Diagnostic patterns after adoption of shape-sensing robotic-assisted bronchoscopy: a retrospective cohort study

Lung cancer is the leading cause of cancer-related deaths, due in part to the high proportion of late-stage diagnoses. Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a novel bronchoscopic platform that enhances access to peripheral pulmonary lesions. However, its impact on diagnostic stage and procedural outcomes in clinical practice is not well established in the literature. This analysis assesses the impact of a new ssRAB program on these outcomes at a single site within an academic health system.

A retrospective chart review of patients who underwent an ssRAB biopsy following an abnormal lung imaging study at a single center in the United States from September 2020 to December 2023. The primary outcome was diagnostic stage. Secondary outcomes included histopathological findings, nodule size, sensitivity, and intraoperative complications. Statistical analyses included descriptive statistics and logistic regression to evaluate diagnostic trends over time.

A total of 399 patients underwent ssRAB, with 397 (99.5%) receiving a tissue biopsy during this period. Diagnostic yield was 94.0% (n = 373). Median nodule size was 16 mm (IQR: 12-28 mm). Over the study period, the odds of an early stage diagnosis increased by 5.2% each quarter(P = 0.0485), a trend towards a decrease in nodule size (0.8 mm, P = 0.09) and two pneumothorax events (0.5%).

Implementation of an ssRAB platform was associated with an increased rate in early stage cancer diagnoses. These findings may suggest that integrating advanced bronchoscopic technologies into lung nodule evaluation pathways, including screening programs and expedited pulmonology referrals for incidental nodule findings, may enhance early diagnosis and improve clinical outcomes.