Effectiveness of CT Navigation in the Diagnosis of Peripheral Pulmonary Lesions

Abstract

The objective: to evaluate the diagnostic effectiveness of computed tomographic navigation (CTn), bronchoscopic navigation (BN) in transbronchial biopsy (TBB) of peripheral lesions in the lungs.

Subjects and Methods. An analysis of CT navigation data during bronchoscopy (BS) of 201 patients (Ctn Group) with peripheral lung formations (area of interest) was carried out. The advancement of bronchoscope to the area of interest during bronchoscopy was performed under CT navigation with VBN playing the major role. Comparison was made to the group (CG) of 195 patients in whom no CT navigation was used.

Results. The overall bronchoscopy effectiveness using CT navigation and bronchoscopic navigation was statistically significantly higher versus the cases when they were not used, 95/201 (47.2%) vs. 65/195 (33.3%), χ² =7.98; p<0.01. Bronchoscopy effectiveness in the CTn and CG Groups differed significantly for lesion in the lung measuring >1 to ≤2 cm (46.9% vs. 28.2%; pz=0.008) and lesions ≤1 cm (28.0% vs. 12.9%; pz=0.048). For large lesion >2 to ≤3 cm, the differences did not reach statistical significance. There were significant differences in bronchoscopy effectiveness between the CTn and CG Groups when lesions were localized in the middle (61.2% vs. 35.8%; pz=0.008) and peripheral (32.0% vs. 22.2%; pz=0.048) zones of the lung. With lesions located in the central part and at its boundaries, the differences between the groups were not significant. When CT navigation and virtual bronchoscopy were used, the presence of connection to the bronchus significantly increased the likelihood of successful bronchoscopy (OR=6.35; 95% CI 3.43-11.78) than in the absence of one.