Robotic versus cone-beam computed tomography navigation bronchoscopy: propensity-matched analysis of diagnostic yield.

OBJECTIVE

Small peripheral pulmonary lesions are nowadays preferably diagnosed by navigation bronchoscopy, yet reported diagnostic yields vary across different techniques. Shape-sensing robotic-assisted bronchoscopy (ssRAB), now also available in Europe, combines real-time shape sensing with an actively steerable catheter, potentially improving diagnostic yield. We aimed to compare ssRAB combined with cone-beam computed tomography (CBCT) imaging (ssRAB+CBCT) against our current standard, CBCT-based navigation bronchoscopy (CBCT-NB) alone.

METHODS

We conducted a single-centre, propensity score-matched analysis comparing patients undergoing ssRAB+CBCT with patients undergoing CBCT-NB for the diagnosis of small peripheral pulmonary lesions. Matching was performed on known lesion characteristics influencing yield. Primary outcome was strict diagnostic yield. Secondary outcomes included diagnostic accuracy at follow-up, safety and procedure-related metrics.

RESULTS

A total of 131 patients with 183 biopsied lesions were included in the ssRAB+CBCT arm. Median lesion size was 12 mm (interquartile range 8-18 mm). Propensity score matching with lesions from our reference CBCT-NB cohort was successful in 150 out of 183 lesions. The diagnostic yield at the lesion level was 73% for the ssRAB+CBCT arm and 70% for the CBCT-NB arm; the mean difference of 3.3% (95% CI -6.9-13.5%) was not statistically significant (p=0.521). The diagnostic yield at the patient level for the ssRAB+CBCT arm was 82%.

CONCLUSION

ssRAB+CBCT has a diagnostic yield similar to that of our highly optimised CBCT-NB programme, and was below the study's powering assumption of a 15% increase in diagnostic yield. There was a suggestion of benefit in small nodules with a negative bronchus sign. The unique features of ssRAB mean that it holds promise, but larger studies are warranted to clarify its position and optimal case selection, compared with other navigation bronchoscopy technologies, its clinical impact and its cost-effectiveness.