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Assessment of Diagnostic Yield Using a Robotic Navigational Bronchoscopy System With CBCT

Primary Purpose

Lung Cancer

Status
Recruiting
Phase
Not Applicable
Locations
Netherlands
Study Type
Interventional
Intervention
Biopsy with the Robotic- Ion Endoluminal System with Adjunct Real-time Imaging
Sponsored by
Intuitive Surgical
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Lung Cancer focused on measuring Lung Cancer, Biopsy, Bronchoscopy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patient is aged 18 years or older at time of consent. Patient is suitable for elective nodule biopsy via bronchoscopy under general anesthesia per Investigator's discretion. Patient has solid or semi-solid pulmonary nodule(s) of ≥6 mm and ≤3 cm in largest dimension (based on pre-procedure CT scan). Pulmonary nodule(s) intended for biopsy during the study procedure is (are) located at least 4 (≥4) airway generations out (trachea = generation 0, e.g. subsegmental bronchi or beyond) based on pre-procedure CT scan. Patient has a moderate to high risk of lung cancer based on clinical, demographic, and radiologic information or with suspected metastatic disease. High risk for malignancy patients are eligible if a biopsy is required or requested prior to intervention. Patient is willing and able to give written informed consent for Clinical Investigation participation. Patient is not legally incapacitated or in a legal/court ordered institution. Exclusion Criteria: Patient has a lack of fitness or exercise capacity to undergo bronchoscopy under general anesthesia as determined by Investigator prior to procedure. Patient with type 1 pure ground glass opacity target nodule(s) intended for biopsy during study procedure. Presence of bullae(s) with a size of >1 cm on pre-procedure CT scan located in close proximity to target nodule(s) and near the planned trajectory of the biopsy instruments. Presence of mediastinal nodal disease on pre-procedure CT or PET-CT scan. Patient with American Society of Anesthesiologists Classification (ASA) ≥4. Patient underwent a pneumonectomy. Any invasive concomitant procedure (outside of lymph node staging) not related to the pulmonary nodule(s) or suspected disease state. Female patient of child-bearing potential who is unable to take adequate contraceptive precautions or is known to be pregnant, and/or breast feeding. Patient has a documented medical history of uncorrectable coagulopathy, bleeding, or platelet disorder. Patient is taking antiplatelet or anticoagulant medications that cannot be stopped per standard practice. Patient is currently participating or has participated in another Clinical Investigation within the past 30 days, such as interventional trials or trials with experimental agents or agents of unknown risk, that may affect the endpoints of this Clinical Investigation. Investigator, in their professional opinion, has decided that it is in the patient's best interest to not participate in the Clinical Investigation. Patient is not willing to comply with post study procedure participation requirements.

Sites / Locations

  • Radboud University Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Robotic Navigational Bronchoscopy

Arm Description

Patients undergoing biopsy with the Ion Endoluminal System

Outcomes

Primary Outcome Measures

Diagnostic yield of sample(s) obtained (post learning curve)
Diagnostic yield is the number of nodules in which the procedure was diagnostic (either malignant or non-malignant), relative to the total number of attempted navigation procedures

Secondary Outcome Measures

Sensitivity for malignancy of sample(s) obtained
Sensitivity for malignancy of samples is assessed as the number of subjects with a malignant condition determined through the study procedure (true positives) relative to the number of subjects with an underlying malignant disease state (true positives + false negatives). The subjects underlying disease state will be determined by follow-up diagnostic interventions or treatment decisions/interventions, and/or radiographic follow-up.
Rate of achieving biopsy tool position within the targeted nodule(s) as confirmed by CBCT 3D imaging
The rate of Tool in Nodule is how often the biopsy tool to sample the tissue is positioned directly within the nodule before the sample is taken. If biopsy forceps are used, it is how often the instrument is surrounding the nodule before the sample is taken.

