Virtual Bronchoscopic Navigation System Combined With Ebdobronchial Ultrasound To Diagnose Peripheral Pulmonarylesions

Objective:To evaluate the virtual bronchial navigation(VBN) system combined with endobronchial ultrasound(EBUS) diagnosis of peripheral pulmonary lesions.Methods:fourty-two patients[28 males and 14 females, mean age(58±11)years]with peripheral pulmonary lesions confirmed by computered tomography(CT) were involved in between April 1 2014 and October 1st 2014. Patients were allocated to VBN asisted group(VBN group)and non-VBN assited group(NVBN group)based on the use of VBN systerm.17 cases were involved in VBN group and 25 cases were involved in NVBN group. Bronchoscopic insertion was assisted using the VBN system in the VBN group. The bronchoscope was introduced into the bronchus of the NVBN group without VBN support and with reference only to CT axial images. Then both groups received EBUS examinations.For peripheral lesions with accessible EBUS images,Pathological samples were collected using forceps and/or a brush;while those cases without accessible EBUS images,pathological samples were collected based on the localization by image data.The diagnosis of pulmonary peripheral lesions of the 2 groups were compared.Results:There was no significant difference in the diagnostic yield between the VBN group and the NVBN group(70.6% vs. 60.0%, P=0.482). When the lesions less than 20 mm in diameter of the lesions were analyzed, the diagnostic yield was higher in the VBN group,but the difference was not significant. A significant difference was observed in the time needed to determine the location of target lesion(8.49±2.29 min in VBN group vs. 8.49±2.29 min in NVBN group,P=0.046). There was no significant difference in the total bronchoscopic procedure time for each group(29.14± 4.11 min vs. 30.52 ± 6.55 min, P=0.229),There was one complication in the VBNA group (pneumothorax) and one complication in the NVBNA group( hemorrhage).The incidence of complications did not differ between the two groups. The median generation of virtual bronchial images constructed based on data from the VBNA group was six(three to nine). With the help of VBN systerm, the bronchoscopy can be inserted into the fourth-generation bronchus on average.A total of 94.1% of virtual images were in agreement with the actual images for the shape of each bronchial bifurcation on the route.Conclusions: Virtual bronchoscopy navigation can shorten the time needed to confirm the target lesions; Diagnostic yield was higher for VBN system combine with EBUS than for EBUS,but the difference was not significant. Virtual bronchoscopy navigation combined with EBUS is a safe method in diagnosis of pulmonary peripheral lesions.