Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules.

INTRODUCTION: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground glass nodules (GGN) and part solid nodules (PSN), are slow growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) is scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN.

METHODS: A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6mm, from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB.

RESULTS: A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5mm (IQR 4.5, 6). Patients were divided in two groups: 27 in the ssRAB group and 38 in the CCTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p= .646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs 88.5%; p= .828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs 2; p= .135).

CONCLUSION: Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure.