Role of post-mapping computed tomography in virtual-assisted lung mapping

Abstract

Background

Virtual-assisted lung mapping is a novel bronchoscopic preoperative lung marking technique in which virtual bronchoscopy is used to predict the locations of multiple dye markings. Post-mapping computed tomography is performed to confirm the locations of the actual markings. This study aimed to examine the accuracy of marking locations predicted by virtual bronchoscopy and elucidate the role of post-mapping computed tomography.

Methods

Automated and manual virtual bronchoscopy was used to predict marking locations. After bronchoscopic dye marking under local anesthesia, computed tomography was performed to confirm the actual marking locations before surgery. Discrepancies between marking locations predicted by the different methods and the actual markings were examined on computed tomography images. Forty-three markings in 11 patients were analyzed.

Results

The average difference between the predicted and actual marking locations was 30 mm. There was no significant difference between the latest version of the automated virtual bronchoscopy system (30.7 ± 17.2 mm) and manual virtual bronchoscopy (29.8 ± 19.1 mm). The difference was significantly greater in the upper vs. lower lobes (37.1 ± 20.1 vs. 23.0 ± 6.8 mm, for automated virtual bronchoscopy; p < 0.01). Despite this discrepancy, all targeted lesions were successfully resected using 3-dimensional image guidance based on post-mapping computed tomography reflecting the actual marking locations.

Conclusions

Markings predicted by virtual bronchoscopy were dislocated from the actual markings by an average of 3 cm. However, surgery was accurately performed using post-mapping computed tomography guidance, demonstrating the indispensable role of post-mapping computed tomography in virtual-assisted lung mapping.

Keywords

Anatomic landmarks Bronchoscopy Lung neoplasms Surgery computer-assisted

Get full access to this article

View all access options for this article.

References

Sato

Omasa

Chen

. Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. J Thorac Cardiovasc Surg 2014; 147: 1813–9.

Sato

Yamada

Menju

. Virtual-assisted lung mapping: outcome of 100 consecutive cases in a single institute. Eur J Cardiothorac Surg 2015; 47: e131–9.

Yamanashi

Sato

Marumo

. Emphysematous lungs do not affect visibility of virtual-assisted lung mapping. Asian Cardiovasc Thorac Ann 2016; 24: 152–7.

Sato M. Virtual assisted lung mapping: navigational thoracoscopic lung resection. Cancer Res Front 2016;2:85–104. Available at: http://cancer-research-frontiers.org/wp-content/uploads/2016/03/CRF-2016-2-85.pdf. Accessed December 23, 2016.

Sato

Aoyama

Yamada

. Thoracoscopic wedge lung resection using virtual-assisted lung mapping. Asian Cardiovasc Thorac Ann 2015; 23: 46–54.

Sato M, Murayama T, Nakajima J. Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP). J Thorac Dis 2016;8(Suppl 9):S716–30. Available at: http://jtd.amegroups.com/article/view/9754/pdf. Accessed December 23, 2016.

Sakiyama

Kondo

Matsuoka

. Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg 2003; 126: 1207–9.

Iguchi

Yoshioka

Muro

. Systemic air embolism during preoperative pulmonary marking with a short hook wire and suture system under CT fluoroscopy guidance. Jpn J Radiol 2009; 27: 385–8.

Kamiyoshihara

Sakata

Ishikawa

Morishita

. Cerebral arterial air embolism following CT-guided lung needle marking. Report of a case. J Cardiovasc Surg (Torino) 2001; 42: 699–700.

10.

Asano

Shindoh

Shigemitsu

. Ultrathin bronchoscopic barium marking with virtual bronchoscopic navigation for fluoroscopy-assisted thoracoscopic surgery. Chest 2004; 126: 1687–93.

11.

Schwarz

Greif

Becker

Ernst

Mehta

. Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study. Chest 2006; 129: 988–94.