Changes in diagnostic patterns in patients with lung cancer following implementation of a shape-sensening robotic-assisted navigation bronchoscopy (SSRAB) platform.

<bold>BACKGROUND:</bold> Lung cancer is the leading cause of cancer-related deaths, due in part to the high proportion of cases diagnosed in later stages. <bold>AIMS AND OBJECTIVES:</bold> We evaluate how the implementation of a SSRAB platform at a single center was linked to cancer stage migration. <bold>Methods:</bold> Patients undergoing a SSRAB at a center in the United States by a single pulmonologist were tracked from the date of system install (September 2020) through January 2024. Patients received a biopsy following an abnormal lung imaging study and their chart was reviewed for pathology, nodule size, and stage at diagnosis. <bold>Results:</bold> Among 399 biopsied patients with a suspicious pulmonary nodule, 92% (n=363) had a diagnostic biopsy, of which 61% (n=238) were diagnosed with a malignant lung tumor. Median nodule size at diagnosis was 16mm (IQR: 12-28). In the first quarter after system install, 66% of patients were diagnosed early-stage (i.e. stage I or II) with a median nodule size of 21mm. In the final quarter of the study period, 75% of patients were diagnosed early stage with a median nodule size of 14.5mm. In total, quarter-over-quarter, there was a 5.2% increase in odds of an early-stage diagnosis (p = 0.0485) and 0.8mm decrease in nodule size (p = 0.09). <bold>CONCLUSION:</bold> Implementation of a SSRAB platform was associated with a proportionate reduction in late-stage cancer diagnoses over time. A robust early detection program, including screening and incidental findings, plus rapid referral to and evaluation by pulmonology, help maximize the clinical impact of novel tools that enable the biopsy of smaller lesions.