Virtual endobronchial ultrasound for transbronchial needle aspiration

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration could be performed better with computer-based preparation. Three-dimensional virtual bronchoscopy was used to develop 2 modes of computer-based "virtual endobronchial ultrasound." "Virtual endobronchial ultrasound standard" used conventional virtual bronchoscopy to determine the spot and angle for transbronchial needle aspiration, which was further evaluated by virtual bronchoscopy. "Virtual endobronchial ultrasound advanced" used multiple layers of 3-dimensional images of the target lesions and associated vascular structures in combination with virtual bronchoscopy. Target lesions and associated vascular structures (eg, pulmonary artery) were visualized through half-transparent bronchial walls. Both methods required 5 to 15 minutes of preparation per case. Virtual endobronchial ultrasound standard required only basic computer software for virtual bronchoscopy, whereas virtual endobronchial ultrasound advanced required an advanced computer application. Virtual endobronchial ultrasound advanced allowed for a more intuitive recognition of the target. Both methods were useful in evaluating the feasibility of transbronchial needle aspiration, especially when the target was out of regular mediastinal lymph nodes, or in targeting a lesion located at a high upper angle (eg, 4L lymph node). Because the puncture spot was predetermined, bronchoscopists did not have to search for the target using ultrasound at the time of actual endobronchial ultrasound-guided transbronchial needle aspiration; rather, ultrasound was used only for confirmation of the target location and visualization of transbronchial needle aspiration. Both computer-based preparation methods of virtual endobronchial ultrasound were useful in predetermining the puncture spot of transbronchial needle aspiration, suggesting their potential complementary role to the conventional technique of endobronchial ultrasound-guided transbronchial needle aspiration.