Value of virtual 3D CT bronchoscopy in comparison with conventional bronchoscopy for evaluation of tracheal and bronchial tree pathology

Background: Conventional bronchoscopy (CB) is the gold standard for airway evaluation but carries risks of complications.Virtual bronchoscopy (VB), derived from MDCT data, offers a non-invasive alternative, yet its comparative diagnostic accuracy across diverse pathologies requires validation.Objectives: This study aimed to evaluate the diagnostic accuracy and safety of 3D-CT virtual bronchoscopy compared to conventional bronchoscopy for assessing tracheal and bronchial tree pathology.Methods: This prospective comparative study included 50 patients with suspected airway pathology at Fayoum University Hospital.All patients underwent non-contrast 16-slice MDCT with 3D postprocessing (VB), followed by conventional fiberoptic bronchoscopy.Results: VB demonstrated high overall accuracy (92.0%) compared to CB (94.0%), with no significant difference between modalities (McNemar's p=1.000; 86% agreement).VB achieved 91.1% sensitivity and 100% specificity.It detected 100% of post-intubation stenosis cases and 95.7% of bronchogenic carcinomas but showed lower sensitivity for foreign bodies and tracheomegaly (66.7%).Crucially, VB had a superior safety profile with zero complications, whereas CB was associated with coughing (90%), bleeding (100%), and desaturation (2%).Conclusions: Virtual bronchoscopy is a safe, highly accurate non-invasive alternative for evaluating airway stenosis and masses.While it cannot replace CB for tissue sampling or mucosal assessment, it serves as an excellent screening tool and pre-procedural roadmap, particularly for high-risk patients.