International Journal of Medical and Health Research

Authors
Dr. Karen Veronica Fernandes, Dr. Anupam Jhobta, Dr. Malay Sarkar, Dr. Shruti Thakur, Dr. Ram Gopal Sood

Abstract
Introduction: Lung tumours represent a true epidemic of the twentieth century. Lung cancer has become the leading cause of cancer-related mortality worldwide. Multidetector CT has revolutionized anatomic and functional imaging of the central airways and enhanced the ability to diagnose airway pathology especially using three- dimensional reconstruction techniques. These images aid both radiologists and referring clinicians by demonstrating anatomic relationships and the extent of disease Aim: To evaluate the diagnostic accuracy of MDCT virtual bronchoscopy (VB) compared to fiberoptic bronchoscopy (FOB) in detecting tracheobronchial neoplasms. To find ways in which MDCT VB could be additive to FOB. Materials and methods: Fifty-eight patients with suspected tracheobronchial malignancies were selected for a comparative analysis analysis between VB and FOB. Lesions were evaluated in terms of site of lesion, type of lesion, degree of stenosis and visualization of airway distal to the lesion. Additional findings were also sought in each modality. Results: The study comprised 38 men and 21 women. VB detected 110 lesions and FOB identified 84 lesions. Concordant findings for tumour detection and localization were noted in 69 airways. Sensitivity of VB was therefore 82.1% and specificity was 97.2%. The accuracy was 96.4%. There was a substantial agreement (κ: 0.69; C.I. 0.64 to 0.74) between VB and FOB regarding the site of tumour detection. In assessing the type of lesion, the study showed sensitivities and specificities of 60% and 99.6% respectively for endoluminal lesions (moderate agreement, κ=0.50), 87.2% and 98.3% respectively for lesions causing extrinsic compression (substantial agreement, κ=0.67). Overall, the agreement between VB and FOB regarding the grade of stenosis detected in corresponding areas/ levels was moderate to substantial (κ: 0.63; C.I. 0.56 to 0.71). VB offered the advantage of being able to visualize areas beyond even high grade stenoses. VB was able to explore the airways beyond stenosis in 33 patients, whereas, FOB was able to explore the airways beyond stenosis in 6 patients. Thus, virtual bronchoscopy had a sensitivity of 100% and a NPV of 100 %. Conclusion: The results of the study indicate that VB is an excellent non-invasive modality that can be used efficiently as a first-line investigative tool and complementary tool to FOB in the diagnosis, treatment and management of patients with tracheobronchial neoplasms. It can guide the referring clinician in further management of the patient. It can also replace FOB in selected cases.