Full Information

First Posted
September 20, 2023
Last Updated
October 10, 2023
Sponsor
Intuitive Surgical
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1. Study Identification

Unique Protocol Identification Number
NCT06084208
Brief Title
Assessment of Diagnostic Yield Using a Robotic Navigational Bronchoscopy System With CBCT
Official Title
A Prospective Investigation to Assess the Diagnostic Yield of Using a Robotic Navigational Bronchoscopy System With Adjunct Real-time Imaging
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 15, 2023 (Actual)
Primary Completion Date
March 30, 2025 (Anticipated)
Study Completion Date
May 31, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Intuitive Surgical

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of this research study is to evaluate the effectiveness of the ION endoluminal system at reaching and obtaining biopsies from lung nodules when used in combination with 3-dimensional imaging such as CT scans. The learning curve of the procedure will be assessed and data on safety will also be collected.
Detailed Description
This is a prospective, interventional, single-centre, dual-arm study which will be conducted in the Netherlands and will involve up to 131 patients undergoing a pulmonary nodule biopsy using the Ion Endoluminal System in conjunction with 3D imaging. Outcomes in these patients will be compared to 91 propensity score matched Cone Beam CT- Navigational Bronchoscopy (CBCT-NB) controls obtained from the site's existing CBCT-NB database. The objectives of the study are focused on evaluating the procedure learning curve and characteristics of the pulmonary nodule biopsy procedure, including diagnostic yield, rate of tool in nodule, sensitivity for malignancy and safety. A learning curve analysis will be retrospectively performed to determine when both operators have reached competency with the Ion Endoluminal System. Criteria for passing the learning curve for measuring proficiency in the CUSUM will be diagnostic yield. Additional parameters like tool in lesion and procedure durations will also be monitored. All subjects will be followed up at 1 week and 1 month after the procedure. If the biopsy did not provide a diagnosis or did not show cancer, then they will have further follow up at 6 and 13 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer
Keywords
Lung Cancer, Biopsy, Bronchoscopy

