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

项目摘要/摘要 肺癌是癌症死亡的主要原因，全世界有160多万人死于肺癌。 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 使用。用于癌症的后续诊断和分期，微创支气管镜和支气管镜检查 使用超声(EBUS)。一种重大的范式转变，由肺癌的持续推出所刺激 筛查早期发现，正在开启一个专注于早期可治疗疾病的新纪元。它还 揭示了缺乏准确、全面的跟踪工具构成的主要绊脚石- 关于诊断和分期。本次更新项目的目标是构建一个多通道的形象导引 用于肺癌诊断和分期的支气管镜系统。 作为解决这一关键需求的一步，肺癌诊断最近也看到了 图像导航系统中的范式转变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。当到达肿瘤或淋巴结时， 医生现在必须进行活组织检查。不幸的是，医生使用EBUS的技巧差异很大， 尤其是对于不在专家中心的医生，导致活检产量很低。在一个相关的注释中， 综合试运行需要遍历许多分布广泛的节点站点，这是一项很少完成的任务 因为它所需要的技能。因此，现有的制导系统受到两个限制：1)它们 不指导EBUS和活检靶点任务；2)缺乏有效、系统的指导方案 全面的节点分期，需要达到决定性的分期决策。 为了认识到这些限制的严重性，AQUIRE进行了两项全国性的多中心试验 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 外围肿瘤诊断的诊断成功率为47%，而中央-胸部结节分期的诊断成功率为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，以及太少的淋巴- 对节点站进行了活检，导致了太多不确定的分期决定。 我们这次更新的目标是创建一种新的图像引导支气管镜/EBUS系统 这克服了目前的限制。为此，该项目有以下具体目标： 目的1：研制一种用于肺癌疾病诊断和分期的影像引导支气管镜系统。 目标2：进行动物(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，将优化后的系统与最先进的实践进行比较。 最终系统预计将在单个程序中实现准确的诊断/分期决策，具有 患者并发症较少，且易于使用，不依赖于医生的技能。就这样，没有定论 支气管镜检查减少，最终导致更及时的患者治疗。

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.