Merritt Scott A, Gibbs Jason D, Yu Kun-Chang, Patel Viral, Rai Lav, Cornish Duane C, Bascom Rebecca, Higgins William E
College of Engineering, Penn State University, University Park, PA.
Endographics Imaging Systems, Inc., State College, PA.
Chest. 2008 Nov;134(5):1017-1026. doi: 10.1378/chest.08-0603. Epub 2008 Jun 26.
Ultrathin bronchoscopy guided by virtual bronchoscopy (VB) techniques show promise for the diagnosis of peripheral lung lesions. In a phantom study, we evaluated a new real-time, VB-based, image-guided system for guiding the bronchoscopic biopsy of peripheral lung lesions and compared its performance to that of standard bronchoscopy practice.
Twelve bronchoscopists of varying experience levels participated in the study. The task was to use an ultrathin bronchoscope and a biopsy forceps to localize 10 synthetically created lesions situated at varying airway depths. For route planning and guidance, the bronchoscopists employed either standard bronchoscopy practice or the real-time image-guided system. Outcome measures were biopsy site position error, which was defined as the distance from the forceps contact point to the ground-truth lesion boundary, and localization success, which was defined as a site identification having a biopsy site position error of < or = 5 mm.
Mean (+/- SD) localization success more than doubled from 43 +/- 16% using standard practice to 94 +/- 7.9% using image guidance (p < 10(-15) [McNemar paired test]). The mean biopsy site position error dropped from 9.7 +/- 9.1 mm for standard practice to 2.2 +/- 2.3 mm for image guidance. For standard practice, localization success decreased from 56% for generation 3 to 4 lesions to 31% for generation 6 to 8 lesions and also decreased from 51% for lesions on a carina vs 23% for lesions situated away from a carina. These factors were far less pronounced when using image guidance, as follows: success for generation 3 to 4 lesions, 97%; success for generation 6 to 8 lesions, 91%; success for lesions on a carina, 98%; success for lesions away from a carina, 86%. Bronchoscopist experience did not significantly affect performance using the image-guided system.
Real-time, VB-based image guidance can potentially far exceed standard bronchoscopy practice for enabling the bronchoscopic biopsy of peripheral lung lesions.
虚拟支气管镜（VB）技术引导下的超细支气管镜检查在周围型肺病变诊断方面显示出前景。在一项模型研究中，我们评估了一种基于VB的新型实时图像引导系统，用于引导周围型肺病变的支气管镜活检，并将其性能与标准支气管镜操作进行比较。
12名经验水平各异的支气管镜医师参与了该研究。任务是使用超细支气管镜和活检钳定位10个位于不同气道深度的人工制造的病变。为了进行路径规划和引导，支气管镜医师采用标准支气管镜操作或实时图像引导系统。结果指标包括活检部位位置误差，定义为活检钳接触点到真实病变边界的距离，以及定位成功率，定义为活检部位位置误差≤5mm的部位识别。
平均（±标准差）定位成功率从标准操作时的43±16%增加到图像引导时的94±7.9%，增加了一倍多（p<10⁻¹⁵[McNemar配对检验]）。平均活检部位位置误差从标准操作时的9.7±9.1mm降至图像引导时的2.2±2.3mm。对于标准操作，定位成功率从第3至4代病变的56%降至第6至8代病变的31%，并且从隆突处病变的51%降至远离隆突处病变的23%。使用图像引导时，这些因素的影响要小得多，具体如下：第3至4代病变的成功率为97%；第6至8代病变的成功率为91%；隆突处病变的成功率为98%；远离隆突处病变的成功率为86%。支气管镜医师的经验对使用图像引导系统的性能没有显著影响。
基于VB的实时图像引导在实现周围型肺病变的支气管镜活检方面可能远远超过标准支气管镜操作。
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