Revista del Instituto Nacional de Enfermedades Respiratorias
Print version ISSN 0187-7585
CHAY, Leticia et al. Correlation between virtual bronchoscopy and fiberoptic bronchoscopy in non-neoplasic stenosis of the larger airways. Rev. Inst. Nal. Enf. Resp. Mex. [online]. 2005, vol.18, n.1, pp. 22-26. ISSN 0187-7585.
Introduction: Imaging of the larger airways can be done by fiberoptic bronchoscopy (FOB) or by virtual bronchoscopy by means of three dimensional helical computed tomography (VBHCT3D). Objectives: To compare the differences of both methods for the assessment of non neoplastic stenosis of the trachea and main bronchi, as diagnostic tools helpful in the planning of treatment in such cases. Material and methods: Sixteen cases, 6 women and 10 men, ages 16 to 57, mean 33 years; clinical course 2 to 108 months, mean 8 months. In all: FOB and VBHCT3D. Sensitivity (Se) and Specificity (Sp) were determined and statistical significance for both methods and Pearson's r for length and degree of the stenotic segment using VBHCT3D. Results: Location: 7 cases with subglotic and 4 with tracheal stenosis, 2 cases tracheal collapse, 1 case stenosis of the left main bronchus, 2 granulomas of the trachea. Etiology: 7 cases post tracheal intubation, 5 cases post traumatic, 1 post tracheostomy, 2 tracheomalacia, 1 granulomatous disease. Treatment: 7 Grillo Pearson's technique, five resection of the large airways and terminoterminal anastomosis, 1 dilatation, 1 laser therapy, 2 non-surgical. For the detection of stenosis, FOB and VBHCT3D had 100% Se and Sp; for the degree of stenosis. FOB had 100% Sp and Se, VBHCT3D had 60% Se and Sp. To evaluate the length of stenosis, FOB could not pass the obstruction in 12 cases. In the 12 surgical cases, for VBHCT3D there was exact correlation in 7 and a 10% mean error in 5 cases. For the length of the stenosis in the freshly resected specimen, Pearson's r by VBHCT3D p< 0.05 -r=0.7782, degree of stenosis p< 0.01 -r=0.9534. All 12 resected specimens showed various degrees of fibrosis, chronic inflammation, epidermoid metaplasia and granulomas. Conclusions: VBHCT3D can detect degree and length of stenosis, but the gold standard for stenosis and degree is FOB, but in severe cases the instrument can not pass the obstruction and assess its length. VBHCT3D detects degree and length of stenosis non invasively and is expensive. FOB visualizes stenosis and its degree with precision, is less expensive. Both methods are helpful in the diagnosis of degree and lenght of the obstruction and in the planning of surgical treatment.
Keywords : Fiberoptic bronchoscopy; virtual bronchoscopy; helicoidal tomography; tracheal stenosis; bronchial stenosis; airway resection; laser.