Abstract
Robotic‐assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta‐analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta‐analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high‐quality prospective studies still need to be conducted.
Keywords: bronchoscopy, lung cancer, meta‐analysis, peripheral pulmonary lesion, robotic‐assisted bronchoscopy
We performed a meta‐analysis to analyze the diagnostic yield and safety of robotic‐assisted bronchoscopy in patients with peripheral pulmonary lesions. A total of 725 lesions from 10 studies were included. The pooled diagnostic yield was 80.4% (95% CI: 75.7%–85.1%), and the pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield.
INTRODUCTION
With the wide application of chest computed tomography (CT), an increasing number of peripheral pulmonary lesions (PPLs) are being detected. 1 The evaluation of PPLs is often challenging. For lesions suspicious for lung cancer, nonsurgical biopsy is recommended. 2 , 3
Transbronchial sampling is a routinely performed nonsurgical biopsy method. Since it avoids destroying normal pleura and lung tissue, transbronchial sampling is much safer than transthoracic sampling. Unfortunately, the application of traditional transbronchial sampling is mainly limited to large and central lesions, and it has a poor diagnostic yield of 14% for peripheral lesions less than 2 cm in size. 4 With the development of guided bronchoscopy, such as radial endobronchial ultrasound (rEBUS), electromagnetic navigation bronchoscopy (ENB), and virtual bronchoscopic navigation (VBN), the diagnostic yield has been increased to nearly 70%. 5 Despite the significant improvement, the diagnostic yield of transbronchial sampling remains suboptimal.
Two robotic‐assisted bronchoscopy (RAB) platforms (Monarch Platform, Auris Health, Inc. and Ion Endoluminal System, Intuitive Surgical, Inc.) have received Food and Drug Administration (FDA) clearance since 2018. 6 The Monarch platform relies on electromagnetic navigation technology, while the Ion platform is based on novel shape‐sensing technology. With enhanced stability and improved accessibility, RAB is expected to have a better diagnostic performance for PPLs. 7 , 8 , 9 Several studies have explored the diagnostic performance of these two platforms; however, most of them are small, single‐center studies. Recently, a new RAB platform (Galaxy System) has received FDA approval. In addition to the advantages of RAB, the Galaxy System with its proprietary tool‐in‐lesion tomography (TiLT+) technology provides integrated tomosynthesis to overcome CT‐to‐body divergence. However, limited data is available on this platform. 10
To date, only one meta‐analysis has specifically evaluated the diagnostic performance of RAB. 11 Nevertheless, the diagnostic yields in the included studies were defined differently and some new studies have been published. In this meta‐analysis, both old and recent studies were included. To enhance the reliability of the results, diagnostic yields from included studies were reconstructed according to a uniform definition. Furthermore, we also analyzed factors affecting the performance of RAB.
METHODS
This meta‐analysis has been registered in PROSPERO (registration no.: CRD42022363103). We reported this article following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) reporting checklist.
Literature search
We searched PubMed (MEDLINE), Embase, Web of Science, Cochrane Central Register of Controlled Trails (CENTRAL), and ClinicalTrials.gov from inception to April 2023 to identify studies reporting the diagnostic yield of RAB for PPLs. Table S1 shows the literature search strategy. As a supplement, references cited in the included studies and relevant reviews were manually searched.
Study selection
Two investigators (C.Z. and R.L.) independently assessed retrieved studies and disagreements were resolved by discussion. We included studies that evaluated the diagnostic yield of RAB in patients with PPLs. We excluded studies with <10 patients, studies that were not published in English, or studies that reported insufficient data to calculate the diagnostic yield according to a uniform definition. We also excluded case reports, review articles, or conference abstracts. When two or more articles shared data or subsets of data, the most recent article or the article with most details was included.
Data extraction
Two investigators (C.Z. and F.X.) independently extracted the following information: first author, publication year, study design (retrospective or prospective), number of patients and lesions, lesion size, number of lesions with a bronchus sign, number of solid lesions, robotic platforms, auxiliary techniques, sampling methods, diagnostic results, and complications. Disagreements were discussed with a third investigator (J.S.).