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
A prospective, single-center, dual-arm, interventional study, where data from 131 recruited patients undergoing a Robotic Navigational Bronchoscopy System procedure with CBCT are compared to 91 matched Navigation Bronchoscopy with CBCT controls.
Masking
None (Open Label)
Allocation
N/A
Enrollment
131 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Robotic Navigational Bronchoscopy
Arm Type
Experimental
Arm Description
Patients undergoing biopsy with the Ion Endoluminal System
Intervention Type
Device
Intervention Name(s)
Biopsy with the Robotic- Ion Endoluminal System with Adjunct Real-time Imaging
Intervention Description
Biopsy with the Robotic- Navigational Bronchoscopy System with Cone Beam Computed Tomography (CBCT)
Primary Outcome Measure Information:
Title
Diagnostic yield of sample(s) obtained (post learning curve)
Description
Diagnostic yield is the number of nodules in which the procedure was diagnostic (either malignant or non-malignant), relative to the total number of attempted navigation procedures
Time Frame
Up to 13 months post procedure]
Secondary Outcome Measure Information:
Title
Sensitivity for malignancy of sample(s) obtained
Description
Sensitivity for malignancy of samples is assessed as the number of subjects with a malignant condition determined through the study procedure (true positives) relative to the number of subjects with an underlying malignant disease state (true positives + false negatives). The subjects underlying disease state will be determined by follow-up diagnostic interventions or treatment decisions/interventions, and/or radiographic follow-up.
Time Frame
Up to 13 months post procedure
Title
Rate of achieving biopsy tool position within the targeted nodule(s) as confirmed by CBCT 3D imaging
Description
The rate of Tool in Nodule is how often the biopsy tool to sample the tissue is positioned directly within the nodule before the sample is taken. If biopsy forceps are used, it is how often the instrument is surrounding the nodule before the sample is taken.
Time Frame
At time of the biopsy procedure (Day 0)
Other Pre-specified Outcome Measures:
Title
Rate of procedure-related Adverse Events through 30 days post-procedure
Description
The study's safety endpoint is the rate of procedure-related Adverse Events through 30 days post-procedure
Time Frame
30 days
Title
Procedure-related characteristics
Description
Procedure time (from catheter inserted into the patient's airways to catheter removed from the patient's airways) will be reported
Time Frame
At time of the biopsy procedure (Day 0)
Title
rEBUS visualization characteristics
Description
The frequency of use of a concentric rEBUS visualization view during the biopsy will be summarized.
Time Frame
At time of the biopsy procedure (Day 0)
Title
Biopsy workflow
Description
The sequence of biopsy tools used will be summarized.
Time Frame
At time of the biopsy procedure (Day 0)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is aged 18 years or older at time of consent. Patient is suitable for elective nodule biopsy via bronchoscopy under general anesthesia per Investigator's discretion. Patient has solid or semi-solid pulmonary nodule(s) of ≥6 mm and ≤3 cm in largest dimension (based on pre-procedure CT scan). Pulmonary nodule(s) intended for biopsy during the study procedure is (are) located at least 4 (≥4) airway generations out (trachea = generation 0, e.g. subsegmental bronchi or beyond) based on pre-procedure CT scan. Patient has a moderate to high risk of lung cancer based on clinical, demographic, and radiologic information or with suspected metastatic disease. High risk for malignancy patients are eligible if a biopsy is required or requested prior to intervention. Patient is willing and able to give written informed consent for Clinical Investigation participation. Patient is not legally incapacitated or in a legal/court ordered institution. Exclusion Criteria: Patient has a lack of fitness or exercise capacity to undergo bronchoscopy under general anesthesia as determined by Investigator prior to procedure. Patient with type 1 pure ground glass opacity target nodule(s) intended for biopsy during study procedure. Presence of bullae(s) with a size of >1 cm on pre-procedure CT scan located in close proximity to target nodule(s) and near the planned trajectory of the biopsy instruments. Presence of mediastinal nodal disease on pre-procedure CT or PET-CT scan. Patient with American Society of Anesthesiologists Classification (ASA) ≥4. Patient underwent a pneumonectomy. Any invasive concomitant procedure (outside of lymph node staging) not related to the pulmonary nodule(s) or suspected disease state. Female patient of child-bearing potential who is unable to take adequate contraceptive precautions or is known to be pregnant, and/or breast feeding. Patient has a documented medical history of uncorrectable coagulopathy, bleeding, or platelet disorder. Patient is taking antiplatelet or anticoagulant medications that cannot be stopped per standard practice. Patient is currently participating or has participated in another Clinical Investigation within the past 30 days, such as interventional trials or trials with experimental agents or agents of unknown risk, that may affect the endpoints of this Clinical Investigation. Investigator, in their professional opinion, has decided that it is in the patient's best interest to not participate in the Clinical Investigation. Patient is not willing to comply with post study procedure participation requirements.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Carine Van den Abeele
Phone
+41 79 656 95 48
Email
Carine.vandenabeele@intusurg.com
First Name & Middle Initial & Last Name or Official Title & Degree
Martha Bean
Phone
+49 172 899 4278
Email
Martha.Bean@intusurg.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sundeep Master
Organizational Affiliation
Intuitive Surgical
Official's Role
Study Director
Facility Information:
Facility Name
Radboud University Medical Center
City
Nijmegen
ZIP/Postal Code
6500 HB
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Aniek Bruinen, Msc
Email
researchunit.long@radboudumc.nl
First Name & Middle Initial & Last Name & Degree
Erik HF van der Heijden, MD, PhD
First Name & Middle Initial & Last Name & Degree
Roel LJ Verhoeven, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
No plan to share IPD.

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Assessment of Diagnostic Yield Using a Robotic Navigational Bronchoscopy System With CBCT

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