Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield

被引:25
作者
Diez-Ferrer, Marta [1 ]
Morales, Arturo [2 ]
Tebe, Cristian [3 ]
Cubero, Noelia [1 ]
Lopez-Lisbona, Rosa [1 ]
Padrones, Susana [1 ]
Aso, Samantha [1 ]
Dorca, Jordi [1 ]
Gil, Debora [4 ]
Rosell, Antoni [1 ]
Minchole, Elisa
Zaccour, Antonio Botero
Tazi, Rachid
Sanchez, Carles
Borras, Agnes
Esteban-Lansaque, Antonio
机构
[1] Univ Barcelona, Dept Resp Med, Univ Hosp Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Lhospitalet De Llobregat, Spain
[2] Pontificia Univ Catolica Chile, Fac Med, Dept Resp Dis, Santiago, Chile
[3] Bellvitge Biomed Res Inst IDIBELL, Dept Stat, Lhospitalet De Llobregat, Spain
[4] Autonomous Univ Barcelona, Comp Vis Ctr, Bellaterra, Spain
关键词
Lung cancer; Peripheral lung lesion; Diagnosis; Bronchoscopy; Ultrathin bronchoscopy; Virtual bronchoscopic navigation; PERIPHERAL PULMONARY-LESIONS; BRONCHIAL GENOMIC CLASSIFIER; LUNG-CANCER; COMBINATION; NODULES;
D O I
10.1159/000493270
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs = 20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources. (C) 2018 S. Karger AG, Basel
引用
收藏
页码:252 / 258
页数:7
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