ABC of manual airway mapping

To diagnose a peripheral pulmonary lesion represented by lung cancer using a bronchoscope, accurately grasping the bronchial route to reach the peripheral pulmonary lesion is necessary. In recent years, the use of virtual bronchoscopic navigation has become widespread. However, it is ideal if, by looking at the axial computed tomography (CT) images, doctors think and accordingly perform the tracing branch technique, which draws the bronchial route.

 Notably, approaching the lesion is the most difficult task. Although advancements in bronchial navigation can address this difficulty, the limitations of high equipment cost, extraction of navigation data from CT, and the time and effort required to create a navigation image remain. Moreover, the navigation itself cannot always accurately represent the peripheral bronchi. Hence the “branch reading technique”, also called “bronchial branch tracing method” which was discovery by Dr. Noriaki Kurimoto. This is a simple manual airway mapping planning which is based on the consecutive CT images that showed the branches that led to the peripheral bronchus involved with the lesion and making it feasible for accurately guiding pulmonary lesions along with bronchial generations.

 But in Taiwan, there is still some difficutly to do bronchial branch tracing method due to exam time is limit and we usually need to do brochoscopy 10-15 patients every days. So we used annother diagnostic methods, called CEO methods. “C” is known the rough lesion site by CT, “E” is found the lesion by endobronchial ultrasound (EBUS) and “O” is confirmed by rapid onsite evaluation (ROSE). In our hospital, CEO medthods can imporved the diagnostic yield without more procedure time. The efficiency of CEO method depends on the bronchoscopist’s skill. Training could solve this issue. High diagnostic yield of our cohort is related to procedural skills of the bronchoscopists and the presence of ROSE.

 In conclusion, bronchial branch tracing method or CEO methods for bronchoscopic navigation serves as a feasible and economical method for guiding peripheral pulmonary nodule biopsy, it could be conducive to access more distal airways and achieve similar diagnostic yield in comparison with virtual bronchoscopic navigation.