Diagnostic Utility of Sampling Multiple Synchronous Pulmonary Nodules During Same-Session Robotic-Assisted...

Area of Science:

• Pulmonology
• Thoracic Surgery
• Diagnostic Imaging

Background:

• The clinical benefit of sampling multiple peripheral pulmonary nodules (mPPNs) in a single robotic-assisted bronchoscopy (RAB) procedure remains unclear.
• Assessing mPPNs is crucial for accurate lung cancer diagnosis and management.

Purpose of the Study:

• To evaluate the impact of sampling mPPNs during RAB on patient diagnosis and treatment.
• To identify predictors of clinical benefit from multinodule evaluation during RAB.

Main Methods:

• A single-center analysis of 341 consecutive RAB procedures targeting 503 PPNs.
• Primary outcomes included the proportion of patients benefiting from secondary PPN sampling and predictors of this benefit.

Main Results:

• Sampling mPPNs impacted the final diagnosis in 38% of cases, with 56% of lung cancer patients receiving meaningful information.
• Factors predicting benefit included lack of rapid on-site cytologic evaluation, concentric radial-probe endobronchial ultrasound imaging, and use of multiple biopsy tools.
• Multinodule RABs increased radiation dose and procedure duration but had similar pneumothorax rates compared to single-nodule procedures.

Conclusions:

• Routinely targeting mPPNs during a single RAB session is recommended, irrespective of nodule characteristics.
• These findings underscore the utility of modern bronchoscopy in managing thoracic diseases, particularly lung cancer.