Sample Adequacy PD-L1 and NGS in NSCLC: Shape-Sensing Robotic Assisted Bronchoscopy Versus CT Guided Lung Biopsy.

Abstract

Background: Routine assessment of programmed death-ligand 1 (PD-L1) expression and comprehensive next-generation sequencing (NGS) is recommended to guide treatment selection in patients with non-small cell lung cancer (NSCLC). Obtaining adequate tissue for biomarker and molecular analyses is therefore essential. This study compared sample adequacy for PD-L1 and NGS testing between shape-sensing robotic-assisted bronchoscopy (ssRAB) and computed tomography-guided transthoracic lung biopsy (CTTB) in patients with NSCLC.

Methods: We conducted a single-center retrospective study of patients with NSCLC who underwent biopsy of PPL by ssRAB or CTTB between June 2020 and December 2025. Demographic, procedural, pathological, biomarker and molecular data were extracted from electronic medical records, and descriptive statistics analysis and multivariable logistic regression were performed.

Results: A total of 402 patients were included, comprising 198 in the ssRAB cohort and 204 in the CTTB cohort. ssRAB demonstrated significantly higher sample adequacy rates than CTTB for both PD-L1 (98.8% vs. 90.6%, p < 0.001) and NGS testing (92.3% vs. 79.1%, p = 0.005). In multivariable logistic regression analyses, ssRAB was independently associated with higher odds of PD-L1 sample adequacy (adjusted OR 11.48, 95% CI 2.89-78.30; p = 0.002) and NGS sample adequacy (adjusted OR 4.01, 95% CI 1.64-11.40; p = 0.004) compared with CTTB. In a separate model evaluating biopsy tools, cryobiopsy use was independently associated with higher odds of PD-L1 adequacy (adjusted OR 16.54, 95% CI 2.92-317.65; p = 0.010) and NGS adequacy (adjusted OR 5.83, 95% CI 1.93-25.39; p = 0.006) compared with non-cryobiopsy sampling.

Conclusions: ssRAB-acquired specimens were associated with higher rates of PD-L1 and NGS sample adequacy than CTTB-acquired specimens in patients with NSCLC. Future prospective studies are needed to better understand the procedural and specimen-related factors underlying these differences.