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Multimodal Image-Guided Intervention System for Lung-Cancer Diagnosis and Staging

用于肺癌诊断和分期的多模态图像引导干预系统

基本信息

批准号：
10321636
负责人：
William Evan Higgins
金额：
$ 39.84万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-24 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10321636
关键词：
3-Dimensional Accounting Address Animals Biopsy Bronchoscopes Bronchoscopy Cancer Etiology Cessation of life Chest Clinical Research Computers Data Detection Diagnosis Diagnostic Diagnostic Neoplasm Staging Disease Early Diagnosis Family suidae Functional Imaging Funding Goals Human Image Judgment Lesion Lung Malignant Neoplasms Malignant neoplasm of lung Methods Modernization Multicenter Trials Multimodal Imaging Navigation System Nodal Patients Performance Peripheral Phase Physicians Positron-Emission Tomography Problem Solving Procedures Protocols documentation Psyche structure Resolution Scanning Staging Structure Survival Rate System Techniques Three-Dimensional Imaging Time Tissues Work X-Ray Computed Tomography accurate diagnosis base cancer diagnosis disease diagnosis efficacy study image guided image guided intervention improved in vivo innovation lung basal segment lung cancer screening lymph nodes minimally invasive multimodality prospective prototype radiological imaging safety and feasibility safety testing screening program skills tool tumor tumor diagnosis ultrasound

项目摘要

Project Summary/Abstract Lung cancer is the leading cause of cancer death, accounting for over 1.6 million deaths worldwide. For initial detection of suspect peripheral tumors and central-chest lymph nodes, CT and PET imaging are used. For follow-on cancer diagnosis and staging, minimally invasive bronchoscopy and endobronchial ultrasound (EBUS) are used. A major paradigm shift, spurred by the ongoing roll-out of lung-cancer screening for early detection, is ushering in a new era focused on early-stage treatable disease. It also brings to light the major stumbling block posed by the lack of accurate, comprehensive tools for follow- on diagnosis and staging. The goal of this renewal project is to construct a multimodal image-guided bronchoscopy system for lung-cancer diagnosis and staging. As a step toward addressing this critical need, lung-cancer diagnosis has also seen a recent paradigm shift in that image-guided navigation systems have solved the task of bronchoscopic navigation. Navigation, however, is only part of the task. Upon reaching a tumor or lymph node, the physician must now perform a biopsy. Unfortunately, physician skill in using EBUS varies greatly, especially for physicians not at expert centers, resulting in poor biopsy yields. On a related note, comprehensive staging requires traversing many widely spaced nodal stations, a task rarely done because of the skill it demands. Thus, existing guidance systems suffer from two limitations: 1) they do not guide EBUS and the task of biopsy targeting; 2) they lack an efficient, systematic protocol for guiding comprehensive nodal staging, needed for reaching conclusive staging decisions. To appreciate how critical these limitations are, two national multi-center trials by the AQuIRE consortium studying state-of-the-art bronchoscopy tools for lung-cancer diagnosis and staging found a poor 47% diagnostic yield for peripheral tumor diagnosis and a 50% yield for central-chest nodal staging--- i.e., too many tumor biopsies were missed, resulting in too many uncertain diagnoses, and too few lymph- node stations were biopsied, resulting in too many uncertain staging decisions. Our objective now in this renewal is to create a new image-guided bronchoscopy/EBUS system that overcomes current limitations. To this end, the project has the following Specific Aims: Aim 1: Prototype an image-guided bronchoscopy system for lung-cancer disease diagnosis and staging. Aim 2: Perform animal (with PennVet), phantom, and human studies to optimize the system. Aim 3: Conduct prospective human studies to compare the optimized system to state-of-the-art practice. The final system is expected to enable accurate diagnosis/staging decisions in a single procedure, have fewer patient complications, and be easy to use independent of physician skill. In this way, inconclusive bronchoscopies decrease, ultimately leading to more timely patient treatment.

项目总结/摘要肺癌是癌症死亡的主要原因，全世界有超过160万人死于肺癌。对于可疑的外周肿瘤和中央胸部淋巴结的初步检测，CT和PET成像是采用对于后续癌症诊断和分期，微创支气管镜检查和支气管内使用超声波（EBUS）。一个主要的范式转变，由肺癌的不断推出刺激，早期检测筛查正在迎来一个专注于早期可治疗疾病的新时代。它还揭示了缺乏准确、全面的工具所造成的主要障碍，在诊断和分期上。这个更新项目的目标是构建一个多模态图像引导支气管镜系统用于肺癌诊断和分期。作为解决这一关键需求的一步，肺癌诊断最近也出现了一个新的趋势。图像引导导航系统的范式转变已经解决了支气管镜检查的任务，导航然而，导航只是任务的一部分。一旦到达肿瘤或淋巴结，医生现在必须进行活检。不幸的是，医生使用EBUS的技能差异很大，特别是对于不在专家中心的医生，导致较差的活组织检查产率。与此相关的是，综合分段需要穿越许多间隔很大的节点站，这是一项很少有人做的任务因为它需要技巧因此，现有的制导系统存在两个局限性：1）不指导EBUS和活检靶向任务; 2）他们缺乏有效的，系统的方案来指导全面的节点分期，需要达到结论性分期决策。为了理解这些限制的重要性，AQuIRE的两项国家多中心试验一个研究用于肺癌诊断和分期的最先进的支气管镜检查工具的联盟发现，外周肿瘤诊断的诊断率为47%，中央胸淋巴结分期的诊断率为50%。也就是说，太多的肿瘤活检被遗漏，导致太多的不确定诊断，太少的淋巴结，对节点站点进行活检，导致太多不确定的分期决定。本次更新的目标是创建一种新的图像引导支气管镜检查/EBUS系统它克服了当前的局限性。为此，该项目有以下具体目标：目的1：建立一个用于肺癌疾病诊断和分期的图像引导支气管镜系统原型。目的2：进行动物（使用PennVet）、体模和人体研究，以优化系统。目的3：进行前瞻性人体研究，以比较优化系统与最先进的实践。最终的系统有望在一次手术中做出准确的诊断/分期决定，较少的患者并发症，并且易于独立于医师技能使用。这样看来，支气管镜检查减少，最终导致更及时的患者治疗。