THE COMBINATION OF SHAPE SENSING ROBOTIC BRONCHOSCOPY WITH MOBILE 3D IMAGING TO VERIFY TOOL-IN-LESION AND ASSESS DIVERGENCE

Abstract

TOPIC: Procedures TYPE: Late Breaking PURPOSE: With recent advances in robotic bronchoscopy for peripheral pulmonary nodule sampling, there has been notable improvements in reach, stability, and precision. However, barriers such as CT to body divergence and sampling error remain. Traditional cone beam systems have been shown to overcome these hurdles, however, this imaging modality is expensive and can have limited availability. The combination of shape-sensing robotic bronchoscopy (SSRAB) and mobile C-arm with CT capabilities could not only enhance the confidence of the pathology results with confirmation of tool-in-lesion for peripheral pulmonary nodules but may also overcome diaphragmatic motion through real-time 3D image feedback to make precise micro-adjustments and optimize outcomes in a transportable fashion. METHODS: A single-center prospective study was conducted to evaluate the combined use of SSRAB with portable cone beam computed tomography to visualize tool-in-lesion as a correlate to diagnostic yield (NCT# 04740047). Fluoroscopy and radiation data were captured. Additionally, data regarding nodule motion during navigation and breath holds were captured to quantify nodule motion and divergence. RESULTS: Twenty-two lesions were captured in 12 males (54.5%) and 10 females (45.5%). The median lesion size was 15 mm (range 10 – 27 mm) with the median airway generation being 7 (range 5-11) and median distance from pleura of 13 mm (range 1 - 45.8 mm). Most lesions were in the left upper lobe (8, 34.8%). Tool-in-lesion was visualized at the time of the procedure in 21 lesions (95.5%). Based on immediate histopathologic review, 14 (63.63%) nodules were malignant and 6 (27.3%) were benign. Two specimens were suggestive of inflammation and are awaiting follow up imaging. Mean number of spins was 2.6 (± 1.8 spins) with a mean fluoroscopy time of 9.1 minutes (± 6.6 minutes) and a mean Dose Area Product of 51.1 Gy*cm2 (± 33.9 Gy*cm2). There were no episodes of bleeding or pneumothorax. Observed CT-body divergence was overcome using the combination of both technologies as evidenced by the tool-in-lesion rate and will be quantified when the entire dataset is available. CONCLUSIONS: The combination of SSRAB and mobile 3D imaging allows for adequate visualization of tool in lesion without the need for a fixed cone beam CT and may improve diagnostic yield. CLINICAL IMPLICATIONS: Shape-sensing robotic technology combined with mobile CT imaging allows for accurate placement of the biopsy tool in the lesion. This combination may enhance diagnostic ability for sampling of peripheral pulmonary nodules and translate well in the applications of therapeutics in the future. Mobile 3D imaging allows for flexibility and maneuverability without the need for an expensive fixed cone beam CT room with adequate image quality. DISCLOSURES: No relevant relationships by Jennifer Duke, source=Web Response No relevant relationships by Eric Edell, source=Web Response No relevant relationships by Sebastian Fernandez-Bussy, source=Web Response No relevant relationships by Ryan Kern, source=Web Response Research grant relationship with Intuitive Surgical Please note: $5001 - $20000 by Janani Reisenauer, source=Web Response, value=Grant/Research Support