Robotic Bronchoscopy for Peripheral Pulmonary Lesion Biopsy: Evidence-Based Review of the Two Platforms.

Abhishek Kumar,Jose D Caceres,Nikhil K Meena,Gurshan Sandhu,Siddharthan Vaithilingam

doi:10.3390/diagnostics11081479

Abstract

Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. “CT-to-body divergence” has been identified as a major limitation of this modality. In-tandem use of the ultrathin bronchoscope and radial endobronchial ultrasound probe has yielded only comparable results, attributable to the limited peripheral reach, device maneuverability, stability, and distractors like atelectasis. As such, experts have identified three key steps in peripheral nodule sampling—navigation (to the lesion), confirmation (of the correct location), and acquisition (tissue sampling by tools). Robotic bronchoscopy (RB) is a novel innovation that aspires to improve upon these aspects and consequently, achieve a better diagnostic yield. Through this publication, we aim to review the technical aspects, safety, feasibility, and early efficacy data for this new diagnostic modality.

Highlights

Lung cancer ranks third in the number of newly diagnosed cancers each year, only to the breast and prostate cancers, but causes the highest number of cancer-related deaths annually in the United States [1]
Lesions located centrally within or adjacent to the airways are amenable to sampling using conventional flexible or convex endobronchial ultrasound bronchoscopy. Despite many advancements such as the thin/ultrathin bronchoscopes, radial endobronchial ultrasound, and electromagnetic navigation (EMN) systems, the diagnostic sensitivity of the bronchoscopic modalities remains significantly lower than CT-guided transthoracic needle biopsy for peripheral pulmonary nodules (~70% vs. 90%, respectively) [4,5]
Robotic bronchoscopy (RB) performed significantly better in nodule localization (100% vs. 85% and 65% for EMN and UTB-radial endobronchial ultrasound (rEBUS), respectively) as well as needle puncture (80% vs. 45% and 25% for EMN and UTB-rEBUS, respectively)

Summary

Introduction

Lung cancer ranks third in the number of newly diagnosed cancers each year, only to the breast and prostate cancers, but causes the highest number of cancer-related deaths annually in the United States [1]. Despite many advancements such as the thin/ultrathin bronchoscopes, radial endobronchial ultrasound (rEBUS), and electromagnetic navigation (EMN) systems, the diagnostic sensitivity of the bronchoscopic modalities remains significantly lower than CT-guided transthoracic needle biopsy for peripheral pulmonary nodules (~70% vs 90%, respectively) [4,5]. That said, this advantage comes with a significantly higher risk of pneumothorax (roughly, 20% with transthoracic needle biopsy vs 3% with bronchoscopy) [6,7,8,9]. Robotic bronchoscopy (RB) is a novel technology that aims to improve the diagnostic sensitivity of peripheral pulmonary nodule biopsies with fewer procedural complications

Objectives

Methods

Findings

Conclusion