title: Localization of Peripheral Pulmonary Lesions Using a Method of Computed Tomography-Anatomic Correlation and Radial Probe Endobronchial Ultrasound Confirmation.
abstract: Peripheral pulmonary lesions requiring a diagnosis continue to present challenges to clinicians. One significant barrier is the inability to reliably locate peripheral lesions by bronchoscopic approaches. Multiplanar computed tomographic (CT) scan reconstruction is available to most physicians and provides axial, coronal, and sagittal images that may be used to estimate target lesion location and guide bronchoscopists during procedures.
  
  
  
  This study was performed to evaluate a systematic method of CT-anatomic correlation based on multiplanar reconstruction CT scanning with monoplanar fluoroscopy during bronchoscopy to locate peripheral pulmonary lesions and confirm lesion location, using radial probe endobronchial ultrasound.
  
  
  
  A retrospective review of peripheral bronchoscopy cases in which radial probe endobronchial ultrasound for peripheral lesions was performed at a tertiary care, university hospital. All cases involved a systematic approach of reviewing axial, coronal, and sagittal CT reconstructions, coupled with monoplanar fluoroscopy during procedures to assist with locating peripheral lesions.
  
  
  
  Using the method of CT-anatomic correlation, 332 of 348 (95.4%) of all lesions were successfully localized and confirmed, using radial probe endobronchial ultrasound. Lesions 1-2 cm in size accounted for 45% of all lesions, and the ability to locate lesions was not significantly different based on lesion size. Mean time to lesion localization was 6.8 minutes. Larger lesions and lesions demonstrating an air bronchus sign on CT scan were located in less time. The overall diagnostic yield was 58.9%.
  
  
  
  A systematic approach applying CT-anatomic correlation with multiplanar CT scan reconstruction and monoplanar fluoroscopy during procedures can result in an efficient, and successful process for locating peripheral pulmonary lesions.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Chen
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.
authors.forename: Andrea
authors.initials: A
authors.lastname: Loiselle
authors.affiliation: 2 Division of Medical Education, and.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.affiliation: 3 Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri; and.
authors.forename: Jack
authors.initials: J
authors.lastname: Baty
authors.affiliation: 4 Department of Respiratory Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri.
authors.forename: David
authors.initials: D
authors.lastname: Misselhorn
mesh_terms: D001999:Bronchoscopy / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005471:Fluoroscopy; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: bronchoscopy; diagnostics; lesion identification