PHILADELPHIA (January 22, 2020) – In the first published study since the market release of robot-assisted bronchoscopy, researchers at Fox Chase Cancer Center have found the technology to be safe, feasible, and reliable for achieving diagnoses for lung cancer.
Robotic bronchoscopy is a diagnostic technology used to view the inside of the lungs and obtain tissue samples for biopsy. Fox Chase was one of the first cancer centers in the nation to obtain this technology, marketed as the Monarch Platform.
Two Fox Chase researchers in the Division of Pulmonary, Sleep and Critical Care Medicine—Christopher J. Manley, MD, director of Interventional Pulmonology, and Rohit Kumar, MD, director of the Respiratory and Pulmonary Function Service—helped conduct the first retrospective data review of robotic bronchoscopy cases since the technology’s market release in 2018. Specifically, they helped analyze electronic records of 165 patients on whom robotic bronchoscopy was used to biopsy a total of 167 lung lesions between June and December 2018.
The multicenter study included collaborators from Icahn School of Medicine at Mount Sinai, University of Pittsburgh Medical Center, University of Chicago Medicine, and Michigan State University College of Human Medicine Spectrum Health.
Results concerning the safety, feasibility, and effectiveness of the technology in diagnosing lung cancer were very promising, particularly given how new the technology is.
“The reassuring thing about this technology,” said Manley, “is that even from an early stage, with just the first 165 patients, you see very good safety and very good outcomes, which is reassuring and very encouraging for the future.”
Procedure-related complications with robotic bronchoscopy were comparable to those from other guided bronchoscopy studies, in the low single digits. Navigation success, or the ability to get the camera and biopsy tools to the specific site of a lesion, was achieved in 88.6 percent of the robotic bronchoscopy study cases. Finally, diagnostic yield, the proportion of patients in whom robotic bronchoscopy yielded a definitive diagnosis, was 69.1 percent to 77 percent, a high yield compared to the 40 percent to 70 percent average of other modern bronchoscopic techniques.
These results, Manley said, are due to three main benefits of robotic bronchoscopy. “There’s the increased flexibility and dexterity of the camera—the old-fashioned bronchoscope could only really move in two directions, and this robot can move in every direction. There’s the stability of the sheath and the robot to support the scope, so the device doesn’t move after we navigate to the lesion. And then the third benefit, based on those two things, is that the biopsies are very reproducible.”
Now that robotic bronchoscopy is more commonly available at more centers, the next step is to conduct larger studies to get a better sense of how the technology fits into the diagnosis and staging of lung cancer. Manley has received grant funding to conduct a prospective trial at Fox Chase in which researchers will enroll patients at the outset of the study, rather than being forced to look at often incomplete patient records after the fact.
Additionally, Fox Chase will be looking into opportunities to pair robotic bronchoscopy with complementary technologies, like advanced imaging or targeted drug delivery, that can improve patient care. “The point is to open up treatment options, and robotic bronchoscopy is going to provide options that are minimally invasive with good outcomes and therapeutic intent,” said Manley.
The paper, “Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results From the Initial Multicenter Experience,” was published in BMC Pulmonary Medicine.