Feasibility of shape-sensing robotic-assisted bronchoscopy for biomarker identification in patients with thoracic malignancies

J Thorac Cardiovasc Surg. 2023 Jul;166(1):231-240.e2. doi: 10.1016/j.jtcvs.2022.10.059. Epub 2022 Nov 25.


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; Biocartis) 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, polymerase chain reaction-based molecular testing, and PD-L1 IHC in >80% of cases. Tumor histology and adequacy on intraoperative cytologic assessment might be associated with sample quality and suitability for downstream assays.

Keywords: molecular testing; next-generation sequencing; pulmonary nodule; robotic-assisted bronchoscopy; thoracic malignancy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • B7-H1 Antigen
  • Biomarkers, Tumor / analysis
  • Biomarkers, Tumor / genetics
  • Bronchoscopy
  • Carcinoma, Non-Small-Cell Lung* / chemistry
  • Carcinoma, Non-Small-Cell Lung* / genetics
  • Carcinoma, Non-Small-Cell Lung* / surgery
  • Feasibility Studies
  • Humans
  • Lung Neoplasms* / chemistry
  • Lung Neoplasms* / genetics
  • Lung Neoplasms* / surgery
  • Retrospective Studies
  • Robotic Surgical Procedures*
  • Thoracic Neoplasms*


  • B7-H1 Antigen
  • Biomarkers, Tumor