Image enhancement technology in bronchoscopy: a prospective multicentre study in lung cancer

Area of Science:

• Pulmonology
• Oncology
• Medical Imaging

Background:

• Lung cancer patients often have central airway lesions.
• Previous studies linked vessel characteristics to malignancy.
• High-definition (HD+) bronchoscopy with i-scan shows vascular abnormalities, but pathological correlation is unestablished.

Purpose of the Study:

• To evaluate the utility of HD+ bronchoscopy with i-scan in detecting additional lesions in patients with suspected lung cancer.
• To establish the correlation between vascular patterns and histopathology.
• To assess the clinical relevance of detected lesions.

Main Methods:

• A multicenter, randomized, controlled, crossover study involving 107 patients with suspected lung cancer.
• HD+ bronchoscopy with i-scan1 and i-scan2 settings was performed in random order.
• Endoscopists obtained biopsies, visual grades, and classified vascular patterns for blinded evaluation.

Main Results:

• Additional lesions were detected in 33% of patients.
• Vascular patterns showed a significant correlation with high-grade (pre-)invasive lesions (p<0.001).
• Relevant second lesions impacting treatment and staging were found in 3% of patients. Interobserver agreement for vascular pattern classification was low.

Conclusions:

• HD+ bronchoscopy with i-scan effectively detects additional lesions in lung cancer patients.
• The vascular pattern of these lesions correlates with pathology, though observer agreement is limited.
• These findings highlight the potential clinical significance of additional lesions detected via enhanced bronchoscopy.