RESUMEN
PURPOSE: We aimed to put forward the contribution of virtual bronchoscopy in the determination and diagnosis of tracheobronchial system pathologies. We compared the data obtained from PET/CT and virtual bronchoscopy (VB) with the fiberoptic bronchoscopy (FOB) data of the cases with a diagnosis or pre-diagnosis of lung tumor. MATERIALS AND METHODS: A total of 261 (male=238, female=23) lung cancer cases with a mean age of 53±7.3 years (range =35-77 years), who had undergone FOB and had bronchoalveolar lavage and/or biopsy results, were included in this multicenter, prospective study conducted between 2006 and 2008. FOB data confirmed with cytohistopathology were considered as the gold standard. Five cases that had peripheral lesions, with negative cytopathological results were excluded from the study. Positron emission tomography images were fused with 16/slice multi-detector computed tomography system images (Discovery ST PET/16 slice CT fusion system HPOWER 60; General Electric Medical Systems, Milwaukee, WI, USA). Thereafter, all of the cases were evaluated with virtual bronchoscopy, using a special multidisplay workstation with multiplanar reformatting (MPR) and minimum intensity projection (MINIP) to see the fused images simultaneously. The data obtained with both virtual bronchoscopy (PET/CT VB) and FOB in different centers were recorded, and the evaluation and comparison of these data were done by an independent researcher. The sensitivity, specificity, and positive and negative predictive values of making an accurate diagnosis and defining concomitant pathologies by both methods, were calculated. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of VB and PET/CT-VB in determining the segment involved by malignancy were as follows, 91%, 83%, 94%, 77%, and 89%, and 95%, 97%, 99%, 87%, and 96%, respectively. CONCLUSIONS: The sensitivity of PET/CT-VB in determining the involved tracheobronchial segment(s) in malignancy and concomitant pathologies in cases with lung tumor was remarkably higher than that with CT-VB. Therefore, PET/CT-VB is recommended to be included in routine lung cancer examinations since it provides similar outcomes to that of FOB+cytohistopathological examination.
Asunto(s)
Broncoscopía/métodos , Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico , Tomografía Computarizada Multidetector , Imagen Multimodal , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Biopsia , Lavado Broncoalveolar , Distribución de Chi-Cuadrado , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Sensibilidad y Especificidad , TurquíaRESUMEN
BACKGROUND: Patients with squamous cell carcinoma of the head and neck constitute a high risk group for synchronous and metachronous tumours. OBJECTIVE: This study aimed to investigate the usefulness of white light and autofluorescence bronchoscopy in the evaluation of pre-malignant and early neoplastic lesions in patients with laryngeal cancer, who are at high risk of concomitant lung cancer. METHODS: This prospective, cross-sectional study included 30 patients who had undergone total laryngectomy for squamous cell carcinoma of the larynx. The tracheobronchial system was investigated for the presence of pre-malignant and malignant lesions, using a combination of white light and autofluorescence bronchoscopy. Biopsies were obtained from areas with a pathological appearance, and histopathological studies were performed. RESULTS: All patients had a permanent tracheostomy. Light and autofluorescence bronchoscopy indicated that the tracheobronchial system was normal in 11 patients. A total of 27 biopsies was taken from the remaining 19 patients, and revealed invasive squamous cell carcinoma in one patient and pre-malignant changes in six. CONCLUSION: Bronchoscopy is a valuable and practical tool for screening patients at high risk of lung cancer, and requires minimal intervention especially in patients with a permanent tracheostomy. Of the various bronchoscopic techniques becoming available, autofluorescence bronchoscopy shows promise for the detection of pre-invasive malignant changes of the tracheobronchial system in patients previously operated upon for laryngeal cancer.