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  • Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions

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Lung cancer
Original research
Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions
  1. Sebastian Fernandez-Bussy1,
  2. Alejandra Yu Lee-Mateus1,
  3. Alanna Barrios-Ruiz1,
  4. Sofia Valdes-Camacho1,
  5. Katherine Lin2,
  6. Mohamed I Ibrahim1,
  7. Bryan F Vaca-Cartagena1,
  8. Rodrigo Funes-Ferrada1,
  9. Janani Reisenauer3,
  10. Kelly S Robertson1,
  11. Britney N Hazelett1,
  12. Ryan M Chadha4,
  13. David Abia-Trujillo1
  1. 1 Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
  2. 2 Department of General Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
  3. 3 Division of Thoracic Surgery, Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  4. 4 Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, Florida, USA
  1. Correspondence to Dr Sebastian Fernandez-Bussy; fernandez-bussy.sebastian{at}mayo.edu

Abstract

Background Sampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy (ssRAB) provides an alternative diagnostic procedure for this subtype of lesions.

Methods A retrospective study on PPL attached to the peripheral pleura (PP), comprising costal and diaphragmatic pleura, mediastinal pleura (MP), and fissural pleura (FP) sampled by ssRAB, from January 2020 to December 2023. Clinicodemographic data, PPL characteristics and procedure-related details were recorded. Primary outcome was diagnostic yield, defined as all conclusive diagnoses, malignant or benign, over the total number of procedures. Secondary outcomes were safety profile, defined as the number of procedure-related complications, and diagnostic yield with the use of mobile cone-beam CT (mCBCT) and by biopsy tool.

Results 182 nodules were sampled from 178 patients. PPLs were grouped as: PP (n=95), MP (n=30) and FP (n=57). Overall diagnostic yield was 80.2% (146/182) and sensitivity for malignancy was 83.2% (104/125). Diagnostic yield was associated with upper location (OR 2.86; 95% CI 1.35 to 6.03, p=0.006), mCBCT (OR 2.27; 95% CI 1.06 to 4.86, p=0.036) and cryobiopsy (OR 2.90; 95% CI 1.31 to 6.47, p=0.009). Pneumothorax requiring chest tube was reported in five patients (2.8%), and a Nashville Scale grade 3 bleeding occurred in one patient (0.6%).

Conclusion For pleural-based and fissure-based nodules, ssRAB showed a high diagnostic yield with low complications. The addition of mCBCT and cryobiopsy improved the diagnostic performance for this subtype of lesions.

  • Bronchoscopy
  • Lung Cancer
  • Pleural Disease

Data availability statement

Data are available on reasonable request. Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author (SF-B), on reasonable request.

https://doi.org/10.1136/thorax-2024-222502

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    Data availability statement

    Data are available on reasonable request. Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author (SF-B), on reasonable request.

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    Footnotes

    • X @abia_david

    • Contributors SF-B was the guarantor of this article. SF-B, JR and DA-T were responsible for study conception design and development of the study protocol. AYL-M, KL and BFV-C were responsible for data collection, analysis and interpretation. AYL-M, AB-R and SV-C were involved manuscript writing. All authors (SF-B, AYL-M, AB-R, SCV, KL, MII, BFV-C, RF-F, KSR, BNH, RMC and DA-T) were involved in revision and final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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