Virtual Bronchoscopic Navigation is Useful in the Diagnosis of Synchronous Pulmonary Squamous Cell Carcinomas

Abstract

Virtual bronchoscopy (VB) has become a useful method for investigating peripheral pulmonary lesions. This is the first case report of synchronous lung cancers that were diagnosed by transbronchial biopsy and/or brushing cytology supported by VB. An 81-year-old man had an abnormal shadow in his left upper lung field on the chest x-ray. His chest computerized tomography revealed 2 tumors involving peripheral airways, one 43×35 mm in size in the left S3 segment, and the other 21×18 mm in size in the left S10 segment. Digital imaging and communications in medicine data in the patient's chest computerized tomography were recorded and analyzed by the VB navigation system. Two routes of VB images from trachea to each tumor were semiautomatically adopted and saved. Bronchoscopy was performed according to the VB navigation using a standard videoscope and an ultrathin bronchoscope. First, a standard videoscope was used for observation of a central bronchial tree, and then an ultrathin bronchoscope was used for observation of a more peripheral area. Specimens from the lesions, which were obtained by forceps or brush, supported by the navigation, proved that both lesions were squamous cell carcinomas. Bronchoscopic examination can be performed quickly even in case of synchronous lung cancers owing to elimination of trial and error method for detecting the bronchial routes to the lesions.