Comparison of Virtual and Fiberoptic Bronchoscopy

Abstract

Preoperative diagnostic procedures in the treatment of non-small-cell lung carcinoma (NSCLC) include fiberbronchoscopy (FBS) and CT scanning of the thorax and abdomen. The introduction of double-detector helical computed tomography has led to improved image resolution which allows three-dimensional reconstruction of the bronchial tree. A special computer simulation provides a virtual endoscopic view into the inner surface of the bronchial system. In order to determine whether the so-called virtual bronchoscopy (VBS) accurately reflects the anatomic situation of the bronchial tree, neoplastic lesion, and postoperative control of sleeve resections, we performed a virtual bronchoscopy in 24 patients with NSCLC and in 6 patients following sleeve resections and compared the results with the findings of fiberoptic bronchoscopy. An anatomic computer simulation of the bronchial tree was created in 100% of the investigated patients. Central tumor stenosis or occlusion was visualized by VBS as well as by FBS. In peripheral tumorous lesions VBS revealed the correct diagnosis in only 75%. VBS, however, enables viewing beyond the stenosis. FBS remains the gold standard in the endoscopic diagnostic procedures, showing not only airway patency but also mucosal changes in the vicinity of the tumorous lesion. VBS, however, gives further information about the poststenotic area in occlusive main bronchus stenosis. Furthermore, adequate control investigation of airway patency in patients following sleeve resections or stent implantation can be performed by VBS.

Computerized Tomography Virtual Bronchoscopy – Will it replace Fibre optic Bronchoscopy in Tracheobronchial Evaluation?

“…In that study thirteen endoluminal lesions were seen equally well with VB and FOB. [8] VB was found to be effective in detecting extraluminal compression with a sensitivity of 95.83% and PPV of 92%. 23 out of 24 extraluminal compression was correctly detected with VB in the present study.…”

“…Statistics in Finkelstein et.al's [7] study in this regard was a sensitivity of 91.5% for endoluminal obstructive lesions. Liewald and coworkers [8] evaluated 30 patients with lung cancer using VB and FOB. In that study thirteen endoluminal lesions were seen equally well with VB and FOB.…”

Virtual bronchoscopy, importance of the method, application and prospects for tumors of the trachea and bronchi

“…Combining the information from the VB images and CT images allows, according to them really to assess not only the intraluminal tumor spread, but also the extraluminal expansion of the mass and its relation with the bronchial tree. Other indicated advantage of VB is related to the fact that the bronchial tree can be assessed also distally to the stenoses that cannot be passed with FB (10,4,5,11,6,12). In this way the length of the stenosis can be appreciated, which is not possible when the FB cannot pass the stenosis.…”

Multidetector CT-generated virtual bronchoscopy: an illustrated review of the potential clinical indications

“…Combining the information from these images allows not only the intraluminal proliferation of the tumour to be appreciated, but also the extraluminal extension of the mass and its relation to the bronchial tree. Another advantage of VB is that the bronchial tree, distal to an obstruction that cannot be passed with FB, can be evaluated [7,[11][12][13]. In this way the length of the stenosis can be estimated, which is of course impossible when the fibreoptic bronchoscope cannot pass the stenosis.…”