Three-Dimensional Airway Reconstruction and Computational Spray Simulation to Guide Bronchoscopic Amphotericin B Delivery in Chronic Pulmonary Aspergillosis: An Exploratory Prospective Cohort Study With Historical Controls.

OBJECTIVE: To initially evaluate the feasibility and potential clinical value of high-resolution computed tomography (HRCT)-based three-dimensional (3D) airway reconstruction combined with computational spray simulation for guiding bronchoscopic amphotericin B delivery in patients with chronic pulmonary aspergillosis (CPA). METHODS: This multicenter, prospective cohort study with an expanded historical control was conducted. Patients in the prospective reconstruction cohort received HRCT-based 3D airway reconstruction combined with computational spray simulation to guide bronchoscopic amphotericin B delivery. Historical controls consisted of eligible CPA patients with complete clinical, imaging, treatment, adverse-event, and 6 month follow-up data who had received conventional bronchoscopic amphotericin B administration before implementation of the reconstruction-guided approach. RESULTS: A total of 10 patients in the reconstruction cohort and 30 historical controls were included. Baseline characteristics were generally comparable between groups, although fatigue was more frequent in the historical control cohort. At 6 months after treatment, the reconstruction cohort showed lower total St. George's respiratory questionnaire (SGRQ) scores than the historical control cohort. And SGRQ scores decreased significantly after treatment in each group, with a decrease of well over four points from baseline. More favourable clinical and radiographic responses and fewer adverse events were observed in the reconstruction cohort. CONCLUSION: The integrated reconstruction-guided strategy may provide a feasible strategy for optimizing bronchoscopic amphotericin B delivery in CPA. Given the historical-control design, small intervention cohort and potential residual confounding, these preliminary findings should be interpreted as exploratory and require confirmation in larger prospective controlled studies.