Robotic bronchoscopic needle‐based confocal laser endomicroscopy to diagnose peripheral lung nodules. Issue 5 (19th December 2022)

• Record Type: Journal Article
• Authors: Manley, Christopher J.; Kramer, Tess; Kumar, Rohit; Gong, Yulan; Ehya, Hormoz; Ross, Eric; Bonta, Peter I.; Annema, Jouke T.
• Is Part Of: Respirology. Volume 28:Issue 5(2023)
• Page Start: 475
• Page End: 483
• Publication Date: 2022-12-19
• Subjects: cytology -- lung cancer -- needle based confocal laser endomicroscopy -- peripheral lung nodule -- rapid onsite evaluation -- robotic bronchoscopy; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.14438
• Languages: English
• ISSNs: 1323-7799

Abstract

Abstract: Background and Objective: Robotic bronchoscopy has demonstrated high navigational success in small peripheral lung nodules but the diagnostic yield is discrepantly lower. Needle based confocal laser endomicroscopy (nCLE) enables real‐time microscopic imaging at the needle tip. We aim to assess feasibility, safety and needle repositioning based on real‐time nCLE‐guidance during robotic bronchoscopy in small peripheral lung nodules. Methods: Patients with suspected peripheral lung cancer underwent fluoroscopy and radial EBUS assisted robotic bronchoscopy. After radial EBUS nodule identification, nCLE‐imaging of the target area was performed. nCLE‐malignancy and airway/lung parenchyma criteria were used to identify the optimal sampling location. In case airway was visualized, repositioning of the biopsy needle was performed. After nCLE tool‐in‐nodule confirmation, needle passes and biopsies were performed at the same location. Measurements and Main Results: Twenty patients were included (final diagnosis n = 17 (lung) cancer) with a median lung nodule size of 14.5 mm (range 8–28 mm). No complications occurred. In 19/20 patients, good quality nCLE‐videos were obtained. In 9 patients (45%), real‐time nCLE‐imaging revealed inadequate positioning of the needle and repositioning was performed. After repositioning, nCLE‐imaging provided tool‐in‐nodule‐confirmation in 19/20 patients. Subsequent ROSE demonstrated representative material in 9/20 patients (45%) and overall diagnostic yield was 80% (16/20). Of the three patients with malignant nCLE‐imaging but inadequate pathology, two were diagnosed with malignancy during follow‐up. Conclusion: Robotic bronchoscopic nCLE‐imaging is feasible and safe. nCLE‐imaging in small, difficult‐to‐access lung nodules provided additional real‐time feedback on the correct needle positioning with the potential to optimize the sampling location and diagnostic yield. Abstract : Robotic bronchoscopic nCLE‐imaging is feasible, safe and enables real‐time visualization of tumour cells at the needle tip. Based on nCLE‐guidance, the robotic bronchoscope was repositioned in almost half of patients. Our data show the potential of robotic bronchoscopic nCLE‐imaging as a safe, improved strategy to diagnose small difficult‐to‐access lung nodules.