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Franke KJ, Hein M, Domanski U, Nilius G, Schroeder M, Wohlschlaeger J, Theegarten D. Transbronchial Catheter Aspiration and Transbronchial Needle Aspiration in the Diagnostic Workup of Peripheral Lung Lesions. Lung 2015; 193:767-72. [PMID: 26156311 DOI: 10.1007/s00408-015-9763-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Increasingly frequent, it is clinically indicated to obtain tissue from a peripheral lung lesion (PLL) to yield a pathological diagnosis. The aim of the present study was to evaluate the diagnostic sensitivity of transbronchial needle aspiration (TBNA) and transbronchial catheter aspiration (TBCA) in addition to transbronchial forceps biopsy (TBB) at conventional bronchoscopy. METHODS Eligible patients showing a PLL on computed tomography scans were included in the study. In all patients, following TBB, TBNA and TBCA were employed in randomised order under fluoroscopy. RESULTS Fourty-eight patients were enrolled, of whom 46 patients with 46 PLLs were included in the analysis. The mean ± SD diameter of the PLL was 27.0 ± 13.3 mm. The overall sensitivity for all modalities was 69.6%; PLL ≤20 or >20 and ≤30 mm in diameter showed a sensitivity of 60.0 and 72.2%, respectively. For malignant PLL (n = 33), the combined sensitivity of TBNA + TBCA versus TBB was significantly higher (63.6 vs. 33.3%, p ≤ 0.05), and could not further be improved by TBB. For benign PLL, TBB was superior to TBNA + TBCA (76.9 vs. 38.5%). CONCLUSIONS TBB, TBNA and TBCA are complementary to one another. Combining the three techniques, even allows transbronchial specimen collection of PLL <3 cm in diameter at conventional bronchoscopy.
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Affiliation(s)
- Karl-Josef Franke
- Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Chair of Internal Medicine I, Witten/Herdecke University, Ambrocker Weg 60, 58091, Hagen, Germany.
| | - Melanie Hein
- Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Chair of Internal Medicine I, Witten/Herdecke University, Ambrocker Weg 60, 58091, Hagen, Germany.
| | - Ulrike Domanski
- Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Chair of Internal Medicine I, Witten/Herdecke University, Ambrocker Weg 60, 58091, Hagen, Germany.
| | - Georg Nilius
- Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Chair of Internal Medicine I, Witten/Herdecke University, Ambrocker Weg 60, 58091, Hagen, Germany.
| | - Maik Schroeder
- Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Chair of Internal Medicine I, Witten/Herdecke University, Ambrocker Weg 60, 58091, Hagen, Germany.
| | - Jeremias Wohlschlaeger
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany. .,Institute of Pathology, Diakonissenkrankenhaus, Knuthstraße 1, 24939, Flensburg, Germany.
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany.
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Matsumoto Y, Izumo T, Sasada S, Tsuchida T, Ohe Y. Diagnostic utility of endobronchial ultrasound with a guide sheath under the computed tomography workstation (ziostation) for small peripheral pulmonary lesions. CLINICAL RESPIRATORY JOURNAL 2015; 11:185-192. [PMID: 26072931 DOI: 10.1111/crj.12321] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS The application of radial probe endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation has improved the diagnostic outcome of bronchoscopy for peripheral pulmonary lesions (PPLs). Nonetheless, while existing navigation systems are very useful for selecting the bronchus containing the target lesion, the associated introductory costs are high. Therefore, we focused on virtual bronchoscopy (VB) using the workstation, ziostation that was already available in many countries as an adjunct modality. METHODS Consecutive patients who underwent bronchoscopy with R-EBUS for PPLs (major diameter ≤30 mm) were enrolled. From late June 2013 to November 2013, 121 patients were examined with ziostation, and from September 2012 to early June 2013, 113 patients were examined without ziostation. We compared the diagnostic yield, EBUS detection rate and procedure time between two groups to evaluate the utility of the VB. RESULTS The ziostation group had significantly higher diagnostic yield than the non-ziostation group (77.7% vs 64.6%, P = 0.030). Following the multivariate analysis, use of ziostation was a significant factor affecting the diagnostic yield. Meanwhile, EBUS detection rate was significantly higher in the ziostation group (94.2% vs 75.2%, P < 0.001). And, procedure time was significantly shorter in the ziostation group (mean ± standard deviation: 24.0 ± 7.4 min vs 26.9 ± 7.9 min, P = 0.005). CONCLUSION VB offered by the workstation was a valuable tool that facilitated more accurate and rapid bronchoscopy procedure for diagnosis of PPLs.
