Ege TERZİBAŞIOĞLU, Artür SALMASLIOĞLU, Koray GÜVEN, Atadan TUNACI, Barış BAKIR, Ümit TÜZÜN, Memduh DURSUN

Endobronşiyal tümörlerde çok kesitli BT sanal bronkoskopinin tanısal etkinliği

Bu çalışmanın amacı; konvansiyonel fiberoptik bronkoskopiye yardımcı yeni bir yöntem olan sanal bronkoskopinin endobronşiyal tümörlerin tanısındaki etkinliğini konvansiyonel bronkoskopi sonuçlarıyla karşılaştırarak araştırmaktır. Akciğer kanseri şüphesi olan 36 hastaya (28 erkek, 8 kadın; 39-74 yaş arasında, yaş ortalaması 61) ilk olarak çok detektörlü bilgisayarlı tomografi (BT)-sanal bronkoskopi daha sonra aynı gün içinde konvansiyonel bronkoskopi tetkiki yapıldı. Tüm hastalar konvansiyonel bronkoskopi sonucundan habersiz olarak değerlendirildi. Sanal bronkoskopi için duyarlılık, özgüllük, pozitif ve negatif prediktif değerleri konvansiyonel bronkoskopi bulguları referans standart alınarak hesaplandı. Çalışmaya alınan 36 hastanın 12’sinde konvansiyonel bronkoskopi normal olarak değerlendirildi. Patoloji saptanan 24 hastanın üçünde mukozal infiltrasyon, 21’inde ise lümeni tama yakın tıkayan (beş hasta) veya lümeni çeşitli oranlarda daraltan (16 hasta) vejetan kitle lezyonlar izlendi. Konvansiyonel bronkoskopide izlenen 21 vejetan tümöral lezyonun tamamı sanal bronkoskopide izlendi. Ayrıca, sanal bronkoskopide izlenen fakat konvansiyonel bronkoskopide mevcut olmayan altı lezyonun retrospektif olarak değerlendirildiğinde, visköz içeriğinin yoğun mukus sekresyonu olduğu anlaşıldı. Altı hastada ise konvansiyonel ve sanal bronkoskopide herhangi bir anormalliğe rastlanmadı. Konvansiyonel bronkoskopide izlenen üç adet mukozal infiltrasyon ise sanal bronkoskopide saptanamadı. Literatür ile uyumlu olarak çok kesitli BT sanal bronkoskopinin duyarlılığının yüksek (%88), özgüllüğünün ise düşük (%50) olduğu görüldü. Pozitif prediktif değeri %78, negatif prediktif değeri %66, doğruluğu ise %75 olarak bulundu.

The diagnostic efficiency of multislice CT virtual bronchoscopy in detecting endobronchial tumors

In this study, the diagnostic efficiency of virtual bronchoscopy, which is a new and helpful method to conventional fiberoptic bronchoscopy, has been investigated for endobronchial lung tumors and its clinical applications are discussed. 36 patients with clinically suspected lung cancer (28 males, 8 females, mean age 61; range from 39 to 74) underwent multislice computed tomography (MSCT) virtual bronchoscopy and then conventional bronchoscopy on the same day. For all patients, investigators were uninformed about results of conventional bronchoscopy. Sensitivity, specificity, positive and negative predictive values of virtual bronchoscopy were calculated using conventional bronchoscopy results as standard reference values. In 12 patients, convetional bronchoscopy did not show pathologic findings. In 24 cases pathologic findings were detected; mucosal infiltration was observed in three cases, vegetating lesions were detected in 21 cases. Review of these 21 cases demonstrated preocclusive stenosis in five and various degrees of luminal stenosis in 16 cases. All 21 tumoral lesions observed with conventional bronchoscopy were also detected with virtual bronchoscopy. Retrospective evaluation of six lesions visualized with virtual bronchoscopy but not detected with conventional bronchoscopy showed that they consisted of highly viscous mucous secretion. No abnormalities were detected on both conventional and virtual bronchoscopy in six patients. Three mucosal infiltrations observed on conventional bronchoscopy were not visualised on virtual bronchoscopy. The sensitivity of MSCT virtual bronchoscopy was 88% and specificity was 50% which is concordant with the literature. Positive predictive value, negative predictive value and accuracy was found 78%, 66% and 75%, respectively.

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