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Ann Thorac Surg 2004;77:1774-1780
© 2004 The Society of Thoracic Surgeons
a Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Québec, Canada
b Department of Radiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Québec, Canada
Accepted for publication October 20, 2003.
* Address reprint requests to Dr Lacasse, Centre de Pneumologie, Hôpital Laval, 2725 Chemin Ste-Foy, Sainte-Foy, Quebec G1V 4G5, Canada
e-mail: yves.lacasse{at}med.ulaval.ca
BACKGROUND: Virtual bronchoscopy (VB) could obviate flexible bronchoscopy (FB) if no endobronchial lesion is detected in patients presenting with a suspicion of malignancy. Our objectives were to evaluate the accuracy (in terms of sensitivity and specificity) of VB in detecting endobronchial lesions, and to determine the anatomical limit of detection of endobronchial lesions by VB.
METHODS: This study involved, in a blind comparison of VB and FB, consecutive patients presenting with symptoms or plain chest radiography abnormalities raising the suspicion of pulmonary neoplasm. After the standard chest computed tomography (CT), additional helical CT data were acquired from the aortic arch to the origin of the segmental bronchi of the inferior lobes in one 20-second breath hold using an helicoidal CT scan (3.0-mm collimation with a pitch of 1.5 and 1.5-mm reconstruction intervals).
RESULTS: One hundred ninety patients were enrolled; 136 patients (including 63 with an endobronchial lesion at FB) contributed to the primary analysis. The sensitivity and specificity of VB to detect endobronchial lesions were 68% (95% confidence interval [CI]: 55% to 79%) and 90% (95% CI: 81% to 96%), respectively. Overall, the agreement between VB and FB regarding the location on endobronchial lesions was substantial (weighted kappa: 0.66). However, VB detected only 26 of the 34 lobar lesions (sensitivity: 76%; CI: 59% to 89%) and 11 of the 23 segmental lesions (sensitivity: 48%; CI: 27% to 69%).
CONCLUSIONS: Beyond the mainstem bronchi, VB is not accurate enough to detect endobronchial lesions and to obviate FB in patients presenting with a suspicion of malignancy.
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