Role of high-definition bronchoscopy in histopathological diagnosis of bronchogenic carcinoma according to bronchial vascular patterns

Abstract

Background Owing to technological advances, a novel technique has become available, called high-definition (HD) bronchoscopy, giving substantially higher resolution images than conventional white light bronchoscopy and producing signal images with resolutions ranging from 850 000 pixels to more than 1 million pixels. HD bronchoscopes are designed for image output onto commercial TVs or computer monitors via i-scan video device. Aim The aim of this study was to determine the relation between different vascular patterns and histopathological type of bronchogenic carcinoma by using HD bronchoscopy and i-scan. Patients and methods The study was performed at Chest Department, Ain Shams University Hospital, from January 2015 till January 2016. The study included 30 patients, comprising 24 males and six females, with age ranging from 45 to 73 years. Bronchogenic carcinoma was diagnosed in all patients: 10 patients had squamous cell type, eight patients had adenocarcinoma, seven patients had small cell type, and five cases had large cell type. All patients were subjected to full history taking, complete clinical examination, and radiographic studies including plain chest radiography and computerized tomography of the chest. Laboratory evaluations included complete blood count, liver functions, renal functions, prothrombin time, partial thromboplastin time, international normalized ratio, and spirometry if needed. All cases were prepared and examined by HD PENTAX 3.2 Medical 70K-series (EB-1970TK) video bronchoscope and i-scan Video Processor EPK-i 5000. Results There was a statistically significant association between vascular pattern and pathology of bronchogenic carcinoma. Tortuous vessels were identified in 80% of patients with squamous cell carcinoma, 60% of large cell type, 42.8% of small cell type, and 12.5% of patients of adenocarcinoma. Dotted vessels were identified in 78.5% of adenocarcinoma cases, 42.8% of small cell type, 20% of large cell type, and 10% of squamous cell type. Abrupt-ending vessels were identified in 10% of squamous cell carcinoma cases, 14.4% of small cell type, and 20% of large cell type. Incidence of tortuous vessels in cases with squamous cell carcinoma was significantly greater (7.429 times) than nontortuous vessels. Incidence of dotted vessels in cases with adenocarcinoma was significantly higher (23.80 times) than nondotted vessels. Conclusion Advanced bronchoscopic technologies may enable obtaining an ‘optical biopsy’ of the bronchial tree, providing high-resolution and three-dimensional virtual images. These technologies may fundamentally improve the diagnostic and therapeutic assessment of bronchial tumors.