Virtual bronchoscopic navigation system shortens the examination time--feasibility study of virtual bronchoscopic navigation system.

Computed tomography (CT)-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope with simulation by virtual bronchoscopy (VB) is effective for diagnosing small peripheral pulmonary lesions. However, we occasionally lose the proper bronchi to the lesion when a bronchoscope is inserted into peripheral bronchi with severe rotation. To overcome this problem, the virtual bronchoscopic navigation system that can display real-time VB images during TBB procedures in comparison with actual bronchi has been developed. We evaluated the usefulness of the virtual bronchoscopic navigation system for CT-guided TBB using an ultrathin bronchoscope (navigation method) to diagnose small peripheral pulmonary lesions, and compared the results to those with previous method that uses VB images in a simulation (simulation method). We performed CT-guided TBB using an ultrathin bronchoscope for 69 patients with 71 small peripheral pulmonary lesions (mean diameter, 13.7 mm) between November 2002 and November 2005 with the navigation method. CT-guided TBB with the navigation method was performed safely without any serious complications for all patients. Mean time to the initial scan, time to the first biopsy and total examination time were 5.3, 8.5 and 24.5 min, respectively. Fifty lesions (70%) were diagnosed by this procedure. Compared to simulation method, diagnostic sensitivity was higher in the navigation method, but the difference was not significant. However, the time to the first biopsy and total examination time were significantly shorter in the navigation method than in the simulation method (p<0.05). In summary, the virtual bronchoscopic navigation system was safely used, effective for diagnosing small peripheral pulmonary lesions, and useful for shortening the examination time of CT-guided TBB using an ultrathin bronchoscope.

[1]  Yoichiro Ishihara,et al.  Transbronchial Diagnosis of A Pulmonary Peripheral Small Lesion Using an Ultrathin Bronchoscope with Virtual Bronchoscopic Navigation , 2002 .

[2]  Hiroto Matsuoka,et al.  Usefulness of ultrathin bronchoscopy in diagnosis of lung cancer. , 2004, Lung cancer.

[3]  D. E. Acker,et al.  Real-time bronchoscope tip localization enables three-dimensional CT image guidance for transbronchial needle aspiration in swine. , 1998, Chest.

[4]  K D Hopper,et al.  Transbronchial biopsy with virtual CT bronchoscopy and nodal highlighting. , 2001, Radiology.

[5]  G. McLennan,et al.  Ultrathin Bronchoscopy as an Adjunct to Standard Bronchoscopy in the Diagnosis of Peripheral Lung Lesions , 2002, Respiration.

[6]  R H Choplin,et al.  Virtual Bronchoscopy: Relationships of Virtual Reality Endobronchial Simulations to Actual Bronchoscopic Findings , 1996 .

[7]  F. Herth,et al.  Electromagnetic Navigation during Flexible Bronchoscopy , 2003, Respiration.

[8]  Martin Sonnenschein,et al.  Multidetector CT virtual bronchoscopy to grade tracheobronchial stenosis. , 2002, AJR. American journal of roentgenology.

[9]  P C Goodman,et al.  Virtual bronchoscopy for directing transbronchial needle aspiration of hilar and mediastinal lymph nodes: a pilot study. , 1998, AJR. American journal of roentgenology.

[10]  Koichi Yamazaki,et al.  Enhanced virtual bronchoscopy using the pulmonary artery: improvement in route mapping for ultraselective transbronchial lung biopsy. , 2004, AJR. American journal of roentgenology.

[11]  K P Wang,et al.  Three-dimensional CT-guided bronchoscopy with a real-time electromagnetic position sensor: a comparison of two image registration methods. , 2000, Chest.

[12]  Koichi Yamazaki,et al.  CT-guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation. , 2004, Chest.

[13]  H. Moriya,et al.  Interactive Virtual Bronchoscopy as a Guide for Transbronchial Biopsy in Two Cases , 1998 .

[14]  H. Feußner,et al.  Electromagnetic catheter navigation during bronchoscopy: validation of a novel method by conventional fluoroscopy. , 2005, Chest.

[15]  A. Ernst,et al.  Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance , 2005 .

[16]  Koichi Yamazaki,et al.  A virtual bronchoscopic navigation system for pulmonary peripheral lesions. , 2006, Chest.

[17]  M. Oki,et al.  Visceral pleural perforation in two cases of ultrathin bronchoscopy. , 2005, Chest.