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. 2025 Sep:207:108681.
doi: 10.1016/j.lungcan.2025.108681. Epub 2025 Jul 28.

Robotic-assisted bronchoscopy for histopathologic subtyping of primary lung adenocarcinoma

Or Kalchiem-Dekel  1 , Rastko Rakočević  2 , Nicolas Toumbacaris  3 , Kay See Tan  3 , Tejaswi R Nadig  4 , Prasad S Adusumilli  5 , Joseph Dycoco  3 , Robert P Lee  2 , Catherine L Oberg  2 , Katherine D Gray  5 , Bernard J Park  5 , Gaetano Rocco  5 , Jaime E Chaft  6 , Stephen B Solomon  7 , David R Jones  5 , Mohit Chawla  2 , Bryan C Husta  4 , Marina K Baine  8 , Matthew J Bott  5
Affiliations

Robotic-assisted bronchoscopy for histopathologic subtyping of primary lung adenocarcinoma

Or Kalchiem-Dekel et al. Lung Cancer. 2025 Sep.

Abstract

Background: The identification of high-grade patterns and mucinous features of invasive primary lung adenocarcinoma on biopsy specimens can have implications on therapeutic decisions across all stages of disease. Shape sensing robotic-assisted bronchoscopy (ssRAB) is an emerging modality for the concomitant diagnosis and staging of lung cancer. We evaluated the performance of ssRAB for adenocarcinoma pattern identification, and particularly high-grade patterns, as well as the histopathologic concordance between biopsy and surgical resection specimens.

Methods: Patients with lung adenocarcinoma diagnosed via ssRAB forceps or cryobiopsy specimens between October 2019 and December 2023 were included in the analysis. Biopsy specimens were evaluated for the identification of histopathologic patterns and mucinous features. A generalized linear mixed model quantified the association between pre- and intra-operative factors and successful pattern identification on biopsy. The concordance between high-grade patterns and mucinous features on ssRAB-acquired biopsy and poorly differentiated grade and mucinous features on subsequent surgical resection was determined.

Results: A total of 242 ssRAB-acquired specimens were included in the final analysis. The biopsy specimen was sufficient to identify adenocarcinoma histopathologic patterns in 71 %. In a multivariable analysis, sampling by cryobiopsy was positively associated with pattern identification (OR 3.54, CI: 1.02-12.30; P = 0.04), as compared with forceps biopsy. A corresponding surgical resection specimen was available in 66 cases. The sensitivity, specificity, positive, and negative predictive values of biopsy were 63, 72, 61, and 74 %, respectively for the presurgical detection of poorly differentiated adenocarcinoma, and 87, 100, 100, and 96 %, respectively for the presurgical detection of mucinous features.

Conclusion: This study is the first to report the performance of ssRAB-acquired biopsy for identification of adenocarcinoma patterns and its concordance with surgical resection. Our findings align with those previously reported for percutaneous lung biopsy. ssRAB emerges as a viable tool for the identification of adenocarcinoma patterns. Future studies are needed to confirm these findings in larger patient cohorts.

Keywords: Adenocarcinoma; Histopathology; Lung cancer; Robotic assisted bronchoscopy.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: PSA received research funding from ATARA Biotherapeutics, is a Scientific Advisory Board member and consultant for ATARA Biotherapeutics, Bayer, Bio4T2, Carisma Therapeutics, Imugene, ImmPactBio, Johnston & Johnston, Orion pharma, Outpace Bio, holds patents, royalties and intellectual property on mesothelin-targeted CAR and other T-cell therapies, which have been licensed to ATARA Biotherapeutics, issued patent method for detection of cancer cells using virus, and pending patent applications on PD-1 dominant negative receptor, wireless pulse-oximetry device, and on an ex vivo malignant pleural effusion culture system. MJB has received consulting fees from Astra-Zeneca and Intuitive Surgical, speaker honoraria from Intuitive Surgical, and research funding from Obsidian Biotherapeutics. BJP has received speaker honoraria from Intuitive Surgical and Medtronic and is a stockholder with CEEVRA. GR has financial relationships with Medtronic, Merck, and Scanlan International. SBS has received a grant and is a consultant for GE Healthcare and is a stockholder with Johnson & Johnson. DRJ is a consultant and a member of the Clinical Trial Steering Committee for AstraZeneca, received research grant support from Merck, is a consultant for More Health, and received speaker fees from Genentech. MC is a consultant member of the Ion Medical Advisory Board for Intuitive Surgical. BCH has received speaker fees from Intuitive Surgical and Siemens Healthineers. All other authors have no conflicts to disclose.

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