Efficacy and safety for robotic bronchoscope in biopsy of pulmonary nodules: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Chao ¹ , ZHANG Jiaqi ¹ , LI Zhen ² , BIAN Guibin ² , LIU Lei ¹ ,  LI Shanqing ¹

1. Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China;
2. Institute of Automation, Chinese Academy of Science, Beijing, 100190, P. R. China;

Corresponding author：

LI Shanqing, Email: lishanqing@pumch.cn

Keywords：

Robotic bronchoscope; pulmonary nodule; diagnostic performance; safety; efficacy; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202207009

Video：

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Objective To systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including Monarch^TM and Ion^TM platforms, and then evaluate the efficacy and safety of the procedure. Methods PubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. Results Finally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the Ion^TM platform and 6 studies used the Monarch^TM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79% (95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.

Citation： GUO Chao, ZHANG Jiaqi, LI Zhen, BIAN Guibin, LIU Lei, LI Shanqing. Efficacy and safety for robotic bronchoscope in biopsy of pulmonary nodules: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 226-232. doi: 10.7507/1007-4848.202207009 Copy

1.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3.	Kian W, Zemel M, Levitas D, et al. Lung cancer screening: A critical appraisal. Curr Opin Oncol, 2022, 34(1): 36-43.
4.	Walter K. Pulmonary nodules. JAMA, 2021, 326(15): 1544.
5.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
6.	Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: A randomized controlled trial. Am J Respir Crit Care Med, 2007, 176(1): 36-41.
7.	Tanner NT, Yarmus L, Chen A, et al. Standard bronchoscopy with fluoroscopy vs thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: A multicenter, prospective, randomized trial. Chest, 2018, 154(5): 1035-1043.
8.	Agrawal A, Ho E, Chaddha U, et al. Factors associated with diagnostic accuracy of robotic bronchoscopy with 12-month follow-up. Ann Thorac Surg, 2022, S0003-4975(22): 00042-X.
9.	Reisenauer J, Simoff MJ, Pritchett MA, et al. Ion: Technology and techniques for shape-sensing robotic-assisted bronchoscopy. Ann Thorac Surg, 2022, 113(1): 308-315.
10.	陈月红, 杜亮, 耿兴远, 等. 无对照二分类数据的Meta分析在RevMan软件中的实现. 中国循证医学杂志, 2014, 14(7): 889-896.
11.	Bajwa A, Bawek S, Bajwa S, et al. 76 consecutive cases of robotic-assisted navigational bronchoscopy at a single center. Am J Respir Crit Care Med, 2021, 203: A4820.
12.	Chen AC, Pastis NJ, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT). Chest, 2021, 159(2): 845-852.
13.	Benn BS, Romero AO, Lum M, et al. Robotic-assisted navigation bronchoscopy as a paradigm shift in peripheral lung access. Lung, 2021, 199(2): 177-186.
14.	Ekeke CN, Vercauteren M, Istvaniczdravkovic S, et al. Lung nodule evaluation using robotic-assisted bronchoscopy at a Veteran's affairs hospital. J Clin Med, 2021, 10(16): 3671.
15.	Fielding DIK, Bashirzadeh F, Son JH, et al. First human use of a new robotic-assisted fiber optic sensing navigation system for small peripheral pulmonary nodules. Respiration, 2019, 98(2): 142-150.
16.	Ost D, Pritchett M, Reisenauer J, et al. Prospective multicenter analysis of shape-sensing robotic-assisted bronchoscopy for the biopsy of pulmonary nodules: Results from the precise study. Chest, 2021, 160(4): A2531-A2533.