Since various definitions of the diagnostic yield are used in different studies, we extracted the actual results of RAB to reconstruct the diagnostic yield based on the intermediate‐level definition proposed by Vachani et al. 12 All malignant and specific benign findings (e.g., infection, granuloma) were considered diagnostic. Nonspecific benign findings (e.g., inflammation) were considered diagnostic only if they were confirmed by an alternative sampling method (e.g., surgery, transthoracic biopsy) or close follow‐up at least 6 months. All other findings (e.g., atypical cells, normal pulmonary elements) were considered nondiagnostic. Diagnostic yield was calculated as the number of diagnostic lesions divided by the total number of lesions. After contacting the authors for additional information, we excluded studies reporting insufficient data to calculate the diagnostic yield. Some studies reported diagnostic data for subgroups based on lesion size (≤30 vs. >30 mm or ≤ 20 vs. >20 mm), lesion appearance (solid vs. nonsolid), lesion location (upper lobe vs. nonupper lobe), bronchus sign presence (positive vs. negative), and rEBUS view (concentric vs. eccentric). These data were also extracted where available. Complication rate was calculated as the number of reported complications divided by the total number of patients.
Quality assessment
The Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool and the modified signaling questions proposed by Nadig et al. were used to assess the quality of included studies by two independent investigators (F.X. and N.C.). 13 , 14 Discordance was resolved by consensus.
Statistical analysis
The pooled diagnostic yield and complication rate were estimated with 95% confidence intervals (CI). Interstudy heterogeneity was assessed using the Cochran Q test and quantified using the I 2 statistic. If significant heterogeneity was observed (p < 0.10, I 2 > 50%), a random‐effects model was used. Otherwise, a fixed‐effect model was used. Forest plots were used to display results of individual studies and syntheses. To explore potential sources of heterogeneity, we performed subgroup analyses based on the study design (prospective vs. retrospective), robotic platform (Ion vs. Monarch), mean/median lesion size (≤20 vs. >20 mm), use of cryoprobes (yes vs. no), and use of cone beam computed tomography (CBCT) (yes vs. no). The robustness of the synthesized results was assessed by a leave‐one‐out sensitivity analysis. Publication bias was assessed using funnel plots and the Egger test. p < 0.05 was considered statistically significant. We performed statistical analyses using R software version 4.2.3 including the “meta” package.
RESULTS
Literature search and study selection
As shown in Figure 1, our systematic search identified a total of 2068 records. After checking for duplicates, 1322 records were excluded based on title and abstract. A total of 26 studies were selected to review the full article. Of these, 16 studies were excluded: five studies did not report diagnostic results, 15 , 16 , 17 , 18 , 19 nine studies did not provide sufficient data to calculate the diagnostic yield according to our definition, 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 and two studies were excluded to avoid duplication of population. 29 , 30 Finally, 10 eligible studies with 725 lesions were included. 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40
FIGURE 1.
Flow chart of study selection.
Study characteristics
The detailed characteristics of included studies are summarized in Table 1. The number of lesions enrolled in each study ranged from 20 to 159, with a mean/median lesion size ranged from 12.2 mm to 23.2 mm. There were five prospective and five retrospective studies. Of these, the Ion platform was used in six studies and the Monarch platform was used in four studies. No clinical data regarding the Galaxy System was reported when a literature search was performed. Different combinations of auxiliary techniques and sampling methods were chosen in individual studies.
TABLE 1.
