TY - JOUR
T1 - Image-guided bronchoscopy for peripheral lung lesions
T2 - A phantom study
AU - Merritt, Scott A.
AU - Gibbs, Jason D.
AU - Yu, Kun Chang
AU - Patel, Viral
AU - Rai, Lav
AU - Cornish, Duane C.
AU - Bascom, Rebecca
AU - Higgins, William E.
N1 - Funding Information:
This research was supported by National Institutes of Health, National Cancer Institute grants R01-CA074325 and R44-CA091534.
PY - 2008/11
Y1 - 2008/11
N2 - Background: 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. Methods: 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 ≤ 5 mm. Results: 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. Conclusions: Real-time, VB-based image guidance can potentially far exceed standard bronchoscopy practice for enabling the bronchoscopic biopsy of peripheral lung lesions.
AB - Background: 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. Methods: 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 ≤ 5 mm. Results: 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. Conclusions: Real-time, VB-based image guidance can potentially far exceed standard bronchoscopy practice for enabling the bronchoscopic biopsy of peripheral lung lesions.
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U2 - 10.1378/chest.08-0603
DO - 10.1378/chest.08-0603
M3 - Article
C2 - 18583513
AN - SCOPUS:55849147006
SN - 0012-3692
VL - 134
SP - 1017
EP - 1026
JO - CHEST
JF - CHEST
IS - 5
ER -