The ENCOMPASS study is a post-market, multicenter, randomized controlled trial comparing two established approaches for obtaining a biopsy of small pulmonary nodules (≤2 cm): CT-guided percutaneous lung nodule biopsy and shape-sensing robotic-assisted bronchoscopy with cone-beam CT (ssRAB with CBCT).
CT-guided percutaneous biopsy and ssRAB with CBCT are two types of lung nodule biopsy procedures routinely used in clinical practice. The study is designed to evaluate the diagnostic efficacy and safety of ssRAB with CBCT compared with CT-guided percutaneous lung nodule biopsy in adults requiring diagnostic evaluation of a pulmonary nodule. The co-primary objectives are to assess non-inferiority of diagnostic efficacy and superiority of safety. The primary endpoints are diagnostic efficacy and the rate of peri-procedural pneumothorax (with or without intervention) associated with the assigned biopsy approach. Eligible participants will be randomized 1:1 to either ssRAB with CBCT or CT-guided percutaneous lung nodule biopsy. If the clinical team determines that the assigned procedure is not suitable, the participant will receive the most appropriate standard of care instead. Both biopsy procedures will be performed according to routine clinical practice, and no experimental devices or procedures will be used. Participants will be followed for up to 12 months through medical record review and routine clinical follow-up. Patient-reported quality of life and, optionally, work status will be assessed using questionnaires at multiple time points. No research-specific assessments, burdensome tests, or advanced imaging outside of standard care will be performed. A chest X-ray will be required following the biopsy procedure, consistent with routine clinical practice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
550
A bronchoscopic lung nodule biopsy procedure performed using shape-sensing robotic-assisted bronchoscopy with cone-beam CT guidance as clinically indicated and according to standard clinical practice.
A percutaneous lung nodule biopsy procedure performed under CT imaging guidance according to standard clinical practice.
Basel University Hospital
Basel, Canton of Basel-City, Switzerland
RECRUITINGUniversity College London Hospitals NHS Foundation
London, United Kingdom
RECRUITINGDiagnostic Efficacy of the Assigned Biopsy Procedure
Diagnostic efficacy will be calculated as the proportion of patients who receive their assigned treatment multiplied by diagnostic yield of their assigned treatment.
Time frame: At the index procedure
Peri-Procedural Pneumothorax Rate
Rate of peri-procedural pneumothorax related to the assigned index biopsy procedure, including pneumothorax identified on routine post-procedure imaging and clinically relevant pneumothorax requiring intervention or escalation of care.
Time frame: From procedure to 7 days (or until subsequent intervention, whichever occurs first).
Diagnostic Yield
Diagnostic yield of the index biopsy procedure, defined according to American Thoracic Society (ATS) and American College of Chest Physicians (ACCP) guidance
Time frame: At the index procedure
Sensitivity for Malignancy
Sensitivity of the index biopsy procedure for the diagnosis of malignancy, based on final diagnosis established through 1-year follow-up
Time frame: Through 1 year post-procedure
Negative Predictive Value
Negative predictive value of the index biopsy procedure based on final diagnosis established through 1-year follow-up
Time frame: Through 1 year post-procedure
Diagnostic accuracy
Diagnostic accuracy of the index biopsy procedure based on final diagnosis established through 1-year follow-up.
Time frame: Through 1 year post-procedure
Adequacy of Specimen for Molecular and/or Immunohistochemistry Testing
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Proportion of biopsy specimens considered adequate for molecular profiling and/or immunohistochemistry (IHC) testing.
Time frame: At the index procedure
Procedure-Related Adverse Events
Incidence of procedure-related adverse events.
Time frame: Through 30 days post-procedure or until the first invasive diagnostic or therapeutic intervention, whichever occurs first
Procedure-related serious adverse events.
Incidence of procedure-related serious adverse events.
Time frame: Through 30 days post-procedure or until the first invasive diagnostic or therapeutic intervention, whichever occurs first
All-Cause Mortality
Incidence of all-cause mortality among study participants.
Time frame: Through study exit
Length of Stay for Procedure-Related Adverse Events
Duration of hospitalization attributable to procedure-related adverse events
Time frame: From the date of hospitalization for a procedure-related adverse event until hospital discharge, for events occurring up to 30 days following the index procedure