CT Scan-Guided Biopsy vs Shape-Sensing Robotic-Assisted Bronchoscopy

This is the authors' abstract. We don't add key points for this paper.

Background Next-generation sequencing and polymerase chain reaction–based molecular testing are central to the management of non–small cell lung cancer. CT-guided lung biopsy (CTBx) is commonly used, but shape-sensing robotic-assisted bronchoscopy (ssRAB) may offer the additional benefits of mediastinal staging and sampling of multiple lesions during a single procedure. Comparative data on molecular testing yield between these approaches remain limited. Research Question Does ssRAB provide tissue adequacy for molecular profiling comparable to CT-guided lung biopsy in patients with NSCLC while maintaining a favorable safety profile? Study Design and Methods All NSCLC patients who underwent ssRAB or CTBx between 2020 and 2023 for diagnosis and molecular profiling were included. The primary outcome was yield for molecular analysis. Secondary outcomes included percent tissue cellularity and procedure complications. Results 308 patients had ssRAB (130, 42%) or CTbx (178, 58%). No differences were found in baseline patient characteristics, mean nodule size (3.3cm ± 1.8 vs 3.1 ± 2.0cm, p=0.517), adequacy for NGS (130 nodules (91.5%) vs. 165 nodules (92.2%), p=0.999) or mean percent tissue cellularity of the samples (36.9 ± 21.9 vs 37.6 ± 21.4, p=0.778), respectively. ssRAB group waited less time for surgery (27.3 ± 37 days vs. 56 ± 45 days, p=0.009). Both groups had similar surgical resection rate(31.5% for ssRAB vs. 32.0% for CTbx, p=0.985). In ssRAB, 18 (13.8%) patients had >1 nodule biopsied compared to 1 patient in CTbx (p < 0.001). 63.1% of ssRAB had concomitant mediastinal staging whereas 20.2% of CTbx patients had subsequent staging (p < 0.001). There were no complications with ssRAB, and 4 pneumothoraces required chest tube placement in the CTbx group (p = 0.224). Interpretation ssRAB may provide a diagnostic yield for biomarker identification comparable to CT-guided biopsy and may allow for concomitant mediastinal staging and biopsy of synchronous pulmonary nodules, with a favorable safety profile.