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Published on: May 4, 2022
Enhancing virtual bronchoscopic navigation route to small peripheral pulmonary lesions using lateral decubitus
Yuki Takigawa1, Ken Sato1, Kotaro Miyake2
1Department of Respiratory Medicine, NHO Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan.
Background:
To evaluate the effectiveness of lateral-decubitus position computed tomography (LDCT) for bronchoscopic biopsies of peripheral pulmonary lesions (PPLs) in patients who underwent the procedure.
Patients And Methods:
In this retrospective single-center study, we included patients who underwent ultrathin bronchoscopy for PPLs after virtual bronchoscopic navigation (VBN) was conducted using supine computed tomography (SCT) and LDCT. LDCT was conducted with the target side up when bronchial route reconstruction using SCT was challenging. The primary outcome was the bronchial generation reached by VBN based on SCT and LDCT. Secondary outcomes included target lung volume, close-to-the-lesion achievement, concordance with bronchoscopic route, and specific diagnostic yield.
Results:
Twelve patients were included in the study. The median length of the target lesion was 13 mm. The median bronchial generation reached using VBN increased from 3.5 on SCT to 5 on LDCT. The median target lung volume on SCT was 963.5 mL, which increased to 1116.5 mL on LDCT. The close-to-the-lesion method was achieved in 91.7% using an ultrathin bronchoscope. The actual bronchial routes toward the target lesions were concordant with VBN based on LDCT in 58.3%. A specific pathological diagnosis was made in 66.7% using ultrathin bronchoscopy.
Conclusions:
LDCT may improve virtual bronchoscopic route reconstruction compared with SCT. This practical and low-risk approach may facilitate navigation planning for challenging PPLs when conventional SCT-based route reconstruction is insufficient.
