Comparative evaluation of guided shape-sensing robotic bronchoscopy vs. electromagnetic navigation with cone-beam computed tomography for pulmonary nodule diagnosis
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Abstract
BACKGROUND: Advances in bronchoscopic techniques have significantly improved the diagnosis of pulmonary nodules, with navigational bronchoscopy systems like electromagnetic navigation bronchoscopy (ENB) and shape-sensing robotic-assisted bronchoscopy (ssRAB) offering enhanced precision and safety. Cone-beam computed tomography (CBCT) has further advanced these systems by providing real-time imaging to both improve diagnostic yield and minimize complications associated with traditional methods.
OBJECTIVE: This study compares the diagnostic yield and navigational success of ENB combined with CBCT (ENB-CBCT) and ssRAB combined with CBCT (ssRAB-CBCT) for the diagnosis of peripheral pulmonary nodules. We aim to evaluate the impact of these technologies on diagnostic accuracy, procedural efficiency, and patient outcomes.
METHODS: A retrospective cohort study was conducted involving 185 patients undergoing bronchoscopy for the evaluation of pulmonary nodules. The primary outcome was the diagnostic yield, defined as the successful identification of malignancy or benign pathology confirmed either at the time of bronchoscopy or via 12-month follow-up. The secondary outcome was navigational success, defined as the ability to position the biopsy tool within the lesion. Comparisons were made between the ENB-CBCT and ssRAB-CBCT groups in terms of diagnostic yield, procedural time, and complications, including pneumothorax.
RESULTS: The ssRAB-CBCT group demonstrated a notably higher diagnostic yield (77%-94%) than the ENB-CBCT group (65%-75%), with a 23.2% overall improvement in diagnostic yield for ssRAB-CBCT. The ssRAB-CBCT group also exhibited greater navigational success, achieving 83% tool-in-lesion accuracy compared to 70.1% in the ENB-CBCT group. While the ssRAB-CBCT group required more CBCT spins, this was attributed to its catheter design and additional biopsies of multiple nodules. The odds of achieving a better diagnostic yield with ssRAB-CBCT were 4.72 times higher (95% CI: 2.05–10.85, P<0.001).
CONCLUSION: This study demonstrates that ssRAB-CBCT significantly improves diagnostic yield and navigational success over ENB-CBCT in the biopsy of peripheral pulmonary nodules. The use of real-time CBCT imaging enhances both the precision of biopsy tool placement and the accuracy of diagnosis. Given these findings, ssRAB-CBCT may offer a superior approach to diagnosing pulmonary nodules, reducing the need for repeat procedures, and potentially improving patient outcomes. Further multicenter studies are needed to validate these results and establish ssRAB-CBCT as a standard practice in clinical settings.
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2025