Robotic-Assisted Bronchoscopy With Cone-Beam CT Imaging to Assess Lung Lesions

How accurate is shape-sensing robotic-assisted bronchoscopy with cone-beam CT image-guided sampling, a novel approach to detecting lung cancer?

The use of shape-sensing robotic-assisted bronchoscopy (ssRAB) with cone-beam computed tomography (CBCT) image-guided sampling is a promising new approach for the nonsurgical diagnosis of central, distal-airway, and peripheral pulmonary lesions, according to research presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held October 16 to 19, in Nashville, Tennessee.

Nonsurgical biopsy is currently recommended for individuals with pulmonary nodules with a moderate pretest likelihood of malignancy. Traditionally, such biopsies have been performed with flexible bronchoscopy, which has demonstrated an average diagnostic yield of 36%, and electromagnetic navigational bronchoscopy, which has demonstrated a diagnostic yield of 72% to 76%. Researchers therefore sought to better quantify the diagnostic accuracy of ssRAB with CBCT, a novel approach to sampling distal airway lesions to detect of lung cancer.

The researchers conducted a retrospective analysis at the University of Texas Southwestern Medical Center, Dallas, Texas, between December 2020 and February 2022, of 200 biopsy procedures using ssRAB with CBCT. These procedures involved 209 lesions being sampled in 198 patients. Study outcomes were based on pathologic interpretation of samples obtained during ssRAB, clinical and radiographic follow-up, and/or additional sampling.

The mean largest lesion diameter was 22.6±13.3 mm; the median diameter of the lesions was 19 mm (range, 7 to 73 mm). The prevalence of malignancy reported was 64.1%. The researchers found that the diagnostic accuracy of ssRAB with CBCT was 91.4% (95% CI, 86.7%-94.8%). The sensitivity of the samples was 87.3% (95% CI, 80.5%-92.4%); the specificity was 98.7% (95% CI, 92.8%-99.9%). The negative predictive value and positive predictive value were 81.3% and 99.2%, respectively.

Among patients who underwent ssRAB with CBCT, the only complication was pneumothorax, which was reported in 1.0% of individuals, of whom 0.5% required insertion of a chest tube.

Results of the current study suggest ssRAB with CBCT has a high sensitivity and specificity for malignancy, with a high negative predictive value and favorable safety profile. The researchers said they “plan to continue prospectively evaluating ssRAB with CBCT to further study the diagnostic accuracy, rates of complications, and details of use.” The researchers concluded that the use of ssRAB with CBCT for sampling distal airway lesions may allow patients to “forgo the need for repetitive testing in the future.”


Madsen K, Styrvoky K, Pham, DT, et al. Diagnostic accuracy of robotic-assisted bronchoscopy using shape-sensing technology with cone-beam CT imaging in evaluation of pulmonary lesions: a retrospective review. Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.