Lung cancer is one of the deadliest cancers in Europe, killing around a quarter of a million people annually. Survival rates are much higher when tumors are diagnosed at an early stage, but the tiniest cancers are often difficult to reach and confirm. These small tumors frequently develop in parts of the lung that lack connecting airways, making them inaccessible to traditional bronchoscopes. Now, the tiniest lung tumors that are hardest to reach can be diagnosed with a robot-assisted bronchoscope.

Researchers at University Hospital Zürich (Zürich, Switzerland) have tested a robot-assisted bronchoscope equipped with cone-beam CT (CBCT) scanning technology to locate and biopsy tumors deep within the lungs. Unlike conventional methods, which rely on thin bronchoscopes and X-ray guidance, this system uses robotic navigation combined with 3D imaging to reach challenging areas. The technology allows physicians to precisely target suspicious growths that were previously out of reach for biopsy.

In a randomized clinical trial involving 78 patients with 127 abnormal lung growths, only 23% of tumors could be biopsied using the standard method. In contrast, more than 84% were successfully reached and sampled using the robot-assisted system. When patients who initially failed biopsy with the traditional technique were re-tested using the new system, success rates climbed to nearly 93%.

The trial revealed that 68 patients were diagnosed with lung cancer, 50 of them at stage 1A—the earliest stage when treatment is most effective. These results, presented at the European Respiratory Society (ERS) Congress, show that robot-assisted bronchoscopy with CBCT achieved a diagnostic yield more than three times higher than conventional methods. A second study also showed the system outperformed other advanced navigation technologies, including 3D airway modeling and electromagnetic navigation bronchoscopy.

Although the system costs around EURO 1 million and adds approximately EURO 2,000 per procedure, researchers argue the benefits justify the investment in centers treating many patients with small, hard-to-reach lesions. Going forward, they plan to explore whether diagnosis and treatment can be combined in a single procedure, for example by adding radio waves or microwaves to destroy tumor tissue immediately after detection.

“This research shows that robot-assisted technology can help diagnose many more of these tiny tumors in hard-to-reach parts of the lungs,” said Professor Aleš Rozman, Chair of the European Respiratory Society’s expert group on interventional pulmonology. “It’s vital that we carry out this type of gold-standard research so that we can justify the significant additional cost of installing and using this equipment.”

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