Shape-sensing robotic bronchoscopy with cone-beam CT shows promise for pulmonary lesions
Click Here to Manage Email Alerts
NASHVILLE, Tenn. — Shape-sensing robotic-assisted bronchoscopy with cone-beam CT imaging showed promise for diagnosing central, distal-airway and peripheral pulmonary lesions in a single-center study presented at the CHEST Annual Meeting.
“Shape-sensing robotic-assisted bronchoscopy combined with advanced imaging techniques such as cone-beam CT is a newer technique that allows us to diagnose and stage lung cancer in a single procedure with high diagnostic accuracy and an excellent safety profile. It has potential to become the standard of care for diagnosing pulmonary lesions if we have further studies confirming these findings,” Kim Styrvoky, MD, assistant professor of medicine at University of Texas Southwestern Medical Center, told Healio.
Styrvoky and colleagues reported results of a retrospective analysis of the first 200 biopsy procedures of 209 lung lesions evaluated using shape-sensing robotic-assisted bronchoscopy (Ion, Intuitive) and cone-beam CT at UT Southwestern from December 2020 to February 2022.
“Often, patients who present with suspicious lung lesions undergo a nonsurgical biopsy prior to definitive treatment; this can be with interventional radiology with CT-guided biopsies or bronchoscopic biopsies. The goal with bronchoscopy is that if we’re able to diagnose these lung nodules and perform mediastinal staging in a single procedure that would potentially allow patients to not have repeated procedures with risks of further complications or delaying their care,” Styrvoky told Healio. “The current bronchoscopic techniques for doing biopsy of lung lesions is limited. There have been recent advances in the field trying to improve that diagnostic yield.”
Shape-sensing robotic-assisted bronchoscopy is a newer technology that features a maneuverable catheter that allows for more precise navigation and with direct visualization while navigating the airways. It enables active robotic control of the catheter during navigation and the biopsy process, according to Styrvoky. Combined with real-time cone-beam CT imaging, this allows the physician to confirm if the catheter and lesion are in good positioning, she said.
“These two technologies combined are hopefully leading to an improved diagnostic yield,” Styrvoky said.
Results of the first 200 procedures to sample 209 lesions in 198 patients were as follows:
- lesions ranged from 7 mm to 73 mm and the mean largest lesion diameter was 22.6 mm;
- overall prevalence of malignancy was 64.1%, the majority being lung cancer but also including metastatic disease from other primaries;
- rate of non-diagnostic sampling was 11% (23 of 209 samples);
- diagnostic accuracy was 91.4%;
- sensitivity was 87.3% and specificity was 98.7%; and
- negative predictive value was 81.3% and positive predictive value was 99.2%.
Of note, “we didn’t look at just nodules; we biopsied solid lesions, ground glass lesions, infiltrates, mass-like opacities — anything that really needed targeted sampling we included in this study, which is similar to what people in real practice would do, not limiting to a certain population,” Styrvoky said.
The procedure yielded low risk for complications. Only two patients had pneumothorax and there were no major bleeding events, according to the results.
“In addition to lung cancer, this technology also has the potential to be used in nonmalignant processes,” Styrvoky said. “Ultimately, I think this technology can be used as a safe way to get targeted sampling in the lungs.”
The researchers plan to continue to prospectively evaluate shape-sensing robotic-assisted bronchoscopy with cone-beam CT to evaluate outcomes, factors that improve diagnostic accuracy, reduce radiation exposure and ultimately fine-tune the procedure to make it as efficient and safe for patients as possible, according to Styrvoky.
This study is being presented in the Novel aids in the diagnosis of lung cancer: Rules and robots session on Monday, Oct. 17, at 1:30 p.m.