Fiorelli Alfonso, Raucci Antonio, Cascone Roberto, Reginelli Alfonso, Di Natale Davide, Santoriello Carlo, Capuozzo Antonio, Grassi Roberto, Serra Nicola, Polverino Mario, Santini Mario
Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy.
Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy.
Interact Cardiovasc Thorac Surg. 2017 Apr 1;24(4):567-575. doi: 10.1093/icvts/ivw404.
We proposed a new virtual bronchoscopy tool to improve the accuracy of traditional transbronchial needle aspiration for mediastinal staging.
Chest-computed tomographic images (1 mm thickness) were reconstructed with Osirix software to produce a virtual bronchoscopic simulation. The target adenopathy was identified by measuring its distance from the carina on multiplanar reconstruction images. The static images were uploaded in iMovie Software, which produced a virtual bronchoscopic movie from the images; the movie was then transferred to a tablet computer to provide real-time guidance during a biopsy. To test the validity of our tool, we divided all consecutive patients undergoing transbronchial needle aspiration retrospectively in two groups based on whether the biopsy was guided by virtual bronchoscopy (virtual bronchoscopy group) or not (traditional group). The intergroup diagnostic yields were statistically compared.
Our analysis included 53 patients in the traditional and 53 in the virtual bronchoscopy group. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the traditional group were 66.6%, 100%, 100%, 10.53% and 67.92%, respectively, and for the virtual bronchoscopy group were 84.31%, 100%, 100%, 20% and 84.91%, respectively. The sensitivity ( P = 0.011) and diagnostic accuracy ( P = 0.011) of sampling the paratracheal station were better for the virtual bronchoscopy group than for the traditional group; no significant differences were found for the subcarinal lymph node.
Our tool is simple, economic and available in all centres. It guided in real time the needle insertion, thereby improving the accuracy of traditional transbronchial needle aspiration, especially when target lesions are located in a difficult site like the paratracheal station.
我们提出了一种新的虚拟支气管镜工具，以提高传统经支气管针吸活检术用于纵隔分期的准确性。
使用Osirix软件重建胸部计算机断层扫描图像（厚度为1毫米），以生成虚拟支气管镜模拟图像。通过在多平面重建图像上测量目标肿大淋巴结与隆突的距离来确定目标。将静态图像上传到iMovie软件中，该软件从这些图像生成虚拟支气管镜电影；然后将该电影传输到平板电脑上，以便在活检过程中提供实时指导。为了测试我们工具的有效性，我们根据活检是否由虚拟支气管镜引导（虚拟支气管镜组）或未引导（传统组），将所有连续接受经支气管针吸活检的患者回顾性地分为两组。对两组间的诊断率进行统计学比较。
我们的分析包括传统组53例患者和虚拟支气管镜组53例患者。传统组的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为66.6%、100%、100%、10.53%和67.92%，虚拟支气管镜组分别为84.31%、100%、100%、20%和84.91%。虚拟支气管镜组对气管旁淋巴结采样的敏感性（P = 0.011）和诊断准确性（P = 0.011）优于传统组；隆突下淋巴结未发现显著差异。
我们的工具简单、经济，所有中心均可使用。它实时引导针的插入，从而提高了传统经支气管针吸活检术的准确性，特别是当目标病变位于如气管旁这样的困难部位时。