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Affiliation(s)
- Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Izumo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Sasada
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Minezawa T, Okamura T, Yatsuya H, Yamamoto N, Morikawa S, Yamaguchi T, Morishita M, Niwa Y, Takeyama T, Mieno Y, Hoshino T, Uozu S, Goto Y, Hayashi M, Isogai S, Matsuo M, Nakanishi T, Hashimoto N, Okazawa M, Imaizumi K. Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study. BMC Med Imaging 2015; 15:21. [PMID: 26092497 PMCID: PMC4475307 DOI: 10.1186/s12880-015-0060-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 05/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions. In some cases, however, it is difficult to obtain adequate biopsy samples for pathological diagnosis. Adequate prediction of the diagnostic accuracy of TBB with EBUS-GS is important before deciding whether bronchoscopy should be performed. Methods We retrospectively reviewed 149 consecutive patients who underwent TBB with EBUS-GS for small-sized peripheral lung lesions (≤30 mm in diameter) from April 2012 to March 2013. We conducted an exploratory analysis to identify clinical factors that can predict an accurate diagnosis by TBB with EBUS-GS. All patients underwent thin-section chest computed tomography (CT) scans (0.5-mm slices), and the CT bronchus sign was evaluated before bronchoscopy in a group discussion. The final diagnoses were pathologically or clinically confirmed in all studied patients (malignant lesions, 110 patients; benign lesions, 39 patients). Results The total diagnostic yield in this study was 72.5 % (95 % confidence interval: 64.8–79.0 %). Lesion size, lesion visibility on chest X-ray, and classification of the CT bronchus sign were factors significantly associated with the definitive biopsy result in the univariate analysis. In the multivariate analysis, only the CT bronchus sign remained as a significant predictive factor for successful bronchoscopic diagnosis. The CT bronchus sign was also significantly associated with the EBUS findings of the lesions. Conclusion Our results suggest that the CT bronchus sign is a powerful predictive factor for successful TBB with EBUS-GS.
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Affiliation(s)
- Tomoyuki Minezawa
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Takuya Okamura
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University, Toyoake, Aichi, Japan.
| | - Naoki Yamamoto
- Laboratory of Molecular Biology & Histochemistry, Fujita Health University, Toyoake, Aichi, Japan.
| | - Sayako Morikawa
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Teppei Yamaguchi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Mariko Morishita
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshikazu Niwa
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Tomoko Takeyama
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Yuki Mieno
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Tami Hoshino
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Sakurako Uozu
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Yasuhiro Goto
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Masamichi Hayashi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Sumito Isogai
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Masaki Matsuo
- Department of Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Japan.
| | - Toru Nakanishi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Mitsushi Okazawa
- Department of Respiratory Medicine, Daiyu-kai Hospital, Ichinomiya, Aichi, Japan.
| | - Kazuyoshi Imaizumi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
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Hayama M, Izumo T, Matsumoto Y, Chavez C, Tsuchida T, Sasada S. Complications with Endobronchial Ultrasound with a Guide Sheath for the Diagnosis of Peripheral Pulmonary Lesions. Respiration 2015; 90:129-35. [PMID: 26112297 DOI: 10.1159/000431383] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/11/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnostic bronchoscopy has been considered as a safe and effective procedure. Endobronchial ultrasound with a guide sheath (EBUS-GS) for the diagnosis of peripheral pulmonary lesions (PPLs) is becoming a common procedure, but reports about its safety are missing. OBJECTIVES The aim of this study was to evaluate the safety profile of EBUS-GS for the diagnosis of PPLs. METHODS All patients with PPLs who underwent EBUS-GS between September 2012 and August 2014 at the National Cancer Center Hospital were included. Postprocedural complications and the durability of devices were retrospectively reviewed. RESULTS During the study period, EBUS-GS procedures were performed for 965 PPLs. The overall complication rate was 1.3% (13/965): 0.8% (8/965) for pneumothorax and 0.5% (5/965) for pulmonary infection. There was no significant hemorrhage, air embolism, tumor seeding or procedure-related death, and there was no breakage of the guide sheath. Only four radial probes were broken during the study period without any adverse reactions. CONCLUSIONS EBUS-GS is a tolerable procedure, and the devices are durable.
