Diagnostic effectiveness and safety of robotic-assisted bronchoscopy for subsolid pulmonary nodules: A multicenter prospective observational study.

Abstract

To analyze the effectiveness and safety of robotic-assisted bronchoscopy (RAB) for subsolid nodules, including semisolid nodules (SSNs) and ground-glass nodules (GGNs). This is a subset analysis of a multicenter, prospective observational study that investigated patients with subsolid nodules undergoing RAB. Effectiveness was defined by reach, measured by radial endobronchial ultrasound (rEBUS) confirmation and median distance from bronchoscope tip to the lesion prior to biopsy, and access, measured by sensitivity for malignancy and diagnostic yield (DY). Adverse events were recorded to assess safety. Of 679 patients analyzed, 91 (13.4%) had subsolid nodules, including 78 with SSNs and 13 with pure GGNs. The median subsolid nodule size was 18.5 mm, 61.5% were in the upper lobes, and 89.0% were in the outer two-thirds of the lung. The malignancy rate was 45.1%, predominantly adenocarcinoma. rEBUS localization rates were 81.4% for SSNs and 61.5% for GGNs, with median distance from the bronchoscope tip of 22.0 mm and 19.5 mm, respectively. Sensitivity for malignancy was 77.8% for SSNs and 75.0% for GGNs, while the strict DY was 50.0% and 61.5%, respectively. Nondiagnostic results occurred in 31 subsolid nodules (34.1%) at the index biopsy. The incidence of pneumothorax was 4.4% and that of pneumothorax necessitating a chest tube was 2.2% in the subsolid nodule cohort. No bleeding, respiratory complications, or mortalities were reported in the subsolid nodule cohort during the 7-day follow-up period. Our findings confirm that RAB is safe and effective for diagnosing subsolid nodules.