Virtual vs. reality in cone-beam CT-guided robotic-assisted bronchoscopy

Area of Science:

• Pulmonology
• Medical Imaging
• Robotic Surgery

Background:

• Shape-sensing robotic bronchoscopy (ssRAB) diagnostic accuracy is affected by computed tomography-to-body divergence (CTBD).
• CTBD, the discrepancy between virtual and actual lesion locations, is understudied regarding its prevalence, types, implications, and determinants during ssRAB.
• This study aimed to quantify CTBD during cone-beam computed tomography (CBCT)-guided ssRAB and identify contributing factors.

Purpose of the Study:

• To quantify computed tomography-to-body divergence (CTBD) during cone-beam computed tomography (CBCT)-guided shape-sensing robotic bronchoscopy (ssRAB).
• To identify factors contributing to CTBD during ssRAB procedures.
• To assess the impact of CTBD on the diagnostic yield of lung lesion sampling.

Main Methods:

• Analysis of a prospectively curated database of patients undergoing mobile CBCT-guided ssRAB for lung lesion sampling.
• Primary outcome measurement: distance and vector of target displacement between preoperative CT and intraoperative CBCT.
• Multivariable logistic regression analysis to identify independent predictors of target lesion displacement.

Main Results:

• Displacement (CTBD) occurred in 67% of 81 targeted lesions across 70 participants.
• In 78% of displacement cases, the ssRAB catheter was closer than expected (forward displacement), with 46% overshooting the lesion.
• Traversing ≥7 airway generations was independently associated with target lesion displacement; diagnostic yield was not significantly different between cases with and without displacement.

Conclusions:

• Computed tomography-to-body divergence (CTBD) is a common occurrence during navigational bronchoscopy, particularly for peripheral lung lesions.
• Bronchoscopists must anticipate lesion displacement and utilize intraoperative imaging to mitigate potential impacts on sampling and complications.
• Despite frequent displacement, the diagnostic yield of ssRAB remained unaffected in this study.