2000 Peripheral Pulmonary Lesions Sampled by Shape-Sensing Robotic-Assisted Bronchoscopy and Mobile Cone-Beam Computed Tomography: The Mayo Clinic Experience.

Abstract

To assess the 5-year experience using shape-sensing robotic-assisted bronchoscopy (ssRAB) in three academic centers following the strict diagnostic yield (DY) consensus, including concurrent mediastinal staging with endobronchial ultrasound transbronchial needle aspiration. A multicenter study on consecutive patients who underwent ssRAB for evaluation of suspicious peripheral pulmonary lesions from July 2019 to August 2024 across the three Mayo Clinic sites. The primary outcome included DY and the analysis of variables associated with it based on the strict definition of DY. Secondary outcomes were intermediate DY, safety, and the potential impact on the streamlining of care for patients with suspicious lung lesions. A total of 2115 peripheral pulmonary lesions were biopsied using ssRAB from 1904 patients. Strict DY was 76.9% and intermediate DY was 80.2%. Sensitivity for malignancy was 85.0% and staging with endobronchial ultrasound transbronchial needle aspiration was concurrently performed in 74% of patients. The 1.1-mm cryoprobe (odds ratio [OR], 1.88; 95% CI, 1.42 to 2.49; P<.001), solid density on computed tomography (OR, 1.42; 95% CI, 1.06 to 1.89; P=.02), maximum diameter (OR, 1.77; 95% CI, 1.43 to 2.19; P<.001), and body mass index (OR, 0.95; 95% CI, 0.95 to 0.98; P<.001), were significant predictors of DY. The rate of adverse events requiring intervention was 2.8%. Early lung cancer detection increased from 46% in 2019 to 69% in 2024, whereas local/advanced diagnosis decreased from 54% to 31% in 2024. In a high-volume multicenter setting, ssRAB showed a consistently high diagnostic performance, particularly for detecting malignancy, and has improved early lung cancer diagnosis with a low complication rate.