Transforming lung cancer diagnosis: the role of robotic-assisted bronchoscopy in early detection and staging

Sebastian Fernandez-Bussy; Rodrigo Funes-Ferrada; Alejandra Yu Lee-Mateus; Bryan F Vaca-Cartagena; Alanna Barrios-Ruiz; Sofia Valdes-Camacho; Neal M Patel; Bryan C Husta; Britney N Hazelett; Mohamed I Ibrahim; Kelly S Robertson; Ryan M Chadha; David Abia-Trujillo

doi:10.1016/j.lungcan.2025.108646

Transforming lung cancer diagnosis: the role of robotic-assisted bronchoscopy in early detection and staging

Lung Cancer. 2025 Jun 27:206:108646. doi: 10.1016/j.lungcan.2025.108646. Online ahead of print.

Affiliations

¹ Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, FL, USA. Electronic address: fernandez-bussy.sebastian@mayo.edu.
² Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
³ Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL, USA.

PMID: 40602203
DOI: 10.1016/j.lungcan.2025.108646

Abstract

Introduction: Minimally invasive techniques, including CT-guided transthoracic biopsy (CTTB) and robotic-assisted bronchoscopy (RAB), play a crucial role in diagnosing peripheral pulmonary lesions suspected of lung cancer. This article aims to assess differences in primary lung cancer diagnosis and staging between patients undergoing ssRAB with shape-sensing RAB (ssRAB) and CTTB.

Methods: This retrospective cohort study included 407 patients who underwent CTTB (2017-2020) and 556 who underwent ssRAB (2020-2023) at a single institution. Propensity score matching (1:1) was applied to balance baseline covariates. Outcomes included cancer stage at diagnosis, procedural safety, and hospital metrics. Logistic regression and descriptive statistics were used to analyze differences.

Results: After matching, 148 patients per group were analyzed. Patients in the ssRAB group were more frequently diagnosed at an early stage compared to the CTTB group (OR = 3.02, 95 % CI: 1.83-5.04, p < 0.001). ssRAB demonstrated significantly lower rates of pneumothorax (3.38 % vs. 44.59 %, p < 0.001) and hospital admissions (5.41 % vs. 19.59 %, p < 0.001). Despite longer procedural times, ssRAB reduced hospital stays by 34 min (p < 0.001). Diagnostic yield for malignancy was comparable between ssRAB and CTTB (86.48 % vs. 89.18 %, p = 0.594).

Conclusion: ssRAB significantly improves early-stage lung cancer detection and reduces procedural risks, offering a safer, patient-centered approach. Its integration into diagnostic pathways represents a transformative advancement in lung cancer care. Further studies are warranted to confirm its broader impact across diverse healthcare settings.

Keywords: CT-guided transthoracic biopsy; Lung Cancer; ssRAB.