Robotic bronchoscopy shows promise to improve lung biopsies, analysis shows

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Kim Styrvoky

Lung nodule biopsies performed with new robotic bronchoscopy technology may be safer and more effective than those done by traditional methods, a study by researchers at the University of Texas Southwestern (UTSW; Dallas-Fort Worth, USA) suggests.

UTSW was among the first in the country to use robotic-assisted bronchoscopy (RAB) to biopsy pulmonary lesions. Paired with advanced imaging that provides real-time 3D visuals, the technology enables UTSW’s Interventional Pulmonology team to navigate an ultra-thin, ultra-flexible tube with light and camera capabilities into a patient’s lungs to pinpoint and test suspicious abnormalities.

The increased dexterity of the steerable tube makes it possible to safely reach areas in the lungs that could not be accessed through traditional bronchoscopy and other sampling tools.

A retrospective analysis of 200 of those procedures found that shape-sensing, robotic-assisted bronchoscopy (ssRAB), when combined with technologies such as intraprocedural cone beam computed tomography imaging (CBCT) and radial endobronchial ultrasound, offers high diagnostic accuracy, sensitivity, and specificity with an excellent safety profile. The findings were published in Lung.

“The goal of advanced bronchoscopy is to diagnose lung nodules and perform mediastinal staging in a single procedure, while achieving a comparable diagnostic yield to percutaneous biopsy and at the same time, minimising complications,” said Kim Styrvoky, assistant professor of internal medicine in the Division of Pulmonary and Critical Care Medicine at UTSW, and Muhanned Abu-Hijleh, professor of internal medicine in the Division of Pulmonary and Critical Care Medicine.

“The diagnostic yield of current bronchoscopic techniques is limited, and there is about a one-in-four chance of pneumothorax, or collapsed lung, with percutaneous biopsy,” Styrvoky said. “Our study showed that this new technology provided accuracy of 91.4%, on par with traditional biopsy methods, while reducing the risk of pneumothorax complication to 1%.”

Lung cancer remains the leading cause of cancer-related deaths for both men and women in the USA. Each year, between 1.5 million and two million pulmonary nodules are identified through diagnostic imaging. UTSW is using robotic bronchoscopy in cases where traditional biopsies present a higher risk of complications, including patients with lesions deep in the lung, near major blood vessels, or adjacent to a portion of diseased lung.

This was UTSW’s first reported study detailing the usage of ssRAB-CBCT, but other trials focusing on various aspects of robotic bronchoscopy are underway.

If further studies confirm the findings, ssRAB-CBCT has the potential to become the standard of care for targeted lung sampling, Styrvoky and Abu-Hijleh said.


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