Abstract
Background: The capability of bronchoscopy in the diagnosis of peripheral pulmonary nodules (PPNs) remains limited. Despite decades of effort, evidence suggests that the diagnostic accuracy for electromagnetic navigational bronchoscopy (EMN) and radial endobronchial ultrasound (EBUS) approach only 50%. New developments in robotic bronchoscopy (RB) may offer improvements in the assessment of PPNs. Methods: A prospective single-blinded randomized controlled comparative study to assess success in localization and puncture of PPNs, using an ultrathin bronchoscope with radial EBUS (UTB-rEBUS) vs EMN vs RB in a human cadaver model of PPNs < 2 cm, was performed. The primary end point was the ability to successfully localize and puncture the target nodule, verified by cone-beam CT comparing RB and EMN. Secondary end points included needle to target position “miss” distance, and UTB-rEBUS comparisons. Results: Sixty procedures were performed to target 20 PPNs over the study period. Implanted PPNs were distributed across all lobes, with 80% located within the lung periphery. The target PPN mean diameter was 16.5 ± 1.5 mm, with 50% noted to have a CT bronchus sign. The rate of successful PPN localization and puncture was superior when using RB, compared with EMN (80% vs 45%; P =.02). Among unsuccessful needle passes, the median needle to target “miss” distance was significantly different when comparing UTB-rEBUS, EMN, and RB (P =.0014). Conclusions: In a cadaver model, use of RB significantly increased the ability to localize and successfully puncture small PPNs when compared with existing technologies. This study demonstrates the potential of RB to precisely reach, localize, and puncture small nodules in the periphery of the lung.
Original language | English (US) |
---|---|
Pages (from-to) | 694-701 |
Number of pages | 8 |
Journal | CHEST |
Volume | 157 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2020 |
Funding
FUNDING/SUPPORT: This study was funded by the Association of Interventional Pulmonary Program Directors.Author contributions: L. Y. takes responsibility for the content of the manuscript, including the data and analysis. L. Y. and A. V. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. L. Y. J. A. M. W. A. C. J. P. S. S. L. S. D. Y. F. M. J. C.-G. D. M. H. L. and A. V. contributed substantially to the study design, data analysis and interpretation, and writing of the manuscript. Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: L. Y. has received research, educational grants, and consulting fees from Olympus, superDimension, Veran Medical, Inspire Medical Consulting, Boston Scientific. M. W. has received research, educational grants, and consulting fees from Olympus, superDimension. H. L. has received research, educational grants, and consulting fees from Veran Medical, Olympus, Inspire Medical Consulting, Veracyte, and superDimension. A. C. has received research, educational grants, and consulting fees from Olympus, Auris, Boston Scientific, and Johnson & Johnson. D. M.has received research, educational grants, and consulting fees from Intuitive Surgical. J. A. has received research, educational grants, and consulting fees from Intuitive, Veran Medical, superDimension, and Boston Scientific. A. V. has received research, educational grants, and consulting fees from Veracyte and Johnson & Johnson. None declared (J. P. S. S. L. S. D. Y.), Interventional Pulmonary Outcomes Group (IPOG) Collaborators: Johns Hopkins University, University of North Carolina, Duke University, Washington University in St Louis, University of Pennsylvania, Stanford University, University of Michigan, Sloan-Kettering Memorial Cancer Center and Vanderbilt University. Other contributions: The IPOG investigators of the PRECISION-1 trial wish to acknowledge the Association of Interventional Pulmonary Program Directors for providing research funding to support this project; Intuitive Surgical for providing the Ion system and cadaveric facility; and Ben Cohn, Ruchi Bhatt, Hiba Lejmi, Sundeep Master, Oliver Wagner, MD, and the Intuitive Clinical Development Engineering team and the Johns Hopkins Interventional Pulmonary Research Core for providing equipment and support.
Keywords
- interventional bronchoscopy
- lung cancer
- lung nodule
- navigational bronchoscopy
- robotic bronchoscopy
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine