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High definition bronchoscopy: a randomized exploratory study of diagnostic value compared to standard white light bronchoscopy and autofluorescence bronchoscopy.

van der Heijden EH, Hoefsloot W, van Hees HW, Schuurbiers OC - Respir. Res. (2015)

Bottom Line: In 29 patients all videos were available for analysis.Sites suspicious for preinvasive lesions were most frequently reported using AFB (0.74 ± 0.12 sites per patient) as compared to 0.17 ± 0.06 for both WLB and HD bronchoscopy (P = 0.003).Further investigations using this technique relating imaging to histology are warranted.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Videobronchoscopy is an essential diagnostic procedure for evaluation of the central airways and pivotal for the diagnosis and staging of lung cancer. Technological improvements have resulted in high definition (HD) images with advanced real time image enhancement techniques (i-scan).

Objectives: In this study we aimed to explore the sensitivity of HD+ i-scan bronchoscopy for detection of epithelial changes like vascular abnormalities and suspicious preinvasive lesions, and tumors.

Methods: In patients scheduled for a therapeutic or diagnostic procedure under general anesthesia videos of the bronchial tree were made using 5 videobronchoscopy modes in random order: normal white light videobronchoscopy (WLB), HD-bronchoscopy (HD), HD bronchoscopy with surface enhancement technique (i-scan1), HD with surface- and tone enhancement technique (i-scan2) and dual mode autofluorescence videobronchoscopy (AFB). The videos were scored in random order by two independent and blinded expert bronchoscopists.

Results: In 29 patients all videos were available for analysis. Vascular abnormalities were scored most frequently in HD + i-scan2 bronchoscopy (1.33 ± 0.29 abnormal or suspicious sites per patient) as compared to 0.12 ± 0.05 site for AFB (P = 0.003). Sites suspicious for preinvasive lesions were most frequently reported using AFB (0.74 ± 0.12 sites per patient) as compared to 0.17 ± 0.06 for both WLB and HD bronchoscopy (P = 0.003). Tumors were detected equally by all modalities. The preferred modality was HD bronchoscopy with i-scan (tone- plus surface and surface enhancement in respectively 38% and 35% of cases P = 0.006).

Conclusions: This study shows that high definition bronchoscopy with image enhancement technique may result in better detection of subtle vascular abnormalities in the airways. Since these abnormalities may be related to preneoplastic lesions and tumors this is of clinical relevance. Further investigations using this technique relating imaging to histology are warranted.

No MeSH data available.


Related in: MedlinePlus

Representative bronchoscopy images from two patients using (from top to bottom) normal white light videobronchoscopy (WLB, panels a and f); HD-bronchoscopy (panels b and g); HD+ i-scan 1: HD bronchoscopy with surface enhancement (panels c and h); HD+ i-scan2: HD bronchoscopy with surface- and tone enhancement (panels d and i) and autofluorescence bronchoscopy (AFB) in twin mode with WLB image on the left and AFB on the right (panels e and j). The bronchoscopic images on the left are from a patient with a (recurrent) squamous cell non small cell lung carcinoma in the mid trachea on the left lateral wall. The images on the on the right show a abnormal vascular pattern. Pathology from this site showed squamous metaplasia, some fibrosis and signs of active inflammation.
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Fig2: Representative bronchoscopy images from two patients using (from top to bottom) normal white light videobronchoscopy (WLB, panels a and f); HD-bronchoscopy (panels b and g); HD+ i-scan 1: HD bronchoscopy with surface enhancement (panels c and h); HD+ i-scan2: HD bronchoscopy with surface- and tone enhancement (panels d and i) and autofluorescence bronchoscopy (AFB) in twin mode with WLB image on the left and AFB on the right (panels e and j). The bronchoscopic images on the left are from a patient with a (recurrent) squamous cell non small cell lung carcinoma in the mid trachea on the left lateral wall. The images on the on the right show a abnormal vascular pattern. Pathology from this site showed squamous metaplasia, some fibrosis and signs of active inflammation.

Mentions: Of the 36 patients eligible for this study, bronchoscopy was performed in 31 patients and a complete set of videos was available for analysis in 29 patients (Figure 1). The mean age of the study population was 63 years (range 40 – 93 yr), 39% were females. The majority of the investigated patients were referred for an interventional pulmonary endoscopic treatment or diagnostic procedure (n = 24), all others were referred for a surgical procedure by the head and neck surgeon. Of the analyzed patients non-small cell lung cancer (NSCLC) was the most frequent condition (n = 16; 52%); five were referred for a head and neck diagnostic procedure (16%) and one for a suspected combined NSCLC and laryngeal cancer. The remaining patients were scheduled for a interventional pulmonary procedure for metastatic colorectal cancer (n = 2), metastatic renal cell cancer (n = 2), melanoma (n = 1), lymphoma (n = 1) benign tracheal stenosis (n = 2) and sarcoidosis (n = 1). In one of the patients with a head and neck cancer a clinically relevant new lesion was detected that needed biopsy which showed NSCLC. Representative bronchoscopy images indicating the differences between the used bronchoscopy modalities is presented in Figure 2.Figure 1


