Transbronchial biopsy of peripheral lung lesions using fluoroscopic guidance combined with an enhanced ray-summation display
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The aim of this study was to investigate the effectiveness of guidance assistance during transbronchial biopsy (TBB) to achieve an appropriate pathway to small and peripheral pulmonary lesions (PPLs) using a combination of fluoroscopy and specialized ray-summation (Ray-sumTBB) images, which were processed from preprocedural lung computed tomography (CT) images. To improve the visibility of the correct pathway to the PPLs, three-dimensional spatial resolution enhancement and CT number conversion processes were applied to the original CT images. The Ray-sumTBB images reconstructed from the processed CT images were used as additional guides. We compared the rates of successful tumor localization and biopsy (arrival rate) between the trial (with Ray-sumTBB) and control (without Ray-sumTBB) groups. The fluoroscopy and examination times were also compared. The arrival rate of the trial group (73.1%) was significantly better than that of the control group (42.3%) (p = 0.048). The fluoroscopy and examination times did not differ significantly between the trial and control groups. No complications were identified in the trial group. Our results suggest that Ray-sumTBB improves the diagnostic accuracy of TBB.
KeywordsTransbronchial biopsy Ray-summation Frequency processing Peripheral pulmonary lesion Ground-glass opacity Endobronchial ultrasound
Compliance with ethical standards
Conflict of interest
None of the authors has any conflicts of interest to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board (IRB) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.
Informed consent was obtained from all study participants.
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