Table 1. Summary of recent robotic bronchoscopy studies using either the MonarchTM or IonTM platforms.
| Study | Platform/No. of pts/follow-up | Navigation success/ confirmation tool |
Bronchus sign | Diagnostic yield definition | Tools/sampling technique | Adjuvant imaging | Reported diagnostic yield |
|---|---|---|---|---|---|---|---|
| Chaddha 2019, BMC Pulm Med (5) | Monarch/N =165/6 months | 89% (r-EBUS) | 64% | +/− (cons/max)† | Needle 100%; forceps 96% | r-EBUS, 2D fluoro | 69–77% |
| Fielding 2019, Respiration (12) | Ion/N =29/6 months | 97% (virtual); 93% (r-EBUS) | 59% | −− | Needle 97%; forceps 69%; Brush 76%; BAL/wash 86% | r-EBUS, 2D fluoro | 79% |
| Chen 2021, Chest (4) | Monarch/N =55/12 months | 96% (r-EBUS) | 59% | ++ | Needle 100%; forceps ×3‡ | r-EBUS, 2D fluoro | 74% |
| Benn 2021, Lung (13) | Ion/N =52/5–6 months | 85% (virtual); 100% (CBCT) | 46% | −− | Needle 100%; forceps 76% | CBCT | 86% |
| Kalchiem-Dekel 2022, Chest (14) | Ion/N =131/12 months | 99% (virtual) | 63% | ++ | Needle 97%; forceps 32% | r-EBUS, 2D fluoro, 3D fluoro | 82% |
| Agrawal 2022, Ann Thorac Surg (11) | Monarch/N =124/12 months | 94% (virtual); 82% (r-EBUS) | 75% | ++ | Needle 94%; forceps 94% | r-EBUS, 2D fluoro | 77% |
Diagnostic yield definitions are as follows: (−−) specimen considered diagnostic if malignant or benign diagnosis, including inflammation. (−) Specimen considered diagnostic if malignant or benign diagnosis, including inflammation (cases with inflammation mostly show resolution or improvement, but incomplete follow-up). (+) Specimen considered diagnostic if malignant or benign diagnosis. Inflammation where follow-up was not available was considered as non-diagnostic. (++) Specimen considered diagnostic if malignant or specific non-malignant process explained presence of pulmonary lesion. Inflammation considered diagnostic if regression or resolution of lesion on follow-up imaging, if remains unchanged on follow-up imaging for >1 year, or confirmed on alternative sampling method (such as transthoracic or surgical biopsy). Inflammation without follow-up, atypical cells, normal pulmonary elements, and specimens with follow-up tests that confirmed a different diagnosis were considered as non-diagnostic. Cases with patients who pursued anti-neoplastic treatment without confirmed diagnosis, patients with new diagnosis of lung cancer via biopsy of another site, or in which definitive diagnosis was not established due to lack of follow-up were considered non-diagnostic. †, both conservative estimates (+) and maximal overall (−) diagnostic yield definitions were provided in this study; ‡, transbronchial forceps biopsy was used if findings from transbronchial needle aspiration was negative on ROSE on three occasions. BAL, bronchoalveolar lavage; 2D, two-dimensional; r-EBUS, radial endobronchial ultrasound; CBCT, cone beam computed tomography; Virtual, virtual target on the respective robotic navigation platform; N/A, data not available; ROSE, rapid on-site evaluation.