Division of Pulmonary and Critical Care Medicine.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Ann Am Thorac Soc. 2023 Dec;20(12):1801-1812. doi: 10.1513/AnnalsATS.202301-075OC.
Conventional electromagnetic navigation bronchoscopy and other guided bronchoscopic modalities have a very desirable safety profile, but their diagnostic yield is only 60-70% for pulmonary lesions. Recently, robotic-assisted bronchoscopy (RAB) platforms have been introduced to improve the diagnostic performance of bronchoscopic modalities. To determine the diagnostic performance and safety profile of RAB (using shape-sensing and electromagnetic navigation-based platforms) by performing a systematic review and meta-analysis. The PubMed, Embase, and Google Scholar databases were searched to find studies that reported on the diagnostic performance and/or the safety profile of one of the RAB systems. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed using MedCalc version 20.118. Pooled diagnostic yield was calculated using a Freeman-Tukey transformation. We planned to use a random-effects model if the index was >40%. Twenty-five studies were included: 20 including diagnostic and safety analyses and 5 including only safety analyses. The pooled diagnostic yield of RAB (20 studies, 1,779 lesions) was 84.3% (95% confidence interval, 81.1-87.2%). The index was 65.6%. On the basis of our subgroup analyses, the heterogeneity was likely driven by differences in study designs (prospective vs. retrospective) and procedural protocols (such as different RAB systems). Lesion size > 2 cm, the presence of a computed tomography bronchus sign, and concentric radial endobronchial ultrasound view were associated with a statistically significant increase in the odds of diagnosis with RAB. The overall rates of pneumothorax, need for tube thoracostomy, and significant hemorrhage were 2.3%, 1.2%, and 0.5%, respectively. RAB systems have significantly increased the diagnostic yield of navigational bronchoscopy compared with conventional systems such as electromagnetic navigation bronchoscopy, but well-designed prospective studies are needed to better understand the impact of various factors, such as the use of three-dimensional imaging modalities, cryobiopsy, and specific ventilatory protocols, on the diagnostic yield of RAB.
传统的电磁导航支气管镜和其他引导式支气管镜方式具有非常理想的安全性，但它们对肺部病变的诊断率仅为 60-70%。最近，引入了机器人辅助支气管镜（RAB）平台，以提高支气管镜方式的诊断性能。通过系统评价和荟萃分析来确定 RAB（使用基于形状感应和电磁导航的平台）的诊断性能和安全性概况。在 PubMed、Embase 和 Google Scholar 数据库中搜索报告了一种 RAB 系统的诊断性能和/或安全性概况的研究。使用 Quality Assessment of Diagnostic Accuracy Studies 2 工具评估纳入研究的质量。使用 MedCalc 版本 20.118 进行荟萃分析。使用 Freeman-Tukey 变换计算汇总诊断率。如果 指数>40%，我们计划使用随机效应模型。共纳入 25 项研究：20 项包括诊断和安全性分析，5 项仅包括安全性分析。RAB（20 项研究，1779 个病变）的汇总诊断率为 84.3%（95%置信区间，81.1-87.2%）。 指数为 65.6%。基于我们的亚组分析，异质性可能是由研究设计（前瞻性与回顾性）和程序方案（如不同的 RAB 系统）的差异驱动的。病变大小>2cm、存在 CT 支气管征以及同心径向支气管内超声视图与 RAB 诊断的几率显著增加相关。气胸、需要胸腔引流管和明显出血的总发生率分别为 2.3%、1.2%和 0.5%。RAB 系统与电磁导航支气管镜等传统系统相比，显著提高了导航支气管镜的诊断率，但需要进行精心设计的前瞻性研究，以更好地了解三维成像方式、冷冻活检和特定通气方案等各种因素对 RAB 诊断率的影响。
