Assessing the early returns of robotic-assisted bronchoscopy in a patient population at high risk for cancer: factors associated with a diagnostic procedure and pathologic outcomes
Rami Naaman, Christopher M. Kapp, Odile David, Kevin Kovitz, Benjamin Aronson, Kevin Haas
{"title":"Assessing the early returns of robotic-assisted bronchoscopy in a patient population at high risk for cancer: factors associated with a diagnostic procedure and pathologic outcomes","authors":"Rami Naaman, Christopher M. Kapp, Odile David, Kevin Kovitz, Benjamin Aronson, Kevin Haas","doi":"10.1186/s43168-023-00238-x","DOIUrl":null,"url":null,"abstract":"Abstract Background Lung cancer remains the most common cause of cancer-related deaths in the USA. Successful implementation of lung cancer screening programs has led to increased detection of peripheral pulmonary lesions (PPL). Robotic-assisted bronchoscopy (RB) is a relatively novel tool used to safely diagnose PPN. Additionally, with the developing precision of personalized medicine and targeted therapy, obtaining adequate tissue for next-generation sequencing (NGS) has become critical to optimizing the medical management of lung cancer. Our aim is to assess the diagnostic yield of RB, identify patient and procedure characteristics associated with performing a diagnostic biopsy, and evaluate the adequacy of tumor cellularity for biomarker identification. Results We performed a retrospective observational study consecutively enrolling 54 adult patients who underwent RB between January 2022 and March 2023. Records were reviewed for medical comorbidities and smoking status. PPL characteristics included size, location, presence of a bronchus sign on mapping computed tomography (CT) scans, distance from airway and pleura on CT, and days between obtaining CT and the bronchoscopy. Procedural factors included the radial endobronchial ultrasound (r-EBUS) view obtained and the sampling method(s) with which a diagnosis was achieved. Records were reviewed for final pathology and the need for further procedures to establish a diagnosis. Samples that yielded non-small cell lung cancer (NSCLC) were sent for an NGS panel if deemed adequate. The panels were reviewed to identify potentially actionable mutations. Multivariable logistic regression was performed to assess patients and lesions characteristics associated with a diagnostic biopsy. We sampled 56 lesions, 45 (80.4%) were from current or former smokers. The overall diagnostic yield was 73.2% and 68.9% for nodules less than 3 cm. Lesions size ranged from 8 mm nodules to 70 mm masses, with an average size 20.3 mm. Mean nodule size from diagnostic procedures was 21.5 mm and 16.9 mm from non-diagnostic ones ( p = 0.04). Logistic regression analysis showed that the presence of a bronchus sign was associated with a diagnostic procedure (OR 19.4, p = 0.023), while lack of a r-EBUS view predicted a non-diagnostic bronchoscopy (OR 0.02, p = 0.013). 28 diagnostic biopsies (68.3%) yielded NSCLC and of the 25 cases that we followed, 22 samples (88%) were adequate for NGS. Conclusions The presence of a bronchus sign on CT and obtaining r-EBUS view during RB were associated with a higher diagnostic yield. RB successfully sampled PPL with adequate tumor cellularity for NGS.