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Feasibility of Shape-Sensing Robotic-Assisted Bronchoscopy for Biomarker Identification in Thoracic Malignancies

Published:November 24, 2022DOI:https://doi.org/10.1016/j.jtcvs.2022.10.059
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      Abstract

      Objective

      Molecular diagnostic assays require samples with high nucleic acid content to generate reliable data. Similarly, programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) requires samples with adequate tumor content. We investigated whether shape-sensing robotic-assisted bronchoscopy (ssRAB) provides adequate samples for molecular and predictive testing.

      Methods

      We retrospectively identified diagnostic samples from a prospectively collected database. Pathologic reports were reviewed to assess adequacy of samples for molecular testing and feasibility of PD-L1 IHC. Tumor cellularity was quantified by an independent pathologist using paraffin-embedded sections. Univariable and multivariable linear regression models were constructed to assess associations between lesion- and procedure-related variables and tumor cellularity.

      Results

      In total, 128 samples were analyzed: 104 primary lung cancers and 24 metastatic lesions. On initial pathologic assessment, ssRAB samples were deemed to be adequate for molecular testing in 84% of cases; on independent review of cellular blocks, median tumor cellularity was 60% (interquartile range, 25%-80%). Hybrid capture–based next-generation sequencing was successful for 25 of 26 samples (96%), polymerase chain reaction–based molecular testing (Idylla) was successful for 49 of 52 samples (94%), and PD-L1 IHC was successful for 61 of 67 samples (91%). Carcinoid and small cell carcinoma histologic subtype and adequacy on rapid on-site evaluation were associated with higher tumor cellularity.

      Conclusions

      The ssRAB platform provided adequate tissue for next-generation sequencing, PCR-based molecular testing, and PD-L1 IHC in >80% of cases. Tumor histology and adequacy on intraoperative cytologic assessment may be associated with sample quality and suitability for downstream assays.

      Keywords

      Abbreviations:

      EBUS (endobronchial ultrasound), EMN (electromagnetic navigation), FNA (fine-needle aspiration), IHC (immunohistochemistry), IQR (interquartile range), NGS (next-generation sequencing), NSCLC (non-small cell lung cancer), PCR (polymerase chain reaction), PD-L1 (programmed death-ligand 1), ROSE (rapid on-site evaluation), ssRAB (shape-sensing robotic-assisted bronchoscopy), TBFB (transbronchial forceps biopsy), TBNA (transbronchial needle aspiration)
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