Comparison of navigation bronchoscopy vs shape sensing robotic assisted bronchoscopy in terms of malignancy diagnoses and lung cancer staging in a safety-net healthcare system.

Abstract

e23156 Background: Two bronchoscopic techniques, electromagnetic navigation bronchoscopy (NB) and shape sensing robotic assisted bronchoscopy (ssRAB), have been used for diagnostic evaluation of peripheral pulmonary nodules. We compared the number of procedures required for a final malignant diagnosis and staging outcomes for lung cancer. There is limited literature comparing these procedures, none from a safety-net setting performed by a single interventional pulmonologist (IP). Methods: We conducted this study at John Peter Smith Healthcare Network (JPS) using prospectively collected data from ssRAB data maintained by the Interventional Pulmonary team from September 2023 to August 2024 and data from NB procedures using Epic EHR chart review from December 2020 to June 2023. NB procedure was decommissioned in June 2023 and ssRAB (Ion platform, Intuitive Surgical Inc) was acquired by JPS in September 2024. North Texas IRB approved the study 2199873-1. Chi-square tests compared categorical variables, with p < 0.05 as significant. Results: Our study included 359 patients (NB = 226; ssRAB = 133). All procedures were performed by a single IP.Median age, race/ethnicity and gender distribution were similar in both procedures. 42% were non-Hispanic White in both NB and ssRAB. We compared the total number of procedures (bronchoscopy, interventional radiology, surgery as indicated) to get diagnostic accuracy of malignancy.120 patients were diagnosed with malignancies when NB (53%) was used vs 65 (49%) using ssRAB.Of those undergoing NB, 60.8% obtained a malignant diagnosis (including adequate molecular testing for accurate treatment planning) after one procedure were diagnosed with a single procedure, 23.3% needed 2 procedures, 13.3% 3 procedures and 3 patients needed 4 procedures. Using ssRAB, 84.6% of patients were diagnosed after one procedure, 12.3% after 2 and 3.1% after 3 procedures. Difference in diagnosing malignancy was significant (p = 0.007).Median nodule size for NB was 2.4cm and ssRAB was 1.7cm, this was highly significant (p < 0.001). Types of malignancies are shown in the Table, they are comparable. Out of total 79 patients with lung adenocarcinoma (LA) and lung squamous (LS) in NB, 23 (29%) were stage 0-1. For ssRAB, 16(41%) out of 39 (LA and LS) were stages 0-1. For stage 4, these were 25(31.6%) for NB vs 10 (25.6%) for ssRAB. Conclusions: Both methods yielded comparable malignancy diagnoses, however, ssRAB required fewer total procedures, even when nodules were smaller, suggesting greater effectiveness. There is a trend in diagnosing common lung cancers at earlier stages using ssRAB, potentially improving survival. Cancer Lung adenocarcinoma Lung squamous Other lung cancers Metastases from other cancers NB (n=120) 54(45%) 25(21.5%) 20(17%) 21(17.5%) ssRAB (n=65) 30(46%) 9(14%) 9(14%) 17(26%)