Comparison of Procedural Safety and Diagnostic Yield Between Robotic-Assisted Bronchoscopy Platforms

RATIONALE: Robotic-assisted bronchoscopy platforms are becoming ubiquitous to aid in sampling peripheral pulmonary nodules. A head-to-head performance between the 2 widely available platforms (Ion and Monarch) has not been investigated. OBJECTIVES: To explore differences in diagnostic yield and safety parameters of the Ion and Monarch platforms. A secondary objective was to elucidate radiographic features of nodules that predicted procedural success. METHODS: A retrospective, 2-site cohort study of adult patients scheduled for robotic-assisted bronchoscopy of pulmonary nodules between August 2020 and August 2023. The procedure was performed with either the Ion or Monarch robotic-assisted bronchoscopy platform, depending on the site, with the assistance of standard 2D fluoroscopy. A series of logistic regression models was constructed to explore the effect of platform type on diagnostic yield, after correction of prespecified confounders. We utilized an inferential lasso regression model to explore the predictive properties of nodule radiographic characteristics on yield. RESULTS: A total of 217 cases were analyzed. The median nodule size was 1.4 cm (IQR=1.1 to 2.1), which was similar across both groups. Our parsimonious model suggested no difference in obtaining a positive diagnosis for the Ion platform [OR: 1.5 (0.9-2.7)]. Both nodule size [OR: 1.42 (1.09-1.86)] and presence of a bronchus sign [OR: 2.14 (1.14-4.01)] correlated with diagnostic yield in our inferential model, both in systems and in aggregate. CONCLUSION: Both platforms offer promise in sampling small peripheral nodules. Neither platform appears to improve procedural yield, although caution is advised regarding the generalizability of this finding. Both nodule size and the presence of the bronchus sign may be helpful in preprocedural patient selection.