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 - 2018/2

Y1 - 2018/2

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

KW - ENDOSCOPY

KW - DIAGNOSIS

KW - WHITE-LIGHT BRONCHOSCOPY

KW - AUTOFLUORESCENCE BRONCHOSCOPY

KW - INTRAEPITHELIAL NEOPLASIA

KW - LESIONS

UR - http://www.scopus.com/inward/record.url?scp=85054511483&partnerID=8YFLogxK

U2 - 10.1136/bmjresp-2018-000295

DO - 10.1136/bmjresp-2018-000295

M3 - Article

AN - SCOPUS:85054511483

VL - 5

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

SN - 2052-4439

IS - 1

M1 - e000295

ER -