Abstract
Although robotic-assisted bronchoscopy (RAB) primarily aims to diagnose early-stage lung cancer, many pulmonary nodules stem from benign causes, including atypical infections (i.e., Coccidioides, Aspergillus, and non-tuberculous mycobacteria). Data on prevalence of atypical infections in patients undergoing RAB with biopsy of pulmonary nodules are limited.
We aimed to determine the prevalence of atypical infections in patients undergoing RAB with biopsy of pulmonary nodules in a Coccidioides endemic area. Further, we compared demographic and clinical characteristics as well as complication rates between three patient groups based on pathology diagnosis: malignancy, infection, or both malignancy and infection.
This single-center, retrospective study examined 526 patients who underwent RAB with a shape-sensing platform at our institution from June 2021 through December 2023.
Of the 526 patients, 261 (49.6%) had malignancy without infection, 107 (20.3%) had cultures positive for infection without malignancy, and 35 patients (6.65%) were diagnosed with both malignancy and a co-existing bacterial and/or atypical infection. Coccidioides serology (IgG) or clinical history was significantly more prevalent in the infection without malignancy group (32.7%) and the malignancy with infection group (42.9%) compared to the malignancy-only group (0%; p<0.001). Complication rates (pneumothorax, bleeding, and hospitalization) did not differ significantly between groups. In a subgroup analysis, 73 patients (13.9%) with granulomatous inflammation on pathology had higher rates of positive fungal (p=0.002), Aspergillus (p=0.042), and acid-fast bacilli (p<.001) cultures compared to patients in the non-granuloma group. Positive cultures of acid-fast bacilli, Coccidioides, or Aspergillus also had granulomatous inflammation in 76%, 29%, and 29% of cases, respectively. Fifty-two patients had more than one positive culture result.
This study highlights the importance of obtaining bronchoscopy cultures in patients undergoing RAB, especially when rapid on-site evaluation of the pulmonary nodule biopsy does not reveal malignancy.