The importance of CT in fluoroscopy mode in the context of a comprehensive bronchological study of peripheral lesions in the lungs

Introduction: The relevance of this study stems from the current clear trend toward maximum individualization of differential diagnostic programs for lung pathology. Particular attention is paid to the diagnosis of small peripheral lesions not associated with the bronchus and endoscopic signs of disease. This article examines the potential of bronchoscopy with various bronchial biopsy options for diagnosing peripheral lung lesions under CT guidance in fluoroscopy with preliminary CT navigation.

Purpose: To evaluate the effectiveness of bronchoscopy with various types of bronchobiopsy under CT control in fluoroscopy mode with preliminary CT navigation in the diagnosis of peripheral focal lung lesions up to 3 cm in maximum dimension.

Materials and methods: The study included patients with focal peripheral lung lesions measuring up to 3 cm in size. The study group included 84 patients and the control group consisted of 85 patients. The groups were matched for age, size, structure, relationship to the bronchus, and location of the lesions. Bronchoscopy with various types of bronchobiopsy was performed under CT guidance using fluoroscopy and preliminary CT navigation. CT scan was retrospectively performed in patients from the control group to determine the presence/absence of bronchial visualization.

Results: The combined approach (CT navigation + bronchoscopy + CT fluoroscopy) demonstrated statistically significant (p< 0.001) and clinically relevant superiority over traditional bronchoscopy. The absolute increase in diagnostic yield was +41.0 % (78.6 % versus 37.6 % in the control group). The odds ratio (OR) of successful diagnostic verification reached 6.2 (95 % CI: 3.3‑11.6), which indicates a 6-fold increase in the probability of establishing a morphological diagnosis when using a combined technique.

Conclusion: The combined method of bronchoscopy with CT navigation and intraoperative CT fluoroscopy is a diagnostic tool that significantly expands the possibilities of morphological verification of peripheral lung formations. Its implementation in the practice of specialized pulmonology and thoracic centers is a justified and promising direction that contributes to improving patient treatment outcomes by increasing the accuracy and timeliness of the diagnostic process.

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