Value of Robotic Navigational Bronchoscopy to Enhance Diagnostic Yield and Guide Oncological Strategy in Treatment of Pulmonary Nodules

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Abstract Submission 

Andrew Brownlee (1), Justin Watson (1), Akbarshakh Akhmerov (1), Shruthi Nammalwar (1), Qiudong (Kevin) Chen (1), Amirhossein Mahfoozi (1), Harmik Soukiasian (2)

(1) Cedars-Sinai Medical Center, Los Angeles, CA, (2) Cedars-Sinai Health System, Los Angeles, CA

Andrew Brownlee    -  Contact Me
Cedars-Sinai Medical Center

Justin Watson    -  Contact Me
Cedars-Sinai Medical Center

Akbarshakh Akhmerov    -  Contact Me
Cedars-Sinai Medical Center

Shruthi Nammalwar    -  Contact Me
Cedars-Sinai Medical Center

Qiudong (Kevin) Chen    -  Contact Me
Cedars-Sinai Medical Center

Amirhossein Mahfoozi    -  Contact Me
Cedars-Sinai Medical Center

*Harmik Soukiasian    -  Contact Me
Cedars-Sinai Health System

Andrew Brownlee    -  Contact Me
Cedars-Sinai Medical Center

Objectives:
Robotic navigational bronchoscopy is increasingly used to improve diagnostic yield for pulmonary nodules compared to the 50-60% obtained by standard bronchoscopy, however safety and efficacy data is limited to small series. The aim of this study was to evaluate diagnostic yield and clinical outcomes in a large multi-surgeon single-center cohort.

Methods:
All patients who underwent robotic navigational bronchoscopy and biopsy from September 2020 to October 2022 were identified from a prospective institutional registry. The primary outcome was diagnostic yield, defined as the proportion of samples with diagnostic pathology. Secondary outcomes were defined according to the Society of Thoracic Surgeons General Thoracic Surgery Database quality benchmarks.

Results:
Robotic navigational bronchoscopy was used to biopsy 503 lesions in 415 patients (mean 1,6, range 1-4): median nodule size was 2.1cm, and lesions were upper lobe in 214 (42.5%) patients, peripheral in 258 (51%) and a bronchus sign was present in 121 (24%) patients. Mediastinal staging was performed using endobronchial ultrasound in 158 (38.6%) patients. Mean procedural time for robotic navigational bronchoscopy was 67+/-30 minutes. Overall diagnostic yield was 89.3% (83%, 87% and 93% for nodules ≤1cm, 1.1-2cm and >2cm, respectively). Diagnostic yield increased with greater nodule size (OR 1.03, CI 1.01-1.07, p=0.026) per 0.1cm increment. Molecular analysis sent in 101 patients was sufficient in 90% of cases. Complications occurred in 22 (5%) patients, including 13 (3.1%) pneumothoraces (7 patients requiring a chest drain), and 5 (1.2%) patients had bleeding requiring a bronchial intervention. Subsequent minimally invasive anatomic pulmonary resection was performed in 140 patients (34%). Additionally, 41 patients were consented for possible concomitant surgical resection during the same anesthesia event, 4 were stopped due to an alternative diagnosis.

Conclusions:
This study suggests robotic navigational bronchoscopy has a high diagnostic yield and obtains adequate tissue for the molecular analysis critical for selection of targeted therapies. With careful patient selection robotic navigational bronchoscopy can be combined with surgery to treat lung cancer as a single procedure with low complication rates.

Lung Cancer