Image enhancement technology in bronchoscopy: A prospective multicentre study in lung cancer

Erik H.F.M. Van Der Heijden, Piero Candoli, Igor Vasilev, Alessandro Messi, Javier Pérez Pallarés, Piotr Yablonskii, Anna Van Der Vorm, Olga C.J. Schuurbiers, Wouter Hoefsloot

Research output

1 Citation (Scopus)

Abstract

Introduction Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established. Methods In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation. Results In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation. Conclusion HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases.

Original languageEnglish
Article numbere000295
JournalBMJ Open Respiratory Research
Volume5
Issue number1
DOIs
Publication statusPublished - 1 May 2018

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Biomedical Enhancement
Image Enhancement
Bronchoscopy
Multicenter Studies
Lung Neoplasms
Blood Vessels
Prospective Studies
Pathology
Cross-Over Studies
Squamous Cell Carcinoma
Neoplasms
Histology
Epithelium
Research Personnel
Biopsy

Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Van Der Heijden, E. H. F. M., Candoli, P., Vasilev, I., Messi, A., Pérez Pallarés, J., Yablonskii, P., ... Hoefsloot, W. (2018). Image enhancement technology in bronchoscopy: A prospective multicentre study in lung cancer. BMJ Open Respiratory Research, 5(1), [e000295]. https://doi.org/10.1136/bmjresp-2018-000295
Van Der Heijden, Erik H.F.M. ; Candoli, Piero ; Vasilev, Igor ; Messi, Alessandro ; Pérez Pallarés, Javier ; Yablonskii, Piotr ; Van Der Vorm, Anna ; Schuurbiers, Olga C.J. ; Hoefsloot, Wouter. / Image enhancement technology in bronchoscopy : A prospective multicentre study in lung cancer. In: BMJ Open Respiratory Research. 2018 ; Vol. 5, No. 1.
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title = "Image enhancement technology in bronchoscopy: A prospective multicentre study in lung cancer",
abstract = "Introduction Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established. Methods In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation. Results In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33{\%}) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4{\%} of the patients, relevant second lesions were detected which determined treatment and staging in 3{\%} of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation. Conclusion HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4{\%} and affected treatment and work-up in 3{\%} of the cases.",
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Van Der Heijden, EHFM, Candoli, P, Vasilev, I, Messi, A, Pérez Pallarés, J, Yablonskii, P, Van Der Vorm, A, Schuurbiers, OCJ & Hoefsloot, W 2018, 'Image enhancement technology in bronchoscopy: A prospective multicentre study in lung cancer', BMJ Open Respiratory Research, vol. 5, no. 1, e000295. https://doi.org/10.1136/bmjresp-2018-000295

Image enhancement technology in bronchoscopy : A prospective multicentre study in lung cancer. / Van Der Heijden, Erik H.F.M.; Candoli, Piero; Vasilev, Igor; Messi, Alessandro; Pérez Pallarés, Javier; Yablonskii, Piotr; Van Der Vorm, Anna; Schuurbiers, Olga C.J.; Hoefsloot, Wouter.

In: BMJ Open Respiratory Research, Vol. 5, No. 1, e000295, 01.05.2018.

Research output

TY - JOUR

T1 - Image enhancement technology in bronchoscopy

T2 - A prospective multicentre study in lung cancer

AU - Van Der Heijden, Erik H.F.M.

AU - Candoli, Piero

AU - Vasilev, Igor

AU - Messi, Alessandro

AU - Pérez Pallarés, Javier

AU - Yablonskii, Piotr

AU - Van Der Vorm, Anna

AU - Schuurbiers, Olga C.J.

AU - Hoefsloot, Wouter

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Introduction Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established. Methods In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation. Results In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation. Conclusion HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases.

AB - Introduction Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established. Methods In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation. Results In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation. Conclusion HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases.

KW - bronchoscopy

KW - histology/cytology

KW - imaging/ct MRI etc

KW - lung cancer

KW - non-small cell lung cancer

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