Department of Radiology, Kasimpasa Military Hospital, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2012 Dec;16(14):1951-60.
We aimed to put forward the contribution of virtual bronchoscopy in the determination and diagnosis of tracheobronchial system pathologies. We compared the data obtained from PET/CT and virtual bronchoscopy (VB) with the fiberoptic bronchoscopy (FOB) data of the cases with a diagnosis or pre-diagnosis of lung tumor.
A total of 261 (male=238, female=23) lung cancer cases with a mean age of 53±7.3 years (range =35-77 years), who had undergone FOB and had bronchoalveolar lavage and/or biopsy results, were included in this multicenter, prospective study conducted between 2006 and 2008. FOB data confirmed with cytohistopathology were considered as the gold standard. Five cases that had peripheral lesions, with negative cytopathological results were excluded from the study. Positron emission tomography images were fused with 16/slice multi-detector computed tomography system images (Discovery ST PET/16 slice CT fusion system HPOWER 60; General Electric Medical Systems, Milwaukee, WI, USA). Thereafter, all of the cases were evaluated with virtual bronchoscopy, using a special multidisplay workstation with multiplanar reformatting (MPR) and minimum intensity projection (MINIP) to see the fused images simultaneously. The data obtained with both virtual bronchoscopy (PET/CT VB) and FOB in different centers were recorded, and the evaluation and comparison of these data were done by an independent researcher. The sensitivity, specificity, and positive and negative predictive values of making an accurate diagnosis and defining concomitant pathologies by both methods, were calculated.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of VB and PET/CT-VB in determining the segment involved by malignancy were as follows, 91%, 83%, 94%, 77%, and 89%, and 95%, 97%, 99%, 87%, and 96%, respectively.
The sensitivity of PET/CT-VB in determining the involved tracheobronchial segment(s) in malignancy and concomitant pathologies in cases with lung tumor was remarkably higher than that with CT-VB. Therefore, PET/CT-VB is recommended to be included in routine lung cancer examinations since it provides similar outcomes to that of FOB+cytohistopathological examination.
我们旨在提出虚拟支气管镜检查在确定和诊断气管支气管系统病变中的作用。我们将 PET/CT 和虚拟支气管镜（VB）获得的数据与经纤维支气管镜（FOB）诊断或预诊断为肺癌的病例数据进行比较。
2006 年至 2008 年期间，我们进行了一项多中心前瞻性研究，共纳入 261 例（男性 238 例，女性 23 例）平均年龄为 53±7.3 岁（范围 35-77 岁）的肺癌病例，这些病例均接受了 FOB，并进行了支气管肺泡灌洗和/或活检。FOB 数据经细胞组织病理学证实为金标准。由于 5 例患者存在外周病变且细胞学检查结果为阴性，因此将其排除在研究之外。将正电子发射断层扫描图像与 16 层多探测器计算机断层扫描系统图像（Discovery ST PET/16 层 CT 融合系统 HPOWER 60；美国通用电气医疗系统公司）融合。此后，所有病例均使用具有多平面重建（MPR）和最小密度投影（MINIP）的特殊多显示器工作站进行虚拟支气管镜检查，以便同时查看融合图像。记录在不同中心获得的虚拟支气管镜（PET/CT-VB）和 FOB 数据，并由独立研究员对这些数据进行评估和比较。计算两种方法准确诊断和确定伴随病变的敏感性、特异性、阳性预测值、阴性预测值和准确率。
VB 和 PET/CT-VB 确定恶性肿瘤累及节段的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为 91%、83%、94%、77%和 89%，95%、97%、99%、87%和 96%。
与 CT-VB 相比，PET/CT-VB 确定肺癌病例中恶性肿瘤累及的气管支气管节段和伴随病变的敏感性显著更高。因此，建议将 PET/CT-VB 纳入常规肺癌检查，因为它与 FOB+细胞组织病理学检查提供相似的结果。
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