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Affiliation(s)
- Manabu Hayama
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
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Chavez C, Sasada S, Izumo T, Watanabe J, Katsurada M, Matsumoto Y, Tsuchida T. Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations. J Thorac Dis 2015; 7:596-602. [PMID: 25973225 DOI: 10.3978/j.issn.2072-1439.2015.03.04] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/28/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Radial endobronchial ultrasound with a guide sheath (EBUS-GS) has improved the diagnostic accuracy of transbronchial biopsy (TBB) for malignant peripheral pulmonary nodules (PPNs). Many underscore the importance of tumor localization but reproducible results on other aspects that affect yield are few. We aimed to analyze the diagnostic performance of TBB with EBUS-GS and to know what group of patients can benefit most. METHODS The database of patients with malignant PPNs (≤30 mm) who underwent EBUS-GS TBB at the National Cancer Center Hospital, Tokyo, Japan from April 2012 to March 2013 was retrospectively reviewed and analysed based on lesion and procedural characteristics. RESULTS Most PPNs (N=212) were adenocarcinoma, measuring 20 mm [mean, standard deviation (SD) 5.45]. Overall diagnostic accuracy was 67.5% (143 of 212 cases). Factors that significantly affected and predicted diagnostic success were EBUS probe within (P=0.001) and parenchymal location that was not adjacent to the costal visceral pleura (P=0.001). When combined, these variables achieved an 87% (59 of 68 lesions) diagnostic yield. CT scan characteristic, lesion size, lobe location, and GS size were non-contributory. CONCLUSIONS EBUS-GS TBB is an acceptable diagnostic method for small peripheral lung cancer. It can be maximized for PPNs that are away from the pleura and when the EBUS probe can be placed within the lesion.
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Affiliation(s)
- Christine Chavez
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Shinji Sasada
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Takehiro Izumo
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Junko Watanabe
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Masahiro Katsurada
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Yuji Matsumoto
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Takaaki Tsuchida
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
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Computed Tomography Characteristics Predictive for Radial EBUS-Miniprobe-Guided Diagnosis of Pulmonary Lesions. J Thorac Oncol 2015; 10:472-8. [DOI: 10.1097/jto.0000000000000410] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Asano F, Shinagawa N, Ishida T, Tsuzuku A, Tachihara M, Kanazawa K, Yamada N, Oizumi S, Moriya H. Virtual bronchoscopic navigation improves the diagnostic yield of radial-endobronchial ultrasound for peripheral pulmonary lesions with involved bronchi on CT. Intern Med 2015; 54:1021-5. [PMID: 25948341 DOI: 10.2169/internalmedicine.54.3497] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful. METHODS The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterior-anterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated. RESULTS Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026). CONCLUSION VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.
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Affiliation(s)
- Fumihiro Asano
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Japan
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Asano F, Eberhardt R, Herth FJF. Virtual bronchoscopic navigation for peripheral pulmonary lesions. Respiration 2014; 88:430-40. [PMID: 25402610 DOI: 10.1159/000367900] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022] Open
Abstract
Virtual bronchoscopic navigation (VBN) is a method in which the bronchoscope is guided on the bronchial route to a peripheral lesion using virtual bronchoscopic images. In reports on VBN for peripheral pulmonary lesions searched in PubMed as of November 2013, the diagnostic yield by ultrathin bronchoscopy in combination with computed tomography and VBN was within the range of 65.4-81.6%. Using endobronchial ultrasonography with a guide sheath (EBUS-GS) and VBN, it was between 63.3 and 84.4%, and using X-ray fluoroscopy and VBN, it was between 62.5 and 78.7%. The overall diagnostic yield was 73.8% [95% confidence interval (CI) 70.9-76.8%] and that for lesions ≤ 2 cm was 67.4% (95% CI 63.3-71.5%). These values indicate high diagnostic rates. In randomized comparative trials, the combination of VBN with EBUS-GS improved the diagnostic yield and shortened the examination time. The diagnostic yields for lesions in the right upper lobe, those invisible on posterior-anterior radiographs and those located in the peripheral third of the lung field were improved by VBN on ultrathin bronchoscopy in combination with X-ray fluoroscopy. The usefulness of VBN was also found on meta-analysis. Taken together, VBN is a promising navigational bronchoscopy method as it requires no specific training, has a low overall complication rate of 1.0% (95% CI 0.2-1.8%) and does not directly induce or cause severe complications. To maximize the full potential of VBN and promote its use, investigation of cases in which it is useful, determination of the optimum combination of procedures, a cost/benefit analysis and advancement of the VBN system are warranted.
