As lung cancer screening identifies an estimated 1.6 million suspicious lung nodules each year in the U.S. alone, physicians face a challenge.

Most peripheral pulmonary lesions are benign, yet the malignant minority represent the leading cause of cancer death for both men and women.

Robotic bronchoscopy may provide a less invasive and more precise approach to diagnosing lung cancer, suggests a five-year, multisite Mayo Clinic study published in Mayo Clinic Proceedings.

The study evaluated 2,115 lung lesions in 1,904 patients across Mayo Clinic campuses in Jacksonville; Phoenix; and Rochester, Minnesota, between 2019 and 2024.

Researchers reported 85% sensitivity for malignancy and 76.9% accuracy, or a strict diagnostic yield, under newly standardised national criteria. They also reported a complication rate of 2.8%.

Since adoption of robotic bronchoscopy, the proportion of lung cancers diagnosed at an early stage at Mayo Clinic increased from 46% in 2019 to nearly 69% by mid-2024.

While lung cancer was caught earlier, diagnoses at advanced stages decreased from 54% to 31% in 2024. 
 
"Lung cancer survival depends heavily on early detection," says lead author Sebastian Fernandez-Bussy, M.D., the James C. and Sarah K. Kennedy Dean of Research and a pulmonary and critical care physician at Mayo Clinic in Florida.

"Technologies that allow us to diagnose and even treat disease earlier — and with fewer complications — can help improve survival."

Lung cancer generally starts with a suspicious pulmonary nodule. When that is detected through screenings, a lung biopsy may be required to confirm the diagnosis.

Shape-sensing robotic-assisted bronchoscopy, cleared by the Food and Drug Administration in 2019, allows physicians to perform as many biopsies needed to be able to gather enough tissue for diagnosis and molecular markers that will further guide an individualised treatment approach.

This technology provides physicians the precision and stability to sample multiple suspicious nodules throughout both lungs.

By adding endobronchial ultrasound, physicians also can perform precise staging for the immune system glands, or mediastinal lymph nodes, all in one procedure.

When combined with real-time 3D imaging or cone beam CT scans, the system also helps physicians confirm the precise placement of the small tool within lesions before biopsy.

"This technology really has been a game-changer for diagnosing lung cancer earlier," Dr. Fernandez-Bussy says.

In this study, the researchers reported that 56% of lesions sampled were malignant. Twenty-one percent were definitively benign, and 23% were nondiagnostic under strict criteria.

The study applied updated strict diagnostic yield definitions from the American Thoracic Society and American College of Chest Physicians, which exclude certain follow-up data that previously inflated reported success rates.

Robotic-assisted bronchoscopy platforms are increasingly being paired with endobronchial therapies, including pulsed electric field ablation, a minimally invasive treatment for patients who are not eligible for surgery or radiation.

Mayo Clinic has begun to offer diagnosis, staging and treatment during a single procedure. 
 
"I call this the 'single anaesthetic lung surgery pathway,' and it means fewer trips to the hospital, less time away from family and shorter recovery times," says co-author Janani Reisenauer, M.D., chair of thoracic surgery at Mayo Clinic in Rochester, Minnesota, who has been involved in clinical trials that deliver cancer treatment within minutes of diagnosis.

Five-year survival for localised lung cancer approaches 67%, compared with approximately 12% for metastatic disease.

National guidelines recommend timely evaluation and treatment after diagnosis. As lung cancer screening expands and more nodules are detected, demand for precise, minimally invasive diagnostic approaches is expected to grow.

This study illustrates the impact of research with patient-contributed biospecimens, and their associated data, in driving discoveries and advancing cures.

Mayo Clinic's Bioresource initiative is now accelerating the pace of such discoveries by expanding researcher access to valuable biospecimens.

Article: 2000 Peripheral Pulmonary Lesions Sampled by Shape-Sensing Robotic-Assisted Bronchoscopy and Mobile Cone-Beam Computed Tomography

Source: Mayo Clinic