Author of

• 10912

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  P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Pulmonology + Endoscopy/Pulmonary
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10916

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    P1.17-004 - Bronchoscopy guided by fine mapping based on thin section CT. (ID 1633)

    09:30 - 09:30  |  Author(s): J. Wang
    • Abstract

    Background
    Diagnostic bronchoscopy has undergone a major shift in the past ten years, as the emerging of new guidance technologies, such as electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope and guide sheath. These technologies have significantly enhanced the diagnostic capabilities of flexible bronchoscopy on peripheral pulmonary lesions (PPLs) compared with traditional methods. However, these procedures have not been routinely carried on in developing coutries, largely due to the high cost of both time and money. We invented a low cost and time-saving method, fine mapping by bronchoscopist based on thin-section CT, which could be extensively applied in developing countries to advance the diagnostic rate of PPLs.

    Methods
    This fine mapping method means bronchoscopist precisely analyzes the information of thin-section CT and targets the region of lesion, and draws the route from the segmental bronchial to the interested bronchial, including messages about relative spatial position and number of bronchial divarication along the route. The bronchoscopist inserts the bronchoscope according to the map, carefully observes the target, and then takes a brushing. The key point of this method is to comfirm the vertical sections of every bronchial divarication based on the multiplanner reconstruction (MPR) of CT scans. A cross-sectional study was conducted on 1148 PPLs of 1155 cases in terms of cytological diagnosis, lesion size, age, gender and histological type which cytological diagnosis all confirmed by histopathology, from July 2010 to June 2013 in the department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences. Between July 2010 and June 2012, traditional bronchoscopy and routine brush biopsy were done on 705 cases of PPLs. The new method of fine mapping was developed around June 2012, and selectivley carried on part of the PPLs from July to December 2012. Then we recruited 169 consecutive patients between January 2013 and June 2013 with records of possible related factors .

    Results
    The diagnostic rate on PPLs of these three groups was increased as 17.3%, 25.8% and 31.5% (P<0.001), while statistically significant was also revealed in lesion size as the average diameter of these each group was decreased as 3.02±1.538cm, 2.89±1.279cm, 2.72±1.227cm（P=0.04）, and there was no significant difference between each groups in terms of age, gender, histological type. For PPLs of lesion size >3cm, these three groups’ diagnostic rate were 25.9%, 38.6% and 50.9% (P<0.001). For the third group that introduced the fine mapping method, according to the univariate logistic regression, the diagnostic yield of the 143 malignant PPLs were statistically significant with the lesion size, solid-appearing, relationship between lesion and targeted bronchus, distance from lesion to opening of the lobar bronchus and the mapping satisfaction degree (P<0.001, P=0.039, P<0.001, P=0.031 and P=0.012, respectively).

    Conclusion
    This convenient and economic method of fine mapping greatly advanced the cytology diagnositic rate of PPLs, especially for PPLs that of bigger size, solid-appearing, cut off sign of targeted bronchus, nearer to the lobar bronchial opening and clearer mapping to target. It showed that routine bronchoscopy introduced this new method might be necessary for selected patients of PPLs.