% in CTTB (p=0.022). Time from biopsy to treatment initiation for new NSCLC diagnoses was shorter with ssRAB compared to CTTB (adjusted mean difference 22 days); however duration of the procedure was longer was ssRAB than with CTTB (adjusted mean difference 10.6 minutes). The authors conclude that ssRAB may have a comparable DY to CTTB but potentially provide superior quantity sufficient biopsies for molecular analysis at a lower complication rate.