| Part Ⅰ Comparison of Two VBN systems in Bronchial Tree Reconstruction and Navigation Pathway PlanningObjective:To explore the differences in virtual bronchoscopic navigation using Synapse 3D system(Version 4.4,Fujifilm,Japan)and Direct Path system(Version 2.0,Olympus,Japan).Methods:A total of 233 subjects who presented to the outpatient department of the Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Navy Military Medical University between July 2021 and December 2021 and were diagnosed with peripheral pulmonary nodules by chest CT in our hospital were retrospectively included.There were 112 males(48.1%)and 121 females(51.9%).The age ranged from 19 to 92 years,with a mean age of(54±13)years.A self-paired design was used to analyze 233 subjects using Synapse 3D system(Version 4.4)and Direct Path system(Version 2.0)and compared the differences between Synapse 3D system(Version 4.4)(Group S)and Direct Path system(Version 2.0)(Group D)in terms of multiplanar reformation and bronchial tree reconstruction duration,navigation pathway planning duration,bronchial tree reconstruction success rate,bronchial tree reconstruction quality,automated navigation pathway planning success rate,most distantly visible bronchial branch generation on the navigation pathway,optimal bronchial branch generation on the navigation pathway,and distance from the navigation endpoint to the center of the lesion.Result:1.Bronchial Tree Reconstruction(1)Bronchial tree reconstruction success rate in Group S and Group D was 100.0%(233 subjects)and 97.9%(228 subjects),respectively.In Group D,bronchial tree reconstruction success rate using chest CT plain scan sequence was 100.0%(166 subjects),which was higher than that using chest CT enhanced scan sequence [93.2%(68 subjects)],and the difference was statistically significant(P=0.003).(2)Bronchial tree reconstruction quality in Group S was assessed as good in 125subjects(54.8%),as medium in 64 subjects(28.1%),and as poor in 39 subjects(17.1%).Bronchial tree reconstruction quality in Group D was assessed as good in 14 subjects(6.1%),as medium in 98 subjects(43.0%),and as poor in 116 subjects(50.9%).Bronchial tree reconstruction quality in Group S was better than that in Group D,and the difference was statistically significant(P<0.001).(3)In Group S,CT obtained with Toshiba Aquilion ONE scanner resulted in superior bronchial tree reconstruction quality relative to CT obtained with Philips Brilliance i CT256 scanner,with statistically significant difference(P=0.027).In Group D,CT obtained with Philips Brilliance i CT 256 scanner resulted in superior bronchial tree reconstruction quality relative to CT obtained with Toshiba Aquilion ONE scanner,with statistically significant difference(P<0.001).2.Navigation Pathway Planning(1)Automated navigation pathway planning success rate in Group S and Group D was 34.8% and 16.7%,respectively.Automated navigation pathway planning success rate in Group S was higher than that in Group D,and the difference was statistically significant(P<0.001).The median navigation pathway planning duration was 1.41(1.10,2.21)s in Group S and 1.08(0.97,1.21)s in Group D,respectively.Navigation pathway planning duration in Group S was longer than that in Group D,with statistically significant difference(P<0.001).Multivariate Logistic regression analysis showed that the diameter of pulmonary nodules,the presence of bronchus sign in pulmonary nodules and the distance from pulmonary nodules to hilum had significant effects on automated navigation pathway planning success rate in Group S and Group D(both P<0.05).(2)The median most distantly visible bronchial branch on the navigation pathway in Group S and Group D was both 6.0(5.0,8.0)generation,with no statistically significant difference(P=0.342).The median optimal bronchial branch on the navigation pathway in Group S and Group D was 6.0(5.0,7.0)generation and 5.0(4.0,6.0)generation,respectively.The optimal bronchial branch generation on the navigation pathway in Group S was more than that in Group D,and the difference was statistically significant(P<0.001).(3)The median distance from the navigation endpoint to the center of the lesion in Group S and in Group D was 15.3(9.6,24.9)mm and 25.2(13.8,34.2)mm,respectively.The distance from the navigation endpoint to the center of the lesion in Group S was closer than that in Group D,with statistically significant difference(P<0.001).Conclusion:1.There was no significant difference in bronchial tree reconstruction success rate between Synapse 3D system(Version 4.4)and Direct Path system(Version 2.0).Compared with Direct Path system(Version 2.0),bronchial tree reconstruction quality was better in Synapse 3D system(Version 4.4).2.Navigation pathway planning duration in Synapse 3D system(Version 4.4)was longer than that in Direct Path system(Version 2.0).3.Automated navigation pathway planning success rate was higher in Synapse 3D system(Version 4.4)than that in Direct Path system(Version 2.0).Factors affecting automated navigation pathway planning success rate in Synapse 3D system(Version 4.4)and Direct Path system(Version 2.0)included pulmonary nodule diameter,the presence or absence of bronchus sign in pulmonary nodule,and the distance of pulmonary nodule from the hilum.4.Compared with Direct Path system(Version 2.0),optimal bronchial branch generation on the navigation pathway was more,the distance from the navigation endpoint to the center of the lesion was closer in Synapse 3D system(Version 4.4).However,there was no significant difference in most distantly visible bronchial branch generation on the navigation pathway between two groups.Part Ⅱ Utilization of Two VBN Systems in Assisting Transbronchial Biopsy of Peripheral Pulmonary NodulesObjective:To explore the difference between Synapse 3D system(Version 4.4,Fujifilm,Japan)and Direct Path system(Version 2.0,Olympus,Japan)in the utilization of VBN-assisted transbronchial biopsy of peripheral pulmonary nodules.Methods:This part was an exploratory study with retrospective cohort design.Fifty-six consecutive patients(59 pulmonary nodules)who underwent transbronchial biopsy of peripheral pulmonary nodules assisted by Synapse 3D system(Version 4.4)in the Respiratory Endoscopy Center of the Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Navy Military Medical University from December 2021 to June 2022 were enrolled as Group S.Forty-two consecutive patients(43pulmonary nodules)who underwent transbronchial biopsy of peripheral pulmonary nodules assisted by Direct Path system(Version 2.0)in the Respiratory Endoscopy Center of the Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Navy Military Medical University from July 2022 to February 2023 were enrolled as Group D.Propensity score matching was used to control for confounding factors in the two groups to compare the localization success rate and diagnostic yield of pulmonary nodules using Synapse 3D system(Version 4.4)and Direct Path system(Version 2.0)for VBN-assisted transbronchial biopsy of peripheral pulmonary nodules.Result:1.Before propensity score matching,the localization success rate of pulmonary nodules in Group S and in Group D was 84.7%(50 nodules)and 86.0%(37 nodules),respectively,with no statistically significant difference(P=0.855).Before propensity score matching,the diagnostic yield of pulmonary nodules in Group S and in Group D was64.4%(38 nodules)and 60.5%(26 nodules),respectively,with no statistically significant difference(P=0.684).2.After propensity score matching,the localization success rate of pulmonary nodules in Group S and in Group D was 85.3%(29 nodules)and 91.2%(31 nodules),respectively,with no statistically significant difference(P=0.709).After propensity score matching,the diagnostic yield of pulmonary nodules in Group S and in Group D was 67.6%(23 nodules)and 61.8%(21 nodules),respectively,with no statistically significant difference(P=0.800).Conclusion:In VBN-assisted transbronchial biopsy of peripheral pulmonary nodules,there was no significant difference in the localization success rate and diagnostic yield of pulmonary nodules between Synapse 3D system(Version 4.4)and Direct Path system(Version 2.0). |
