Vachani, Anil, Murgu, Septimiu Dan, Maldonado, Fabien, Laxmanan, Balaji, Amos, Tony B., Zhou, Meijia, Khan, Faisal, Cumbo-Nacheli, Gustavo, Seaman, Joseph, & Tewari, Pranjal. (2025). Comparison of diagnostic bronchoscopy single-arm trials using an advanced optimization approach for indirect comparisons with partial individual patient data. Respiration. https://doi.org/10.1159/000547686
Lung biopsies can be performed using different technologies, but comparing their effectiveness is difficult because most studies only look at one method at a time. These single-arm studies can be biased by differences in patient populations, hospital practices, and even how “diagnostic yield” (the success rate of getting a clear diagnosis) is defined. Individual patient data can help adjust for these differences, but such data is often available for only one study. This raises the question: how different are the results when comparing two single-arm studies that used different bronchoscopy technologies?
In this study, a matching-adjusted indirect comparison was performed between two types of bronchoscopy: robotic-assisted bronchoscopy (RAB) and electromagnetic navigation bronchoscopy (ENB). The RAB data came from a retrospective multicenter cohort, while the ENB data came from a prospective multicenter clinical study. Diagnostic yield was calculated in two ways. In method 1, yield was measured at 12 months after the initial biopsy, excluding patients lost to follow-up. In method 2, yield was defined more strictly, measured at the time of bronchoscopy, with nonspecific benign findings excluded.
The results showed that RAB had a significantly higher diagnostic yield than ENB under both definitions. With method 1, RAB achieved 87.1% compared to 72.9% for ENB (p < 0.001). With method 2, RAB achieved 64.9% compared to 50.6% for ENB (p = 0.001).
In conclusion, this analysis shows that RAB provides a higher diagnostic yield than ENB, regardless of how yield is defined. However, the study also highlights how definitions and confounding factors can strongly influence outcomes, underscoring the importance of randomized controlled trials to provide more definitive comparisons.
Fig. 1.
Pre-weighting and post-weighting reported 12-month diagnostic yield for RAB and ENB using the same definition for diagnostic yield as was used in the NAVIGATE clinical trial (method 1).