Thus, we proposed a new 3D navigation tool designed to identify the needle insertion point and to improve the accuracy of mediastinal staging in NSCLC patients compared with traditional TBNA for. In recent years, three-dimensional (3D) imaging navigation has been used to guide anatomical sublobar resections, but in only a few cases, it has been applied during traditional TBNA. However, the only great flaw of TBNA is its ‘blindness’. Despite its proven efficacy, TBNA remains underutilized in clinical practice for several reasons: the risk of puncturing vessels, the fear of bronchoscopically induced damage and poor specimen preparation. Traditional transbronchial needle aspiration biopsy (TBNA) has been available for sampling lung tissue or mediastinal adenopathy for almost three decades.
However, these techniques are expensive the high capital and running costs limit their widespread availability.
Ultrasound techniques allow real-time guidance of the sampling procedure with a sensitivity ranging from 83% to 94% in mediastinal staging, as reported in several meta-analyses. The American College of Chest Physicians (ACCP) guidelines recommend fine-needle aspiration (FNA) with endobronchial (EBUS) or endoscopic (EUS), or both combined (EBUS/EUS), ultrasound guidance as a first test in patients with NSCLC with a high suspicion of mediastinal LN involvement. Generally, patients with resectable NSCLC and without clinical N2 involvement can be scheduled for surgery.
Transbronchial needle aspiration, Mediastinal staging, Virtual bronchoscopy INTRODUCTIONĪccurate staging of mediastinal lymph nodes (LN) is mandatory for adequate management of non-small cell lung cancer (NSCLC). It guided in real time the needle insertion, thereby improving the accuracy of traditional transbronchial needle aspiration, especially when target lesions are located in a difficult site like the paratracheal station. The sensitivity ( P = 0.011) and diagnostic accuracy ( P = 0.011) of sampling the paratracheal station were better for the virtual bronchoscopy group than for the traditional group no significant differences were found for the subcarinal lymph node.ĬONCLUSIONS: Our tool is simple, economic and available in all centres. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the traditional group were 66.6%, 100%, 100%, 10.53% and 67.92%, respectively, and for the virtual bronchoscopy group were 84.31%, 100%, 100%, 20% and 84.91%, respectively. RESULTS: Our analysis included 53 patients in the traditional and 53 in the virtual bronchoscopy group. The intergroup diagnostic yields were statistically compared. To test the validity of our tool, we divided all consecutive patients undergoing transbronchial needle aspiration retrospectively in two groups based on whether the biopsy was guided by virtual bronchoscopy (virtual bronchoscopy group) or not (traditional group).
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The static images were uploaded in iMovie Software, which produced a virtual bronchoscopic movie from the images the movie was then transferred to a tablet computer to provide real-time guidance during a biopsy. The target adenopathy was identified by measuring its distance from the carina on multiplanar reconstruction images.
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METHODS: Chest-computed tomographic images (1 mm thickness) were reconstructed with Osirix software to produce a virtual bronchoscopic simulation. OBJECTIVES: We proposed a new virtual bronchoscopy tool to improve the accuracy of traditional transbronchial needle aspiration for mediastinal staging.
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