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Image enhancement technology in bronchoscopy: a prospective multicentre study in lung cancer
  1. Erik H F M van der Heijden1,
  2. Piero Candoli2,
  3. Igor Vasilev3,
  4. Alessandro Messi2,
  5. Javier Pérez Pallarés4,
  6. Piotr Yablonskii3,
  7. Anna van der Vorm1,5,
  8. Olga C J Schuurbiers1 and
  9. Wouter Hoefsloot1
  1. 1 Department of Pulmonary Diseases (614), Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2 Ospedale Umberto I, Viale Dante Alighieri, Ravenna, Italy
  3. 3 Center of Thoracic Surgery, St-Petersburg Research Institute of TB and Thoracic Surgery, St Petersburg, Russia
  4. 4 Hospital General Universitario Santa Lucia, Cartagena, Spain
  5. 5 Technical Medicine Faculty, Twente University, Enschede, The Netherlands
  1. Correspondence to Dr Erik H F M van der Heijden; erik.vanderheijden{at}


Introduction Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established.

Methods In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation.

Results In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation.

Conclusion HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases.

Trial registration number NCT02285426; Results.

  • bronchoscopy
  • lung cancer
  • imaging/ct MRI etc
  • histology/cytology
  • non-small cell lung cancer

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  • Contributors The study concept was initiated by EHFMvdH. The design of this study was critically reviewed by EHFMvdH, PC, IV, OCJS and WH. The manuscript was drafted by EHFMvdH and he is the corresponding author for this work. All authors have critically revised the data and the interpretation thereof, revised the manuscript and approved its intellectual content, and the accuracy of integrity of the work investigated. All authors have acquired patient data.

  • Funding Unrestricted research grants and support from Ankie Hak foundation, Pentax Medical Systems Europe and Radboud Oncology Fund.

  • Competing interests EHFMvdH reports unrestricted research grants from Ankie Hak Foundation, Pentax Medical Europe, and Radboud Oncology Fund during the conduct of this study. Outside the content of the submitted work EHFMvdH reports personal fees from Pentax Medical, grants and other from Astra Zeneca Oncology, other from MSD oncology, grants from Philips Medical Systems, non-financial support from Medtronic. WH reports grants from Insmed Incorporated, non-financial support from Novartis, personal fees from Insmed Incorporated.

  • Patient consent Not required.

  • Ethics approval The study was approved by Central Medical Ethical committee Nijmegen, local medical ethical committee boards and registered in under identifier NCT02285426.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All relevant and obtained data are presented in this manuscript. For further inquiries please contact the corresponding author.

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