Needle-Based Confocal Laser Endomicroscopy for Diagnosis of Lung Cancer in Patients With Peripheral Pulmonary Nodules

PRIMARY OBJECTIVE: I. To compare the first-pass diagnostic yield of the sequential needle passes (rapid on-site evaluation \[ROSE\]) between the robotic-nCLE-TBNA arm and the robotic-guided arm in peripheral pulmonary nodule (PPNs). SECONDARY OBJECTIVES: I. To compare the per-patient diagnostic yield (cumulative pass diagnostic yield: cumulative number of passes until five cumulated passes) of robotic-nCLE-guided TBNA to that of robotic-guided TBNA in PPNs. II. To compare the proportion of patients with lung cancer treatment in the robotic-nCLE-guided TBNA arm to that of the robotic-guided TBNA arm in PPNs. III. To compare the proportion of patients with follow-up (video-assisted thoracoscopic surgery \[VATS\]) or transthoracic needle aspiration (TTNA) or TBNA procedures in the robotic-nCLE-guided TBNA arm to that of the robotic-guided TBNA arm in PPNs. IV. To compare the number of passes needed to obtain a final diagnosis of robotic-nCLE-guided TBNA to that of robotic-guided TBNA in PPNs. V. To assess the diagnostic performance (sensitivity, specificity, positive predictive value \[PPV\], negative predictive value \[NPV\], accuracy) of the sequential cumulative nCLE passes and the sequential cumulative ROSE passes using the final diagnosis as a reference. VI. To assess the feasibility by obtaining adequate confocal laser endomicroscopy (CLE) video footage in \> 80% of the PPN punctures. VII. To assess the safety of nCLE imaging, as defined by: VIIa. The number and frequency of all adverse events (AE)/serious adverse events (SAE) from the start of the procedure until end of 12-month follow-up; VIIb. The number and frequency of nCLE procedure-related AE/SAE from the start of the procedure until end of 12-month follow-up. VIII. To assess the reproducibility of nCLE criteria to the reference standard. Three nCLE characteristics for the detection of malignancy were identified during Wijmans et al. study: VIIIa. Dark enlarged pleomorphic cells; VIIIb. Dark cell clusters consist of overlapping cell structures ('dark clumps') and; VIIIc. Continuous movement of the cells in one direction ('directional streaming'). IX. To create an nCLE image atlas for malignant characteristics in PPNs. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients undergo robotic EBUS TBNA on study. ARM II: Patients undergo EBUS TBNA, nCLE, and receive fluorescein intravenously (IV) on study.