Characteristics of included studies.
| Study | Robotic platform | Study design | Patients, n | Lesions, n | Lesion size, mm | Bronchus sign, n (%) | Solid lesion, n (%) | Auxiliary technique | Sampling method |
|---|---|---|---|---|---|---|---|---|---|
| Fielding et al. 2019 31 | Ion | Pro | 29 | 29 | 12.2 ± 4.2 a | 17 (58.6) | 23 (79.3) | rE, Fl, ROSE | Needle, forceps, brush, BAL/wash |
| Benn et al. 2021 32 | Ion | Pro | 52 | 59 | 19.6 ± 10.9 a | 27 (45.8) | 41 (69.5) | CBCT, ROSE | Needle, forceps |
| Chen et al. 2021 33 | Monarch | Pro | 54 | 54 | 23.2 ± 10.8 a | 32 (59.3) | NR | rE, Fl, ROSE | Needle, forceps |
| Kalchiem‐Dekel et al. 2022 34 | Ion | Retro | 130 | 159 | 18 (13–27) b | 100 (62.9) | 116 (73.0) | rE, Fl, ROSE | Needle, forceps, brush |
| Oberg et al. 2022 35 | Ion | Retro | 112 | 120 | 22 (13–34.3) b | 58 (48.3) | 87 (72.5) | rE, Fl | Needle, forceps, cryoprobe |
| Cumbo‐Nacheli et al. 2022 36 | Monarch | Retro | 20 | 20 | 22 ± 7 a | 10 (50.0) | 17 (85.0) | rE, CBCT | Needle, forceps |
| Xie et al. 2022 37 | Ion | Pro | 30 | 30 | 17.1 ± 4.3 a | 23 (76.7) | 26 (86.7) | rE, Fl, ROSE | Needle, forceps, brush |
| Vu et al. 2023 38 | Ion | Retro | 110 | 110 | 20 (15–24) b | 27 (24.5) | 87 (79.1) | rE, Fl, ROSE | Needle, forceps |
| Agrawal et al. 2023 39 | Monarch | Retro | 124 | 124 | 20.5 (13–30) b | 93 (75.0) | 71 (57.3) | rE, Fl, ROSE | Needle, forceps |
|
Manley et al. 2023 40 |
Monarch | Pro | 20 | 20 | 14.5 (8–28) c | 12 (60.0) | NR | rE, Fl, nCLE, ROSE | Needle, forceps |
Abbreviations: BAL, bronchoalveolar lavage; CBCT, cone beam computed tomography; Fl, fluoroscopy; nCLE, needle‐based confocal laser endomicroscopy; NR, not reported; Pro, prospective; Retro, retrospective; rE, radial endobronchial ultrasound; ROSE, rapid on‐site evaluation.
Data are presented as mean ± standard deviation.
Data are presented as median (interquartile range).
Data are presented as median (range).
Quality assessment
Detailed results of the quality assessment are shown in Table S2. For patient selection, two studies were evaluated as having an unclear risk of bias because it was unclear whether they enrolled participants consecutively. For reference standard, one study was assessed to have a high risk of bias and a high concern regarding applicability because 6‐month radiographic follow‐up was used as the sole reference standard for some nonmalignant lesions. For flow and timing, one study was judged as having a high risk of bias because specific benign diagnoses were not confirmed by subsequent biopsy or imaging.
Diagnostic yield
The pooled diagnostic yield was 80.4% (95% CI: 75.7%–85.1%). The diagnostic yields of individual studies varied from 70.0% to 90.0%. A significant heterogeneity among studies was found (I 2 = 59%, p < 0.01) (Figure 2).
FIGURE 2.
Forest plot of the diagnostic yield.
