Fiberoptic endoscopy remains the gold standard diagnostic
modality for the tracheobronchial pathologies. It is a relatively
safe diagnostic and therapeutic procedure . Fiberoptic
endoscopy high sensitivity put it as the key diagnostic modality
for evaluating the tracheobroncial endoluminal and mucosal
pathologies, however it is an invasive procedure and still has its
side effects, as a time consuming procedure and possess
potential risks of morbidity and mortality (about 0.8%),
especially in higher risk subjects with advanced intrathoracic
pathologies . Therefore , non invasive techniques enabling
evaluation of airways should be consistently developed and
updated.
Virtual bronchoscopy (VB) which may be considered as a
novel advancement in multidetector computed tomography
technology , provides realistic three dimensional view of the
airways lumen , through using a computer generated postprocessing
technique that gives high resolution images of the
airways and provides endotracheal and endobronchial views
that simulate the true surfing view provided by conventional
fiberoptic bronchoscopy.
The purpose of our study was to evaluate the virtual
bronchoscopy as a diagnostic tool in detecting the
tracheobronchial diseases in patients with clinical indication for
bronchoscopy through comparing it with the conventional
fiberoptic endoscopy which is considered the gold standard
diagnostic utility for the tracheobronchial pathologies.
This study took place at Radiology department of Banha
University over a period of 24 months, between 2014 and 2016 .
Fifty patients with clinical and, or radiological indication for
tracheobronchial evaluation through bronchoscopy were
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included. Cases subjected to the study were selected randomly,
based on inclusion criteria ,with no age or gender predilection.
The study was approved by the ethical committee of the Banha
University Hospital.
Patients with clinical and, or radiological indication for
tracheobronchial evaluation through bronchoscopy were
included. Patients who were excluded from this study were
pregnant or lactating females, patients known to have a high
serum creatinine and not on regular dialysis,and patients with
contraindication to conventional bronchoscopy ( as recent
myocardial infarction, unstable angina, serious arrhythmias ,
C02 retention , low PO2, coagulation defect and uncontrolled
asthma).
Fifty patients were eligible for the study but only 43
underwent examination by both modalities fiberoptic
endoscopy and virtual bronchoscopy , as 7 patients did not
examined by fiberoptic endoscope either because they can not
tolerate the FOB examination ,or they refused to underwent the
examination.
Of the 43 patients under the study, 31 patients (71.1%) were
males and 12 patients (27.9%) were females. The mean age of
the study group was 59 with standard deviation ±14.
From the 43 patients underwent examination by both
diagnostic modalities , 39 patients showed tracheobronchial
abnormalities by fiberoptic endoscopic examination, the virtual
bronchoscopic examination confirmed the same abnormality in
33 (84.6%) patients and failed to detect any abnormality in 6
(15.4%) patients. Four patients of the 43 patients did not show
tracheobronchial abnormalities in both diagnostic modalities .
Majority of lesions were obstructing (69.2%),the nonobstructing
lesions represented 18% while partially obstructing
lesions represented 13% only.
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As regarding the ability to bypass lesion, from 39 patients
showed positive lesion by FOB, only 10 lesions (26%) were
bypassed by it, While 100% of lesions detected with VB were
bypassed by it.
Mucosa and vocal cord were assessed using FOB. Regarding
the mucosa, 39 patients (90.7%) showed abnormal mucosa,
while 4patients only (9.3%) showed normal mucosa. Regarding
the vocal cords, only 42 patients were assessed , an the
tracheostomy path was used as a route for the introduction of
FOB in one patient, 100% of patients examined showed normal
vocal cord.
Majority of patients were diagnosed histopathologically as
squamous cell carcinoma (35.1%), followed by adenocarcinoma
(27.0%) , followed by infection (TB) (10.8%) and carcinoid
tumor (8.1%) . The least frequent diagnosis was atypical cells,
bronchial adenoma and inflammatory pseudo-tumor (2.7% for
each) .
Depending on the data collected and analyzed , the
sensitivity of virtual bronchoscopic examination was estimated
as 84.6% while the specificity was estimated as 100%. The PPV
and NPV were calculated as 100% and 40% respectively with
overall accuracy estimated as 86%.
In the majority of cases, the virtual bronchoscopy had the
ability to detect the tracheobronchial pathologies that have been
revealed in the conventional fiberoptic endoscopic examination.
The virtual bronchoscopy provided precise information's about
the morphological pattern of partial or complete airways
obstructions, and gave the opportunity to examine the airways
beyond the stenotic or obstructed area. |