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Affiliation(s)
- Fumihiro Asano
- Pulmonary Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
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Chavez C, Sasada S, Izumo T, Nakamura Y, Tsuta K, Tsuchida T. Image-guided bronchoscopy for histopathologic diagnosis of pure ground glass opacity: a case report. J Thorac Dis 2014; 6:E81-4. [PMID: 24977033 DOI: 10.3978/j.issn.2072-1439.2014.06.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/10/2014] [Indexed: 11/14/2022]
Abstract
Guided bronchoscopy has been found to be useful for the diagnosis of solid peripheral pulmonary lesions (PPLs) but more evidence on ground glass opacities (GGOs), especially those without a solid component, are lacking. A 69-year-old male, asymptomatic, heavy smoker was referred to our department for non-surgical diagnosis of a focal pure GGO in the right upper lobe that was found incidentally on computed tomography (CT). Transbronchial biopsy (TBB) with the aide of endobronchial ultrasound with a guide sheath (EBUS-GS), virtual bronchoscopic navigation (VBN), and fluoroscopy was performed for sampling. There were no complications after the procedure. The diagnosis of adenocarcinoma with lepidic growth pattern was established from the fourth and fifth TBB specimens and was confirmed on subsequent surgical resection. Image-guided bronchoscopy with TBB was successful for the diagnosis of a pure GGO. Use of a larger biopsy device may be helpful for the histopathologic diagnosis of lung adenocarcinoma with lepidic growth.
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Affiliation(s)
- Christine Chavez
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Shinji Sasada
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Takehiro Izumo
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Yukiko Nakamura
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Koji Tsuta
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Takaaki Tsuchida
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
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Sasada S, Izumo T, Chavez C, Matsumoto Y, Tsuchida T. A new middle-range diameter bronchoscope with large channel for transbronchial sampling of peripheral pulmonary lesions. Jpn J Clin Oncol 2014; 44:826-34. [PMID: 24916337 DOI: 10.1093/jjco/hyu079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Although the diagnostic yield of guided bronchoscopy for peripheral pulmonary lesions has improved to 70%, it is still low compared with transthoracic needle aspiration. We produced a new bronchoscope with middle-range diameter and large channel (BF-Y0053, Olympus, Japan), and evaluated its diagnostic efficacy for peripheral pulmonary lesions. METHODS This was a retrospective study on 70 consecutive patients with peripheral pulmonary lesions who underwent diagnostic bronchoscopy using BF-Y0053 combined with endobronchial ultrasound with a guide sheath at the National Cancer Center Hospital from September 2013 to November 2013. Diagnostic performance of the procedure was analyzed and compared among three groups of peripheral pulmonary lesions: 'peripheral-small' lesions (≤ 30 mm and adjacent to visceral pleura), 'central-small' lesions (≤ 30 mm and not adjacent to the visceral pleura), and 'large' lesions (>30 mm). RESULTS Sixty (85.7%) patients had malignant diseases. Diagnosis was established by bronchoscopy in 61 of 70 patients (87.1%); the respective yields for 'central-small' and 'large' lesions were significantly higher than that for 'peripheral-small' lesions (96.3%, 94.4%, 72%, P = 0.0026). This diagnostic accuracy was achieved regardless of other clinical and procedural factors such as, lesion size, feature ground glass opacity (or solid), endobronchial ultrasound-probe location (within or outside) or operator skill. There were no major post-procedural complications. CONCLUSIONS A new middle-range diameter bronchoscope with large channel combined with endobronchial ultrasound with a guide sheath can enhance the efficacy of transbronchial sampling to its maximal potential to diagnose peripheral pulmonary lesions safely and accurately, particularly for patients who have tumors away from the visceral pleura.
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Affiliation(s)
- Shinji Sasada
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takehiro Izumo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Christine Chavez
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Radial Probe Endobronchial Ultrasound for Peripheral Pulmonary Lesions. A 5-Year Institutional Experience. Ann Am Thorac Soc 2014; 11:578-82. [DOI: 10.1513/annalsats.201311-384oc] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leung CC, Porcel JM, Takahashi K, Restrepo MI, Lee P, Wainwright C. Year in review 2013: Lung cancer, respiratory infections, tuberculosis, cystic fibrosis, pleural diseases, bronchoscopic intervention and imaging. Respirology 2014; 19:448-60. [PMID: 24708034 DOI: 10.1111/resp.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Chi Chiu Leung
- Tuberculosis and Chest Service, Department of Health, Hong Kong, China
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