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Predicting reachability to peripheral lesions in transbronchial biopsies using CT-derived geometrical attributes of the bronchial route

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Abstract

Purpose

The bronchoscopist’s ability to locate the lesion with the bronchoscope is critical for a transbronchial biopsy. However, much less study has been done on the transbronchial biopsy route. This study aims to determine whether the geometrical attributes of the bronchial route can predict the difficulty of reaching tumors in bronchoscopic intervention.

Methods

This study included patients who underwent bronchoscopic diagnosis of lung tumors using electromagnetic navigation. The biopsy instrument was considered “reached” and recorded as such if the tip of the tracked bronchoscope or extended working channel was in the tumors. Four geometrical indices were defined: Local curvature (LC), plane rotation (PR), radius, and global relative angle. A Mann–Whitney U test and logistic regression analysis were performed to analyze the difference in geometrical indices between the reachable and unreachable groups. Receiver operating characteristic analysis (ROC) was performed to evaluate the geometrical indices to predict reachability.

Results

Of the 41 patients enrolled in the study, 16 patients were assigned to the unreachable group and 25 patients to the reachable group. LC, PR, and radius have significantly higher values in unreachable cases than in reachable cases (\(p < 0.001\), \(p < 0.001\), \(p = 0.005\)). The logistic regression analysis showed that LC and PR were significantly associated with reachability (\(p < 0.001\), \(p < 0.001\)). The areas under the curve with ROC analysis of the LC and PR index were 0.903 and 0.618. The LC’s cut-off value was 578.25.

Conclusion

We investigated whether the geometrical attributes of the bronchial route to the lesion can predict the difficulty of reaching the lesions in the bronchoscopic biopsy. LC, PR, and radius have significantly higher values in unreachable cases than in reachable cases. LC and PR index can be potentially used to predict the navigational success of the bronchoscope.

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Correspondence to Masahito Naito.

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Nobuhiko Hata receives research funding from Canon USA, Inc. Fumitaro Masaki is an employee of Canon USA, Inc. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved as a retrospective record reviews study by the Institutional Review Board at Mass General Brigham (No 2018P002494) with a waiver to obtain the study consent.

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Naito, M., Masaki, F., Lisk, R. et al. Predicting reachability to peripheral lesions in transbronchial biopsies using CT-derived geometrical attributes of the bronchial route. Int J CARS 18, 247–255 (2023). https://doi.org/10.1007/s11548-022-02723-y

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  • DOI: https://doi.org/10.1007/s11548-022-02723-y

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