Abstract Rationale Lung cancer remains one of the leading causes of cancer-related mortality, but for many patients with non-small cell lung cancer (NSCLC), targeted molecular therapies have been found to significantly improve both patient survival and quality of life. Next-generation sequencing (NGS) allows for the detection of multiple genetic markers which can be utilized to tailor oncogenic therapies. It is unclear which procedure, patient, or radiographic characteristics most influence adequacy of tissue acquisition during robotic bronchoscopy for molecular analysis. Methods Data collection was performed on patients who underwent robotic bronchoscopy for tissue sampling with confirmed diagnoses of NSCLC by initial bronchoscopy. 127 patient cases were reviewed between January 2023 and December 2023. Patient factors, nodule characteristics, procedural details, and pathology data were reviewed with focus on adequacy vs. inadequacy of tissue sampling for molecular testing. Results Of 122 patient cases included, 72 were positive for adenocarcinoma, 33 squamous cell carcinoma, 13 NSCLC-NOS (not otherwise specified), and 4 poorly differentiated-NSCLC. After diagnostic pathology review, 18.9% of samples were adequate, 31.1% were inadequate, and 50% were not tested for NGS. 60.7% of samples were adequate for PDL-1 testing, and 49% were adequate for EGFR testing. In a univariate analysis, location (upper/middle lobe 30.6% vs. lower lobe 66.7%, p 0.05), target lesion size (2cm 58.6% vs. 2cm 18.8%, p 0.05), TNM stage (I/II 20.0% vs. III/IV 61.5%, p 0.05), N stage (N3 100%, N2 75.0%, N1 62.5%, N0 16.7%, p 0.05), use of cryobiopsy (with use 56.5% vs. without use 26.3%, p 0.05), and number of tools used (multiple tools 45.7% vs. single tool 13.3%, p 0.05) were associated with adequacy for NGS testing. Univariate analyses for PD-L1 and EGFR testing showed similar associations of lesion size and location with adequacy. In a multivariate analysis including lesion size and accounting for target lesion location, procedural factors (number of tools utilized and use of cryobiopsy), were no longer associated with adequacy for molecular analysis. Conclusion Robotic bronchoscopy demonstrates an effective and promising approach for acquisition of adequate tissue sampling for molecular testing. Unmodifiable factors such as pulmonary lesions 2 cm, target lesion location, and higher malignancy stage played the largest role in adequacy for molecular analysis. Further work is needed to understand the impact of procedural techniques that can enhance tissue adequacy. Future research should continue to focus on identifying best practices using robotic bronchoscopy to optimize adequate tissue sampling for molecular marker analysis. This abstract is funded by: None
Skewes et al. (Fri,) studied this question.