Some studies reported diagnostic data for subgroups based on lesion characteristics (Table 2). The pooled diagnostic yield for lesions >30 mm was significantly greater than that for lesions ≤30 mm (92.4%, 95% CI: 86.8%–98.0% vs. 79.5%, 95% CI: 71.7%–87.3%, p = 0.03). The pooled diagnostic yields for lesions >20 and ≤ 20 mm were 88.4% (95% CI: 78.6%–98.1%) and 78.0% (95% CI: 72.0%–84.1%), respectively. However, no statistically significant difference was found (p = 0.09). Five studies reported diagnostic yields separately for lesions with concentric and eccentric rEBUS views, 31 , 33 , 34 , 39 , 40 resulting in a pooled diagnostic yield of 89.4% (95% CI: 84.8%–94.0%) versus 79.8% (95% CI: 73.5%–86.0%) (p = 0.01), respectively. Four studies reported diagnostic yields separately for lesions with and without a bronchus sign, 31 , 33 , 34 , 39 resulting in a pooled diagnostic yield of 82.9% (95% CI: 78.2%–87.6%) versus 71.9% (95% CI: 64.0%–79.8%) (p = 0.02), respectively. No statistically significant difference was found between diagnostic yields for lesions with different appearance (solid vs. nonsolid; 80.2%, 95% CI: 74.9%–85.6% vs. 77.6%, 95% CI: 69.6%–85.7%, p = 0.60) or location (upper lobe vs. nonupper lobe; 79.5%, 95% CI: 73.8%–85.2% vs. 78.9%, 95% CI: 71.7%–86.2%, p = 0.90).
TABLE 2.
Diagnostic yield by lesion characteristics.
| No. of studies (lesions) | Pooled diagnostic yield (95% CI) | Test for subgroup differences | |
|---|---|---|---|
| Lesion size, mm | |||
| ≤20 | 4 (176) | 78.0% (72.0%–84.1%) | p = 0.09 |
| >20 | 4 (156) | 88.4% (78.6%–98.1%) | |
| Lesion size, mm | |||
| ≤30 | 4 (267) | 79.5% (71.7%–87.3%) | p = 0.03 |
| >30 | 4 (90) | 92.4% (86.8%–98.0%) | |
| rEBUS view | |||
| Concentric | 5 (169) | 89.4% (84.8%–94.0%) | p = 0.01 |
| Eccentric | 5 (154) | 79.8% (73.5%–86.0%) | |
| Bronchus sign | |||
| Positive | 4 (242) | 82.9% (78.2%–87.6%) | p = 0.02 |
| Negative | 4 (124) | 71.9% (64.0%–79.8%) | |
| Lesion appearance | |||
| Solid | 3 (210) | 80.2% (74.9%–85.6%) | p = 0.60 |
| Nonsolid a | 3 (102) | 77.6% (69.6%–85.7%) | |
| Lesion location | |||
| Upper lobe | 3 (190) | 79.5% (73.8%–85.2%) | p = 0.90 |
| Nonupper lobe | 3 (122) | 78.9% (71.7%–86.2%) | |
Abbreviations: CI, confidence interval; rEBUS, radial endobronchial ultrasound.
Including: ground‐glass, mixed solid and ground‐glass, and cavitary lesions.
To explore potential sources of heterogeneity, subgroup analyses were performed (Table 3). Of the included studies, most studies only used conventional sampling methods (including the needle, forceps, brush, and bronchoalveolar lavage), except for one study that also used cryoprobes. With the use of cryoprobes, the diagnostic yield was statistically significantly higher than that without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). No significant heterogeneity was found within the subgroup with or without the use of cryoprobes. Hence, the use of cryoprobes was a possible source of heterogeneity. To confirm the tool‐in‐lesion, CBCT was used in two studies. However, the use of CBCT did not have a significant effect on the diagnostic yield. Similarly, subgroup analyses based on the study design, robotic platform, and mean/median lesion size also did not show significant differences.
TABLE 3.
Results of subgroup analyses.
