title: CT bronchoscopic simulation for guiding transbronchial needle aspiration of extramural mediastinal and hilar lesions: initial clinical results.
abstract: OBJECTIVE
  To compare the yield of transbronchial needle aspiration (TBNA) with conventional orientation by using axial computed tomographic (CT) sections and that of TBNA with CT bronchoscopic simulation guidance for diagnosis of bronchoscopically occult extramural mediastinal and hilar lesions and the hit rates of both methods with regard to lesion number, size, and location in an intraindividual setting.
  
  
  METHODS
  During this institutional review board-approved study, 28 patients with 50 bronchoscopically invisible lesions (mean short-axis diameter, 14 mm +/- 5 [standard deviation]; range, 6-38 mm) of the mediastinum and hilum gave informed consent and underwent TBNA. For CT bronchoscopic simulation, the target was displayed at virtual bronchoscopy to localize the best needle insertion point for TBNA. Each lesion was initially punctured with knowledge of axial CT sections only, followed by a second pass after reviewing CT bronchoscopic simulation. A hit was defined when specific material (eg, lymphatic or malignant cells) was obtained. Both methods were compared with respect to lesion size and location of successful punctures.
  
  
  RESULTS
  With orientation by using CT bronchoscopic simulation, 29 of 50 lesions were successfully punctured, whereas only 15 lesions were hit with orientation by using axial CT sections (P < .05). Hit rate of CT bronchoscopic simulation was superior to conventional orientation independent of lesion size and location.
  
  
  CONCLUSIONS
  Orientation by using CT bronchoscopic simulation helps improve guidance for TBNA of bronchoscopically invisible lesions of the mediastinum and the hilum, increases the hit rate, and may be a helpful tool for less experienced bronchoscopists.
  
  
  BACKGROUND
  http://radiology.rsnajnls.org/cgi/content/full/250/3/923/DC1.
authors.affiliation: Department of Radiology and Nuclear Medicine, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. guido.weiner@charite.de
authors.forename: Guido M
authors.initials: GM
authors.lastname: Weiner
authors.forename: Karsten
authors.initials: K
authors.lastname: Schulze
authors.forename: Bernhard
authors.initials: B
authors.lastname: Geiger
authors.forename: Harald
authors.initials: H
authors.lastname: Ebhardt
authors.forename: Karl-Juergen
authors.initials: KJ
authors.lastname: Wolf
authors.forename: Thomas
authors.initials: T
authors.lastname: Albrecht
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*