Virtual reality-assisted localization and three-dimensional printing-enhanced multidisciplinary decision to treat radiologically occult superficial endobronchial lung cancer

Abstract

Herein, we report the unique case of a 75-year-old male patient who had undergone a left upper lobectomy for lung cancer and developed an incidental superficial endobronchial squamous cell carcinoma in the right upper lobe that was not localizable on modern cross-sectional imaging modalities. The superficial endobronchial squamous cell carcinoma was successfully localized by computed tomography-driven virtual reality endoscopy and was identically matched with a small, whitish, patch lesion on bronchoscopy. The localized lesion was annotated on the corresponding computed tomography images, and illustrated in a fabricated three-dimensional (3D)-printed airway model. Because the exact anatomic location of the lesion and the acute angle of the adjacent bronchial trajectory were visible in the 3D model, enhanced multidisciplinary consultation resulted in the decision to treat the lesion using photodynamic therapy. Photodynamic therapy was successfully performed without complications. A follow-up bronchoscopy two months after treatment confirmed that the superficial endobronchial squamous cell carcinoma had been cured.