Multi-Dimensional Display of Wang's Lymph Node Map Using Virtual Bronchoscopic Navigation System

Fen Lan; Yaling Yue; Hong Shen; Hui Shen; Qiyuan Wang; Xiujing Yu; Laijuan Chen; Qin Li; Kopen Wang; Qinghua Liu; Yang Xia

doi:10.3389/fmolb.2021.679442

Multi-Dimensional Display of Wang's Lymph Node Map Using Virtual Bronchoscopic Navigation System

Front Mol Biosci. 2021 Jun 7:8:679442. doi: 10.3389/fmolb.2021.679442. eCollection 2021.

Authors

Fen Lan¹, Yaling Yue², Hong Shen³, Hui Shen^{1

4}, Qiyuan Wang⁵, Xiujing Yu⁶, Laijuan Chen⁶, Qin Li¹, Kopen Wang⁷, Qinghua Liu⁸, Yang Xia¹

Affiliations

¹ Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
² Department of Medical Oncology, Handan Central Hospital, Handan, China.
³ Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁴ Department of Respiratory and Critical Care Medicine, Huzhou Central Hospital, Huzhou, China.
⁵ Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
⁶ Department of Endoscopic Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
⁷ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
⁸ Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.

Abstract

Background: Transbronchial needle aspiration (TBNA) is a classical technique for diagnosing mediastinal-hilar lymph node enlargement. However, the diagnostic value of conventional TBNA (cTBNA) is limited in small lymph nodes. Methods: Here, we generated an innovative multi-dimensional virtual lymph node map on top of Wang's lymph node map using a Lungpoint Virtual Bronchoscopic Navigation System. Results: The virtual bronchoscopic navigation (VBN) system was combined with computed tomography (CT) images to generate extrabronchial, endobronchial, sagittal, coronal as well as horizontal views of the 11 intrathoracic lymph node stations and their adjacent tissues and blood vessels. We displayed the specific puncture site of each lymph node station. The 11 stations were divided into four groups: right mediastinal stations, left mediastinal stations, central mediastinal stations and hilar stations. Conclusion: The VBN system provides a precise view of the intrabronchial landmarks, which may increase the diagnostic accuracy of intrathoracic lymph node adenopathy and assist bronchoscopists with practicing TBNA.

Keywords: TBNA; bronchoscopy; lymph node map; mediastinal-hilar lymph node; virtual navigation system.