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Egyptian Journal of Bronchology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s43168-023-00238-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract Background Lung cancer remains the most common cause of cancer-related deaths in the USA. Successful implementation of lung cancer screening programs has led to increased detection of peripheral pulmonary lesions (PPL). Robotic-assisted bronchoscopy (RB) is a relatively novel tool used to safely diagnose PPN. Additionally, with the developing precision of personalized medicine and targeted therapy, obtaining adequate tissue for next-generation sequencing (NGS) has become critical to optimizing the medical management of lung cancer. Our aim is to assess the diagnostic yield of RB, identify patient and procedure characteristics associated with performing a diagnostic biopsy, and evaluate the adequacy of tumor cellularity for biomarker identification. Results We performed a retrospective observational study consecutively enrolling 54 adult patients who underwent RB between January 2022 and March 2023. Records were reviewed for medical comorbidities and smoking status. PPL characteristics included size, location, presence of a bronchus sign on mapping computed tomography (CT) scans, distance from airway and pleura on CT, and days between obtaining CT and the bronchoscopy. Procedural factors included the radial endobronchial ultrasound (r-EBUS) view obtained and the sampling method(s) with which a diagnosis was achieved. Records were reviewed for final pathology and the need for further procedures to establish a diagnosis. Samples that yielded non-small cell lung cancer (NSCLC) were sent for an NGS panel if deemed adequate. The panels were reviewed to identify potentially actionable mutations. Multivariable logistic regression was performed to assess patients and lesions characteristics associated with a diagnostic biopsy. We sampled 56 lesions, 45 (80.4%) were from current or former smokers. The overall diagnostic yield was 73.2% and 68.9% for nodules less than 3 cm. Lesions size ranged from 8 mm nodules to 70 mm masses, with an average size 20.3 mm. Mean nodule size from diagnostic procedures was 21.5 mm and 16.9 mm from non-diagnostic ones ( p = 0.04). Logistic regression analysis showed that the presence of a bronchus sign was associated with a diagnostic procedure (OR 19.4, p = 0.023), while lack of a r-EBUS view predicted a non-diagnostic bronchoscopy (OR 0.02, p = 0.013). 28 diagnostic biopsies (68.3%) yielded NSCLC and of the 25 cases that we followed, 22 samples (88%) were adequate for NGS. Conclusions The presence of a bronchus sign on CT and obtaining r-EBUS view during RB were associated with a higher diagnostic yield. RB successfully sampled PPL with adequate tumor cellularity for NGS.
在美国,肺癌仍然是癌症相关死亡的最常见原因。肺癌筛查计划的成功实施导致周围性肺病变(PPL)的检测增加。机器人辅助支气管镜检查(RB)是一种相对较新的工具,用于安全诊断PPN。此外,随着个性化医疗和靶向治疗精度的提高,获得足够的组织进行下一代测序(NGS)已成为优化肺癌医疗管理的关键。我们的目的是评估RB的诊断率,确定与诊断性活检相关的患者和手术特征,并评估肿瘤细胞的充分性以进行生物标志物鉴定。我们进行了一项回顾性观察性研究,连续招募了54名在2022年1月至2023年3月期间接受RB治疗的成年患者。回顾了医疗合并症和吸烟状况的记录。PPL的特征包括大小、位置、CT上是否有支气管征象、CT上与气道和胸膜的距离、CT检查与支气管镜检查之间的间隔天数。程序因素包括获得的径向支气管内超声(r-EBUS)视图和获得诊断的采样方法。回顾了最终病理记录和进一步诊断的需要。产生非小细胞肺癌(NSCLC)的样本如果认为足够,则送至NGS小组。对这些小组进行了审查,以确定潜在的可操作突变。进行多变量逻辑回归来评估与诊断活检相关的患者和病变特征。我们取样了56个病变,其中45个(80.4%)来自当前或以前的吸烟者。小于3cm的结节的总诊断率分别为73.2%和68.9%。病灶大小从8mm结节到70mm肿块不等,平均20.3 mm。诊断方法的平均结节大小为21.5 mm,非诊断方法的平均结节大小为16.9 mm (p = 0.04)。Logistic回归分析显示,支气管体征的存在与诊断程序相关(OR 19.4, p = 0.023),而缺乏r-EBUS视图预测非诊断性支气管镜检查(OR 0.02, p = 0.013)。28例活检诊断为NSCLC(68.3%),在我们随访的25例病例中,22例样本(88%)足以进行NGS检查。结论CT上支气管征象的出现和RB时的r-EBUS检查具有较高的诊断率。RB成功地取样了具有足够肿瘤细胞的PPL用于NGS。