17.	Folch EE, Pritchett M, Reisenauer J, et al. A prospective, multi-center evaluation of the clinical utility of the ion endoluminal system—Experience using a robotic-assisted bronchoscope system with shape-sensing technology. Am J Respir Crit Care Med, 2020, 201: A2719.
18.	Cumbo-Nacheli G, Chhaya R, Egan J. Robotic bronchoscopy: An initial experience at a tertiary center. Chest, 2019, 156(4): A1767.
19.	Reisenauer J, Duke J, Kern R, et al. The combination of shape sensing robotic bronchoscopy with mobile 3D imaging to verify tool-in-lesion and assess divergence. Chest, 2021, 160(4): A2529.
20.	Rojas-Solano JR, Ugalde-Gamboa L, Machuzak M. Robotic bronchoscopy for diagnosis of suspected lung cancer: A feasibility study. J Bronchology Interv Pulmonol, 2018, 25(3): 168-175.
21.	Pathak K, Hart S, Sutter J, et al. Robotic navigation bronchoscopy using the ion platform: A new era in proving benign disease. Chest, 2021, 160(4): A2052.
22.	Simoff MJ, Pritchett MA, Reisenauer JS, et al. Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: Initial multicenter experience using the Ion™ Endoluminal System. BMC Pulm Med, 2021, 21(1): 322.
23.	Pritchett M, Schirmer C. Shape-sensing robotic assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions. Chest. 2021, 160(4): A1631-A1632.
24.	Kalchiem-Dekel O, Connolly JG, Lin IH, et al. Shape-sensing robotic-assisted bronchoscopy in the diagnosis of pulmonary parenchymal lesions. Chest, 2022, 161(2): 572-582.
25.	Verga S, Marron RM, Kaur N, et al. Application of Ion robotic virtual bronchoscopic navigation with cone beam computed tomography in biopsying suspicious pulmonary nodules. Am J Respir Crit Care Med, 2021, 203: A4819.
26.	Ghosh S, Baltaji S, Weksler B, et al. Robotic bronchoscopy: Our first 100 nodules. Chest, 2021, 160(4): A2051.
27.	Chaddha U, Kovacs SP, Manley C, et al. Robot-assisted bronchoscopy for pulmonary lesion diagnosis: Results from the initial multicenter experience. BMC Pulm Med, 2019, 19(1): 243.
28.	Panchabhai TS, Mehta AC. Historical perspectives of bronchoscopy. Connecting the dots. Ann Am Thorac Soc, 2015, 12(5): 631-641.
29.	Andersen HA, Fontana RS, Harrison EG. Transbronchoscopic lung biopsy in diffuse pulmonary disease. Dis Chest, 1965, 48(2): 187-192.
30.	Hürter T, Hanrath P. Endobronchial sonography: Feasibility and preliminary results. Thorax, 1992, 47(7): 565-567.
31.	Wang Memoli JS, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest, 2012, 142(2): 385-393.
32.	Thomas N, Tanner N, Nietert P, et al. Updated meta-analysis of guided bronchoscopy for the evaluation of pulmonary lesions. Chest. 2019, 156(4): A1702.
33.	Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
34.	Folch EE, Bowling MR, Pritchett MA, et al. NAVIGATE 24-month results: Electromagnetic navigation bronchoscopy for pulmonary lesions at 37 centers in Europe and the United States. J Thorac Oncol, 2022, 17(4): 519-531.
35.	Shen YC, Chen CH, Tu CY. Advances in diagnostic bronchoscopy. Diagnostics (Basel), 2021, 11(11): 1984.
36.	Akulian JA, Molena D, Wahidi MM, et al. A direct comparative study of bronchoscopic navigation planning platforms for peripheral lung navigation: The ATLAS study. J Bronchology Interv Pulmonol, 2022, 29(3): 171-178.
37.	Ross P, Skabla P, Sutter J, et al. Fast track nodule pathway: Same day robotic diagnosis and resection. Chest, 2021, 160(4): A82.
38.	Patel V. Cryobiopsy with Ion robotic bronchoscopy, initial case series findings on safety and efficacy: First known case series to look at further future applications. Chest, 2022, 161(1): A406.

