Improving Shape-Sensing Robotic-Assisted Bronchoscopy Outcomes with Mobile Cone-Beam Computed Tomography Guidance.

Background: Computed tomography to body divergence (CTBD) is one of the main barriers to bronchoscopic techniques for the diagnosis of peripherally located lung nodules. Cone-beam CT (CBCT) guidance is being rapidly adopted to correct for this phenomenon and to potentially increase diagnostic outcomes. In this trial, we hypothesized that the addition of mobile CBCT (m-CBCT) could improve the rate of tool in lesion (TIL) and the diagnostic yield of shape-sensing robotic-assisted bronchoscopy (SS-RAB).

Methods: This was a prospective, single-arm study, which enrolled patients with peripheral lung nodules of 1-3 cm and compared the rate of TIL and the diagnostic yield of SS-RAB alone and combined with mCBCT.

Results: A total of 67 subjects were enrolled, the median nodule size was 1.7 cm (range, 0.9-3 cm). TIL was achieved in 23 patients (34.3%) with SS-RAB alone, and 66 patients (98.6%) with the addition of mCBCT ( < 0.0001). The diagnostic yield of SS-RAB alone was 29.9% (95% CI, 29.3-42.3%) and it was 86.6% (95% CI, 76-93.7%) with the addition of mCBCT ( < 0.0001). There were no pneumothoraxes or any bronchoscopy-related complications, and the median total dose-area product (DAP) was 50.5 Gy-cm.

Conclusions: The addition of mCBCT guidance to SS-RAB allows bronchoscopists to compensate for CTBD, leading to an increase in TIL and diagnostic yield, with acceptable radiation exposure.