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Marta Diez-Ferrer; Arturo Morales; Rosa Lopez Lisbona; Noelia Cubero; Cristian Tebe; Susana Padrones; Samantha Aso; Jordi Dorca; Debora Gil; Antoni Rosell |
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Title |
Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield |
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Journal Article |
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Year |
2019 |
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Respiration |
Abbreviated Journal |
RES |
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97 |
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3 |
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252-258 |
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Lung cancer; Peripheral lung lesion; Diagnosis; Bronchoscopy; Ultrathin bronchoscopy; Virtual bronchoscopic navigation |
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Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources. |
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IAM; 600.145; 600.139 |
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Admin @ si @ DML2019 |
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3134 |
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Marta Diez-Ferrer; Debora Gil; Cristian Tebe; Carles Sanchez |
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Title |
Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation |
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Journal Article |
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Year |
2018 |
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Respiration |
Abbreviated Journal |
RES |
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96 |
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6 |
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525-534 |
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Multidetector computed tomography; Bronchoscopy; Continuous positive airway pressure; Image enhancement; Virtual bronchoscopic navigation |
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Abstract
RATIONALE:
Virtual bronchoscopic navigation (VBN) guidance to peripheral pulmonary lesions is often limited by insufficient segmentation of the peripheral airways.
OBJECTIVES:
To test the effect of applying positive airway pressure (PAP) during CT acquisition to improve segmentation, particularly at end-expiration.
METHODS:
CT acquisitions in inspiration and expiration with 4 PAP protocols were recorded prospectively and compared to baseline inspiratory acquisitions in 20 patients. The 4 protocols explored differences between devices (flow vs. turbine), exposures (within seconds vs. 15-min) and pressure levels (10 vs. 14 cmH2O). Segmentation quality was evaluated with the number of airways and number of endpoints reached. A generalized mixed-effects model explored the estimated effect of each protocol.
MEASUREMENTS AND MAIN RESULTS:
Patient characteristics and lung function did not significantly differ between protocols. Compared to baseline inspiratory acquisitions, expiratory acquisitions after 15 min of 14 cmH2O PAP segmented 1.63-fold more airways (95% CI 1.07-2.48; p = 0.018) and reached 1.34-fold more endpoints (95% CI 1.08-1.66; p = 0.004). Inspiratory acquisitions performed immediately under 10 cmH2O PAP reached 1.20-fold (95% CI 1.09-1.33; p < 0.001) more endpoints; after 15 min the increase was 1.14-fold (95% CI 1.05-1.24; p < 0.001).
CONCLUSIONS:
CT acquisitions with PAP segment more airways and reach more endpoints than baseline inspiratory acquisitions. The improvement is particularly evident at end-expiration after 15 min of 14 cmH2O PAP. Further studies must confirm that the improvement increases diagnostic yield when using VBN to evaluate peripheral pulmonary lesions. |
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IAM; 600.145 |
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Admin @ si @ DGT2018 |
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3135 |
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Marta Diez-Ferrer; Debora Gil; Elena Carreño; Susana Padrones; Samantha Aso |
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Title |
Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation |
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Journal Article |
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2017 |
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Journal of Thoracic Oncology |
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JTO |
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12 |
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1S |
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S596-S597 |
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Thorax CT; diagnosis; Peripheral Pulmonary Nodule |
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A main weakness of virtual bronchoscopic navigation (VBN) is unsuccessful segmentation of distal branches approaching peripheral pulmonary nodules (PPN). CT scan acquisition protocol is pivotal for segmentation covering the utmost periphery. We hypothesize that application of continuous positive airway pressure (CPAP) during CT acquisition could improve visualization and segmentation of peripheral bronchi. The purpose of the present pilot study is to compare quality of segmentations under 4 CT acquisition modes: inspiration (INSP), expiration (EXP) and both with CPAP (INSP-CPAP and EXP-CPAP). |
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IAM; 600.096; 600.075; 600.145 |
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Admin @ si @ DGC2017a |
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2883 |
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Marta Diez-Ferrer; Debora Gil; Elena Carreño; Susana Padrones; Samantha Aso; Vanesa Vicens; Cubero Noelia; Rosa Lopez Lisbona; Carles Sanchez; Agnes Borras; Antoni Rosell |
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Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation |
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Journal Article |
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2016 |
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Chest Journal |
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CHEST |
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150 |
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4 |
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1003A |
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IAM; 600.096; 600.075 |
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Admin @ si @ DGC2016 |
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3099 |
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Marta Diez-Ferrer; Debora Gil; Elena Carreño; Susana Padrones; Samantha Aso; Vanesa Vicens; Noelia Cubero de Frutos; Rosa Lopez Lisbona; Carles Sanchez; Agnes Borras; Antoni Rosell |
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Title |
Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation |
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2017 |
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European Respiratory Journal |
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ERJ |
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IAM |
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Admin @ si @ DGC2017b |
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3632 |
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