| No. of studies (lesions) | Pooled diagnostic yield (95% CI) | Heterogeneity | Test for subgroup differences | |
|---|---|---|---|---|
| Platform | ||||
| Ion | 6 (507) | 82.5% (76.5%–88.5%) | I 2 = 68%, p < 0.01 | p = 0.11 |
| Monarch | 4 (218) | 75.8% (70.2%–81.5%) | I 2 = 0%, p = 0.88 | |
| Study design | ||||
| Pro | 5 (192) | 81.4% (76.0%–86.8%) | I 2 = 24%, P = 0.26 | p = 0.81 |
| Retro | 5 (533) | 79.8% (72.8%–86.8%) | I 2 = 76%, p < 0.01 | |
| Mean/median lesion size | ||||
| ≤20 mm | 6 (407) | 80.5% (76.7%–84.3%) | I 2 = 36%, P = 0.17 | p = 0.87 |
| >20 mm | 4 (318) | 79.6% (70.4%–88.8%) | I 2 = 77%, p < 0.01 | |
| Use of cryoprobes | ||||
| Yes | 1 (120) | 90.0% (83.2%–94.7%) | – | p < 0.01 |
| No | 9 (605) | 79.0% (75.8%–82.2%) | I 2 = 22%, p = 0.25 | |
| Use of CBCT | ||||
| Yes | 2 (79) | 80.6% (72.0%–89.3%) | I 2 = 24%, p = 0.25 | p = 0.89 |
| No | 8 (646) | 80.5% (75.1%–85.9%) | I 2 = 66%, p < 0.01 | |
Abbreviations: CBCT, cone beam computed tomography; CI, confidence interval; Pro, prospective; Retro, retrospective.
Safety
Complications were reported in all studies including 681 patients. The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%) (Figure 3). Pneumothorax was the most common complication, with an incidence of 1.8% (95% CI: 0.7%–2.9%). No instances of death were reported.
FIGURE 3.
Forest plot of the complication rate.
Publication bias and sensitivity analysis
Funnel plots of the diagnostic yield and complication rate showed symmetry, indicating the absence of publication bias (Figure S1 in the Supporting Information). Similarly, the Egger test also did not show publication bias (p > 0.05).
For the diagnostic yield and complication rate, none of the studies had an impact on the pooled results based on the sensitivity analysis results, indicating that our meta‐analysis was statistically stable (Figure S2 in the Supporting Information).
DISCUSSION
This meta‐analysis specifically evaluated RAB for the diagnosis of PPLs. Overall, the pooled diagnostic yield was 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric rEBUS view were associated with a statistically significantly higher diagnostic yield. The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%), demonstrating the excellent safety profile of RAB.
The pooled diagnostic yield in our meta‐analysis is comparable to previously published studies that reported pooled diagnostic yields of 76.5%–84.3% for RAB. 11 , 14 , 41 Despite the comparable results, in previous meta‐analyses, the diagnostic yields in the included studies were defined differently. Instead of directly synthesizing the diagnostic yields reported in individual studies, we extracted the actual results of RAB and reconstructed the diagnostic yields according to a uniform definition. Furthermore, we focused on the diagnostic performance of RAB and explored factors influencing its performance.
For traditionally challenging lesions, RAB appears to have an improved diagnostic yield compared to prior techniques. Although lesions with a concentric rEBUS view had a better diagnostic yield, the yield of 79.8% (95% CI: 73.5%–86.0%) for lesions with an eccentric rEBUS view was encouraging because it was considerably higher than the yield of 52.0% reported in the previous study. 42 Similarly, RAB had a favorable impact on the diagnostic yield for lesions without a bronchus sign. In prior publications, the diagnostic yield for such lesions was 39.2% to 52.4%, 42 , 43 , 44 compared to 71.9% (95% CI: 64.0%–79.8%) in this study. The diagnostic yield for lesions ≤20 mm was 78.0% (95% CI: 72.0%–84.1%), which was higher than 60.5% to 64.1% reported previously. 42 , 44
However, the disparity between navigational success and diagnostic yield is noticeable. 45 , 46 Since both robotic platforms rely on preoperative chest CT scan for navigation, this may be partly due to CT‐to‐body divergence. To overcome this problem, CBCT was used for tool‐in‐lesion confirmation before sample acquisition in two studies. Surprisingly, no statistically significant difference in the diagnostic yield was found in the subgroup analysis based on the use of CBCT. The TiLT+ technology of the Galaxy System provides a novel confirmation of tool‐in‐lesion without the need of CBCT. In a preclinical study conducted in porcine models, 95% tool‐in‐lesion was achieved as confirmed by CBCT. 10 More studies are expected to further investigate this novel technology. Adequate tissue acquisition is also critical for PPLs diagnosis. The cryoprobe is a novel sampling tool designed to improve tissue acquisition. 47 One included study used the cryoprobe during RAB, and a significantly higher diagnostic yield was obtained. However, the small number of included studies and the interstudy heterogeneity limit the comparability, and all of the included studies are observational and uncontrolled. The impact of tool‐in‐lesion confirmation using CBCT or other technologies and cryobiopsy on the diagnostic yield of RAB needs to be further evaluated.
