Role of Virtual Bronchoscopy in the Evaluation of Bronchial Lesions

Background Virtual bronchoscopy (VB) is a type of 3-dimensional reconstruction in which the observation point is placed within the airway to produce an endoscopiclike view. Aim To evaluate the diagnostic role of VB in the diagnosis of tracheobronchial lesions, as compared to fiberoptic bronchoscopy (FOB). Subjects Fifty patients with tracheobronchial lesions were enrolled (30 patients with bronchogenic carcinomas and 20 patients with tracheobronchial inflammatory lesions). Methods The patients were examined using VB and FOB. Virtual bronchoscopic studies were calculated and reconstructed from cross-sectional images obtained from spiral computed tomographic examination of the chest. Results Virtual bronchoscopy provided an excellent overview of the trachea, main stem, and lobar bronchi up to the fourth order. The data obtained by VB and FOB (signs of tumor infiltration including endobronchial mass, stenosis, obstruction, and external indentations) were comparable. However, FOB had the advantage of giving direct cues to color, vascularity, and motility. It also detected early tumor infiltration by picking up subtle mucosal changes. Alternatively, VB was superior in bypassing any obstruction and therefore provided an excellent view distal to the obstructive lesions or stenotic segments. Virtual bronchoscopy also defined the optimum pathway for passing instruments into lesions beyond the field of view. Conclusions Here, we compared the diagnostic capacities of both VB and FOB. The interventional and therapeutic ramifications of our findings await further investigations.