Accuracy of Pulmonary Nodule Sampling Using Robotic Assisted Bronchoscopy with Shape Sensing, Fluoroscopy, and Radial Endobronchial Ultrasound (The ACCURACY Study)

Abstract

<b><i>Background:</i></b> Despite recent advances in guided bronchoscopy, the yield of bronchoscopic biopsy of a peripheral pulmonary nodule (PPN) remains highly variable. <b><i>Objective:</i></b> The aim of the study was to evaluate which features of robotic assisted bronchoscopy (RAB) contribute to a successful biopsy in a cadaver model. <b><i>Methods:</i></b> A preclinical, prospective, single-blinded trial using a ventilated human cadaveric model assessed the successful puncture of implanted pulmonary nodules using various localization techniques with RAB. The different approaches included positioning the robotic catheter at predefined distances from the target nodule (<10 mm, 10–20 mm, 20–30 mm), bronchoscopist correction of divergence between the software virtual map and bronchoscopic view if observed, and impact of fluoroscopy and radial endobronchial ultrasound (rEBUS). The primary endpoint was a central target hit (defined as an inner 2/3 target puncture) verified by cone-beam computed tomography. <b><i>Results:</i></b> Thirty-eight RAB procedures were performed to target 16 PPNs. Median nodule size was 16.2 mm. All targets were located in the outer 1/3 of the lung with a bronchus sign in 31.3%. Central target hit rates were improved when the robotic catheter tip was closer to the nodule (<10 mm 68%, 10–20 mm 66%, 20–30 mm 11%, <i>p</i> < 0.001). Multivariable analysis confirmed the strongest predictor of a central target hit was robotic catheter distance to nodule (OR 0.89 per increase in 1 mm, <i>p</i> < 0.001), independent of the presence of a bronchus sign, divergence or concentric rEBUS view. <b><i>Conclusions:</i></b> Utilizing a RAB platform, closer proximity of the robotic catheter to the target nodule results in an increase in peripheral nodule biopsy success.

Advances in the Treatment of Pulmonary Nodules

“…The system is equipped with highresolution cameras and video scopes that provide clear images of the lung nodules, allowing the physician to visualize the location and size of the tumor with greater clarity. The system can also use real-time tracking to adjust the trajectory of the robotic arm to ensure that the bronchoscope stays on course, even when the patient breathes or moves [55][56][57][58].…”

Robotic Bronchoscopy: Review of Three Systems

“…Navigation pathway generation software with the Ion™ system has been shown to be superior to EMN in both the distance from the terminal end of the navigation pathway to target lesions (9.4 mm for robotic bronchoscopy vs. 14.2 mm for tip-tracked electromagnetic navigation vs. 17.2 mm for catheter-based electromagnetic navigation) and the generation of complete distal airway maps [ 42 ]. With RB, proximity to the target lesion has been shown to be the strongest predictor of a central hit on the lesion, independent of the presence of a bronchus sign, divergence, or concentric rEBUS view [ 43 ].…”

3D–2D image registration in the presence of soft-tissue deformation in image-guided transbronchial interventions

“…While the rate of pneumothorax with bronchoscopic biopsy is relatively low (6% (Herout et al 2019) compared to 26% for transthoracic (Zeng et al 2021)), a major challenge in peripheral bronchoscopy is the high rate of geometric miss, leading to wide variability in diagnostic yield (5-75% (Herth et al 2002)). The challenge arises primarily from lung deformation between the pre-operative 3D CT in which the target is defined and intraoperative 2D fluoroscopy, referred to as 'CT-to-body divergence' , Thiboutot and Christopher 2021, Thiboutot et al 2022.…”