Image-guided EBUS bronchoscopy system for lung-cancer staging.
Image-guided EBUS bronchoscopy system for lung-cancer staging.
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用于肺癌分期的图像引导 EBUS 支气管镜系统。
DOI：
10.1016/j.imu.2021.100665
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发表时间：
2021
影响因子：
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通讯作者：
Higgins,WilliamE
中科院分区：
文献类型：
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作者：
Zang,Xiaonan;Cheirsilp,Ronnarit;Byrnes,PatrickD;Kuhlengel,TrevorK;Abendroth,Catherine;Allen,Thomas;Mahraj,Rickhesvar;Toth,Jennifer;Bascom,Rebecca;Higgins,WilliamE
中央胸淋巴结的分期是肺癌患者管理的重要步骤。为此，医生使用集成了视频支气管镜和支气管内超声（EBUS）探头的器械。为了对淋巴结进行活检，医生首先使用视频支气管镜在气道中导航，然后调用EBUS对淋巴结进行定位和活检。不幸的是，这个过程对许多医生来说很困难，活检部位的选择是通过试验和错误来确定的。我们提出了一个完整的图像引导EBUS支气管镜检查系统，专为淋巴结分期。该系统接受患者的3D胸部CT扫描、可选的PET扫描和EBUS支气管镜的视频源作为输入。系统工作流程分为两个阶段：（1）手术计划和（2）图像引导EBUS支气管镜检查。程序规划导出气道引导路线，以促进最佳EBUS扫描和淋巴结活检。在实时手术过程中，系统的图形显示建议执行一系列器械操作，并提供多模式视觉提示以定位合适的活检部位。为此，该系统利用数据融合来驱动多模态虚拟支气管镜和其他可视化工具，引导医生完成器械导航和定位过程。在标准临床工作流程内进行的回顾性肺癌患者研究和后续前瞻性患者研究证明了该系统的可行性和功能。对于前瞻性研究，60/60个选定的淋巴结（100%）使用该系统正确定位，30/33个活检淋巴结（91%）提供了足够的组织样本。此外，包括所有用户交互在内的平均手术时间为6 min 43 s。所有这些指标均优于其他最先进系统和当前实践报告的基准。总体而言，该系统能够安全、有效地进行基于EBUS的淋巴结定位和活检。
The staging of the central-chest lymph nodes is a major step in the management of lung-cancer patients. For this purpose, the physician uses a device that integrates videobronchoscopy and an endobronchial ultrasound (EBUS) probe. To biopsy a lymph node, the physician first uses videobronchoscopy to navigate through the airways and then invokes EBUS to localize and biopsy the node. Unfortunately, this process proves difficult for many physicians, with the choice of biopsy site found by trial and error. We present a complete image-guided EBUS bronchoscopy system tailored to lymph-node staging. The system accepts a patient’s 3D chest CT scan, an optional PET scan, and the EBUS bronchoscope’s video sources as inputs. System workflow follows two phases: (1) procedure planning and (2) image-guided EBUS bronchoscopy. Procedure planning derives airway guidance routes that facilitate optimal EBUS scanning and nodal biopsy. During the live procedure, the system’s graphical display suggests a series of device maneuvers to perform and provides multimodal visual cues for locating suitable biopsy sites. To this end, the system exploits data fusion to drive a multimodal virtual bronchoscope and other visualization tools that lead the physician through the process of device navigation and localization. A retrospective lung-cancer patient study and follow-on prospective patient study, performed within the standard clinical workflow, demonstrate the system’s feasibility and functionality. For the prospective study, 60/60 selected lymph nodes (100%) were correctly localized using the system, and 30/33 biopsied nodes (91%) gave adequate tissue samples. Also, the mean procedure time including all user interactions was 6 min 43 s All of these measures improve upon benchmarks reported for other state-of-the-art systems and current practice. Overall, the system enabled safe, efficient EBUS-based localization and biopsy of lymph nodes.