20. Value of Robotic Navigational Bronchoscopy to Enhance Diagnostic Yield and Guide Oncological Strategy in Treatment of Pulmonary Nodules
University Hospitals Cleveland Medical Center
Cleveland, OH
United States - Contact Me
Dr. Linden attended the University of Pennsylvania School of Medicine and trained in general surgery and cardiothroacic surgery at Brigham and Women's Hospital and Harvard Medical School. He was a staff surgeon at Brigham and Women's Hospital and Harvard Medical School before starting the Division of Thoracic and Esophageal Surgery at University Hospitals of Cleveland. He is currently Chief of Thoracic Surgery at University Hospitals Cleveland Medical Center and Professor of Surgery at The Case Western Reserve University School of Medicine. He started the cardiothoracic fellowship at Case Western Reserve University and is currently the Program Director. He is the Surgical Director of the Seidman Comprehensive Cancer Center of Cleveland.
Cedars-Sinai Medical Center
Los Angeles, CA
United States - Contact Me
Dr. Brownlee completed his Cardiothoracic Fellowship at the University of Chicago. He is an an associate professor of surgery at Cedars-Sinai Medical Center and Medical Director of Thoracic Surgery at Providence Cedars-Sinai Tarzana Medical Center. He is the associate program director of the cardiothoracic surgery residency at Cedars. His clinical interests include thoracic surgical oncology, specifically minimally invasive lung, esophageal and mediastinal surgery as well as endobronchial approaches to diagnosis and staging of thoracic malignancies. He is board certified in general and thoracic surgery. His research focuses are in clinical outcomes with a focus on emerging technologies. and the integration of technology into surgical education. He has a grant from the National Science Foundation and in conjunction with the Booth School of Business is investigating the use of app-based technology to help residents prepare for surgical procedures.
Abstract
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.