The use of MDCT-based computer-aided pathway finding for mediastinal and perihilar lymph node biopsy: a randomized controlled prospective trial.
The use of MDCT-based computer-aided pathway finding for mediastinal and perihilar lymph node biopsy: a randomized controlled prospective trial.
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使用基于 MDCT 的计算机辅助路径查找进行纵隔和肺门周围淋巴结活检：一项随机对照前瞻性试验。
DOI：
10.1159/000103207
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
Hoffman,EricA
中科院分区：
文献类型：
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作者：
McLennan,Geoffrey;Ferguson,JScott;Thomas,Karl;Delsing,AngelaS;Cook-Granroth,Janice;Hoffman,EricA
背景在支气管镜检查中，纵隔和肺门周围的淋巴结样本可以通过经支气管镜检查安全地获得，这通常是评估可疑肺癌的一部分。通常，如果操作员确信针在淋巴结靶点内，则进行针吸样本，并且可以对针芯进行采样，部分原因是如果在核心活检期间(尤其是在肺门周围区域)对大血管进行采样，则存在出血的风险。许多支气管镜医生在这些过程中难以评估用于针采样的三维(3D)定位，特别是当依赖于多排计算机断层扫描(MDCT)图像时，通常在手术前和手术中都能看到二维图像。目的我们开发并评估了一个过程模型和相关软件，用于提供MDCT数据的交互式3D显示，用于这些手术的程序规划和实时虚拟支气管镜路径寻找。方法我们进行了一项前瞻性随机临床研究，以评估计算机辅助纵隔淋巴结活检在87名自愿受试者中的路径辅助。结果我们证明，添加这种计算机辅助路径发现在肺门周围和气管旁淋巴结采样方面(100vs.69%)，但在隆突下采样方面(82vs.85%)，操作员的表现没有改善。使用计算机辅助方法进行淋巴结采样的总体成功率为92%，使用标准临床实践的总成功率为77%。结论本文所述的计算机辅助路径辅助类型，使用术前获得的3D MDCT扫描信息，但在支气管镜检查过程中与实时支气管镜图像交互，将提高大多数支气管镜检查人员执行这些操作的信心，改善临床结果，并将通过成像增加药物的个性化。
BackgroundMediastinal and perihilar lymph node samples can be acquired safely through the transbronchial approach during a bronchoscopic examination that is usually required as part of the evaluation of suspected lung cancer. Typically, needle aspiration samples are performed and needle cores can be sampled if the operator is confident that the needle is within the lymph node target, partly because of the risk of bleeding if a large blood vessel is sampled during core biopsy, especially in the perihilar region. Many bronchoscopists have difficulty assessing the three-dimensional (3D) positioning for needle sampling during these procedures, especially when relying on multidetector-row computerized tomography (MDCT) images displayed two-dimensionally seen prior to and usually during the procedure.ObjectiveWe have developed and evaluated a process model and associated software for providing interactive 3D displays of the MDCT data for procedure planning and real-time virtual bronchoscopic pathfinding for these procedures.MethodsWe undertook a prospective randomized clinical study for evaluating the computer-aided pathfinding assistance in mediastinal lymph node biopsies in 87 consenting subjects.ResultsWe demonstrate that the addition of this computer-aided pathfinding improved operator performance in perihilar and paratracheal lymph node sampling (100 vs. 69%) but not in subcarinal sampling (82 vs. 85%). Overall success with lymph node sampling is 92% using the computer-aided method and 77% using standard clinical practice.ConclusionsThe type of computer-aided pathway assistance described here, using 3D MDCT scanning information obtained before the procedure, but interacting with real-time bronchoscopic images during the bronchoscopic procedure, should improve the confidence of most bronchoscopists in performing these procedures, with improved clinical outcomes, and will add to the personalization of medicine through imaging.