Robotic-assisted bronchoscopy for histopathologic subtyping of primary lung adenocarcinoma

The identification of high-grade patterns and mucinous features of invasive primary lung adenocarcinoma on biopsy specimens can have implications on therapeutic decisions across all stages of disease. Shape sensing robotic-assisted bronchoscopy (ssRAB) is an emerging modality for the concomitant diagnosis and staging of lung cancer. We evaluated the performance of ssRAB for adenocarcinoma pattern identification, and particularly high-grade patterns, as well as the histopathologic concordance between biopsy and surgical resection specimens.

Patients with lung adenocarcinoma diagnosed via ssRAB forceps or cryobiopsy specimens between October 2019 and December 2023 were included in the analysis. Biopsy specimens were evaluated for the identification of histopathologic patterns and mucinous features. A generalized linear mixed model quantified the association between pre- and intra-operative factors and successful pattern identification on biopsy. The concordance between high-grade patterns and mucinous features on ssRAB-acquired biopsy and poorly differentiated grade and mucinous features on subsequent surgical resection was determined.

A total of 242 ssRAB-acquired specimens were included in the final analysis. The biopsy specimen was sufficient to identify adenocarcinoma histopathologic patterns in 71 %. In a multivariable analysis, sampling by cryobiopsy was positively associated with pattern identification (OR 3.54, CI: 1.02-12.30; P = 0.04), as compared with forceps biopsy. A corresponding surgical resection specimen was available in 66 cases. The sensitivity, specificity, positive, and negative predictive values of biopsy were 63, 72, 61, and 74 %, respectively for the presurgical detection of poorly differentiated adenocarcinoma, and 87, 100, 100, and 96 %, respectively for the presurgical detection of mucinous features.

This study is the first to report the performance of ssRAB-acquired biopsy for identification of adenocarcinoma patterns and its concordance with surgical resection. Our findings align with those previously reported for percutaneous lung biopsy. ssRAB emerges as a viable tool for the identification of adenocarcinoma patterns. Future studies are needed to confirm these findings in larger patient cohorts.