This study had some limitations. First, to unify the definition of diagnostic yield, we had to exclude the studies that did not report sufficient data to calculate the diagnostic yield according to our definition. The problems associated with heterogeneous and incomplete outcomes reported by diagnostic accuracy studies were also mentioned in prior meta‐analyses. 41 , 48 Establishment of a standardized definition of the diagnostic outcomes and adherence to reporting guidelines for diagnostic accuracy studies (e.g., STARD 2015) may alleviate this phenomenon. 49 Second, conference abstracts were excluded in this meta‐analysis because it was hard to calculate the diagnostic yield and assess the study quality from the limited information. Since no publication bias was noted, the effect of this limitation on the results should be small. Third, the Galaxy System was not included in this meta‐analysis because no clinical data was reported when literature search was performed. More studies are needed to evaluate its performance. Fourth, our findings regarding the factors affecting the diagnostic performance of RAB should be viewed as exploratory due to the small sample size and the heterogeneity of settings among the included studies. Further high‐quality prospective studies still need to be conducted.
In conclusion, RAB is effective and safe in diagnosing PPLs. The diagnostic yield of RAB seems to be higher than that of prior guided bronchoscopic techniques. Lesions >30 mm, lesions with a bronchus sign, and lesions with a concentric rEBUS view are more likely to yield a diagnostic result. On the other hand, for lesions without some or all of these characteristics, RAB also seems to have an improved diagnostic yield compared to prior techniques. However, the exploration of RAB is still in its early phases. Further studies are still needed to evaluate the diagnostic value of RAB, compare the performance of RAB with other techniques, and determine the factors (e.g., lesion characteristics, auxiliary techniques, sampling methods) affecting the diagnostic performance of RAB.
AUTHOR CONTRIBUTIONS
Chunxi Zhang: Methodology, formal analysis, data curation, visualization, writing – original draft preparation. Fangfang Xie: Methodology, formal analysis, data curation, visualization, writing–review and editing. Runchang Li: Methodology, formal analysis, data curation. Ningxin Cui: Methodology, formal analysis, data curation. Felix J. F. Herth: Conceptualization, project administration, supervision, writing–review and editing. Jiayuan Sun: Conceptualization, project administration, supervision, funding acquisition, writing – review and editing. All authors read and approved the final manuscript.
CONFLICT OF INTEREST STATEMENT
The authors declare that there is no conflict of interest.
Supporting information
Data S1. Supporting Information.
ACKNOWLEDGMENTS
This work was supported by Science and Technology Commission of Shanghai Municipality (20S31905200, 21XD1434400), Joint Clinical Research Center of Institute of Medical Robotics‐Chest Hospital, Shanghai Jiao Tong University (IMR‐XKH202102).
Zhang C, Xie F, Li R, Cui N, Herth FJF, Sun J. Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis. Thorac Cancer. 2024;15(7):505–512. 10.1111/1759-7714.15229
Chunxi Zhang and Fangfang Xie contributed equally to this work.
[Correction added on 26 February 2024, after first online publication: the footnote has been revised to show that ‘Chunxi Zhang and Fangfang Xie’ are equal contributors and share first co‐authorship. Also, ‘Felix J.F. Herth and Jiayuan Sun’ are co‐corresponding authors.]
Contributor Information
Felix J. F. Herth, Email: Felix.Herth@med.uni-heidelberg.de.
Jiayuan Sun, Email: xkyyjysun@163.com.
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Data S1. Supporting Information.