High definition bronchoscopy: a randomized exploratory study of diagnostic value compared to standard white light bronchoscopy and autofluorescence bronchoscopy.

van der Heijden EH, Hoefsloot W, van Hees HW, Schuurbiers OC - Respir. Res. (2015)

Representative bronchoscopy images from two patients using (from top to bottom) normal white light videobronchoscopy (WLB, panels a and f); HD-bronchoscopy (panels b and g); HD+ i-scan 1: HD bronchoscopy with surface enhancement (panels c and h); HD+ i-scan2: HD bronchoscopy with surface- and tone enhancement (panels d and i) and autofluorescence bronchoscopy (AFB) in twin mode with WLB image on the left and AFB on the right (panels e and j). The bronchoscopic images on the left are from a patient with a (recurrent) squamous cell non small cell lung carcinoma in the mid trachea on the left lateral wall. The images on the on the right show a abnormal vascular pattern. Pathology from this site showed squamous metaplasia, some fibrosis and signs of active inflammation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352538&req=5

Fig2: Representative bronchoscopy images from two patients using (from top to bottom) normal white light videobronchoscopy (WLB, panels a and f); HD-bronchoscopy (panels b and g); HD+ i-scan 1: HD bronchoscopy with surface enhancement (panels c and h); HD+ i-scan2: HD bronchoscopy with surface- and tone enhancement (panels d and i) and autofluorescence bronchoscopy (AFB) in twin mode with WLB image on the left and AFB on the right (panels e and j). The bronchoscopic images on the left are from a patient with a (recurrent) squamous cell non small cell lung carcinoma in the mid trachea on the left lateral wall. The images on the on the right show a abnormal vascular pattern. Pathology from this site showed squamous metaplasia, some fibrosis and signs of active inflammation.
Mentions: Of the 36 patients eligible for this study, bronchoscopy was performed in 31 patients and a complete set of videos was available for analysis in 29 patients (Figure 1). The mean age of the study population was 63 years (range 40 – 93 yr), 39% were females. The majority of the investigated patients were referred for an interventional pulmonary endoscopic treatment or diagnostic procedure (n = 24), all others were referred for a surgical procedure by the head and neck surgeon. Of the analyzed patients non-small cell lung cancer (NSCLC) was the most frequent condition (n = 16; 52%); five were referred for a head and neck diagnostic procedure (16%) and one for a suspected combined NSCLC and laryngeal cancer. The remaining patients were scheduled for a interventional pulmonary procedure for metastatic colorectal cancer (n = 2), metastatic renal cell cancer (n = 2), melanoma (n = 1), lymphoma (n = 1) benign tracheal stenosis (n = 2) and sarcoidosis (n = 1). In one of the patients with a head and neck cancer a clinically relevant new lesion was detected that needed biopsy which showed NSCLC. Representative bronchoscopy images indicating the differences between the used bronchoscopy modalities is presented in Figure 2.Figure 1

Bottom Line: In 29 patients all videos were available for analysis.Sites suspicious for preinvasive lesions were most frequently reported using AFB (0.74 ± 0.12 sites per patient) as compared to 0.17 ± 0.06 for both WLB and HD bronchoscopy (P = 0.003).Further investigations using this technique relating imaging to histology are warranted.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Videobronchoscopy is an essential diagnostic procedure for evaluation of the central airways and pivotal for the diagnosis and staging of lung cancer. Technological improvements have resulted in high definition (HD) images with advanced real time image enhancement techniques (i-scan).

Objectives: In this study we aimed to explore the sensitivity of HD+ i-scan bronchoscopy for detection of epithelial changes like vascular abnormalities and suspicious preinvasive lesions, and tumors.

Methods: In patients scheduled for a therapeutic or diagnostic procedure under general anesthesia videos of the bronchial tree were made using 5 videobronchoscopy modes in random order: normal white light videobronchoscopy (WLB), HD-bronchoscopy (HD), HD bronchoscopy with surface enhancement technique (i-scan1), HD with surface- and tone enhancement technique (i-scan2) and dual mode autofluorescence videobronchoscopy (AFB). The videos were scored in random order by two independent and blinded expert bronchoscopists.

Results: In 29 patients all videos were available for analysis. Vascular abnormalities were scored most frequently in HD + i-scan2 bronchoscopy (1.33 ± 0.29 abnormal or suspicious sites per patient) as compared to 0.12 ± 0.05 site for AFB (P = 0.003). Sites suspicious for preinvasive lesions were most frequently reported using AFB (0.74 ± 0.12 sites per patient) as compared to 0.17 ± 0.06 for both WLB and HD bronchoscopy (P = 0.003). Tumors were detected equally by all modalities. The preferred modality was HD bronchoscopy with i-scan (tone- plus surface and surface enhancement in respectively 38% and 35% of cases P = 0.006).

Conclusions: This study shows that high definition bronchoscopy with image enhancement technique may result in better detection of subtle vascular abnormalities in the airways. Since these abnormalities may be related to preneoplastic lesions and tumors this is of clinical relevance. Further investigations using this technique relating imaging to histology are warranted.

No MeSH data available.


Related in: MedlinePlus