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. Kian W, Zemel M, Levitas D, et al. Lung cancer screening: A critical appraisal. Curr Opin Oncol, 2022, 34(1): 36-43.
4. Walter K. Pulmonary nodules. JAMA, 2021, 326(15): 1544.
5. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
6. Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: A randomized controlled trial. Am J Respir Crit Care Med, 2007, 176(1): 36-41.
7. Tanner NT, Yarmus L, Chen A, et al. Standard bronchoscopy with fluoroscopy vs thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: A multicenter, prospective, randomized trial. Chest, 2018, 154(5): 1035-1043.
8. Agrawal A, Ho E, Chaddha U, et al. Factors associated with diagnostic accuracy of robotic bronchoscopy with 12-month follow-up. Ann Thorac Surg, 2022, S0003-4975(22): 00042-X.
9. Reisenauer J, Simoff MJ, Pritchett MA, et al. Ion: Technology and techniques for shape-sensing robotic-assisted bronchoscopy. Ann Thorac Surg, 2022, 113(1): 308-315.
10. 陈月红, 杜亮, 耿兴远, 等. 无对照二分类数据的Meta分析在RevMan软件中的实现. 中国循证医学杂志, 2014, 14(7): 889-896.
11. Bajwa A, Bawek S, Bajwa S, et al. 76 consecutive cases of robotic-assisted navigational bronchoscopy at a single center. Am J Respir Crit Care Med, 2021, 203: A4820.
12. Chen AC, Pastis NJ, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT). Chest, 2021, 159(2): 845-852.
13. Benn BS, Romero AO, Lum M, et al. Robotic-assisted navigation bronchoscopy as a paradigm shift in peripheral lung access. Lung, 2021, 199(2): 177-186.
14. Ekeke CN, Vercauteren M, Istvaniczdravkovic S, et al. Lung nodule evaluation using robotic-assisted bronchoscopy at a Veteran's affairs hospital. J Clin Med, 2021, 10(16): 3671.
15. Fielding DIK, Bashirzadeh F, Son JH, et al. First human use of a new robotic-assisted fiber optic sensing navigation system for small peripheral pulmonary nodules. Respiration, 2019, 98(2): 142-150.
16. Ost D, Pritchett M, Reisenauer J, et al. Prospective multicenter analysis of shape-sensing robotic-assisted bronchoscopy for the biopsy of pulmonary nodules: Results from the precise study. Chest, 2021, 160(4): A2531-A2533.
17. Folch EE, Pritchett M, Reisenauer J, et al. A prospective, multi-center evaluation of the clinical utility of the ion endoluminal system—Experience using a robotic-assisted bronchoscope system with shape-sensing technology. Am J Respir Crit Care Med, 2020, 201: A2719.
18. Cumbo-Nacheli G, Chhaya R, Egan J. Robotic bronchoscopy: An initial experience at a tertiary center. Chest, 2019, 156(4): A1767.
19. Reisenauer J, Duke J, Kern R, et al. The combination of shape sensing robotic bronchoscopy with mobile 3D imaging to verify tool-in-lesion and assess divergence. Chest, 2021, 160(4): A2529.
20. Rojas-Solano JR, Ugalde-Gamboa L, Machuzak M. Robotic bronchoscopy for diagnosis of suspected lung cancer: A feasibility study. J Bronchology Interv Pulmonol, 2018, 25(3): 168-175.
21. Pathak K, Hart S, Sutter J, et al. Robotic navigation bronchoscopy using the ion platform: A new era in proving benign disease. Chest, 2021, 160(4): A2052.
22. Simoff MJ, Pritchett MA, Reisenauer JS, et al. Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: Initial multicenter experience using the Ion™ Endoluminal System. BMC Pulm Med, 2021, 21(1): 322.
23. Pritchett M, Schirmer C. Shape-sensing robotic assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions. Chest. 2021, 160(4): A1631-A1632.
24. Kalchiem-Dekel O, Connolly JG, Lin IH, et al. Shape-sensing robotic-assisted bronchoscopy in the diagnosis of pulmonary parenchymal lesions. Chest, 2022, 161(2): 572-582.
25. Verga S, Marron RM, Kaur N, et al. Application of Ion robotic virtual bronchoscopic navigation with cone beam computed tomography in biopsying suspicious pulmonary nodules. Am J Respir Crit Care Med, 2021, 203: A4819.
26. Ghosh S, Baltaji S, Weksler B, et al. Robotic bronchoscopy: Our first 100 nodules. Chest, 2021, 160(4): A2051.
27. Chaddha U, Kovacs SP, Manley C, et al. Robot-assisted bronchoscopy for pulmonary lesion diagnosis: Results from the initial multicenter experience. BMC Pulm Med, 2019, 19(1): 243.
28. Panchabhai TS, Mehta AC. Historical perspectives of bronchoscopy. Connecting the dots. Ann Am Thorac Soc, 2015, 12(5): 631-641.
29. Andersen HA, Fontana RS, Harrison EG. Transbronchoscopic lung biopsy in diffuse pulmonary disease. Dis Chest, 1965, 48(2): 187-192.
30. Hürter T, Hanrath P. Endobronchial sonography: Feasibility and preliminary results. Thorax, 1992, 47(7): 565-567.
31. Wang Memoli JS, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest, 2012, 142(2): 385-393.
32. Thomas N, Tanner N, Nietert P, et al. Updated meta-analysis of guided bronchoscopy for the evaluation of pulmonary lesions. Chest. 2019, 156(4): A1702.
33. Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
34. Folch EE, Bowling MR, Pritchett MA, et al. NAVIGATE 24-month results: Electromagnetic navigation bronchoscopy for pulmonary lesions at 37 centers in Europe and the United States. J Thorac Oncol, 2022, 17(4): 519-531.
35. Shen YC, Chen CH, Tu CY. Advances in diagnostic bronchoscopy. Diagnostics (Basel), 2021, 11(11): 1984.
36. Akulian JA, Molena D, Wahidi MM, et al. A direct comparative study of bronchoscopic navigation planning platforms for peripheral lung navigation: The ATLAS study. J Bronchology Interv Pulmonol, 2022, 29(3): 171-178.
37. Ross P, Skabla P, Sutter J, et al. Fast track nodule pathway: Same day robotic diagnosis and resection. Chest, 2021, 160(4): A82.
38. Patel V. Cryobiopsy with Ion robotic bronchoscopy, initial case series findings on safety and efficacy: First known case series to look at further future applications. Chest, 2022, 161(1): A406.

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Efficacy and safety for robotic bronchoscope in biopsy of pulmonary nodules: A systematic review and meta-analysis

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