1
|
Kajikawa S, Imai N, Okachi S, Yatsuya H, Souma T, Watanabe T, Goto Y, Minezawa T, Hashimoto N, Imaizumi K, Hasegawa Y. Diagnostic contribution of cytological examination to endobronchial ultrasound-guided transbronchial biopsy for lung malignancies. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:613-620. [PMID: 31849378 PMCID: PMC6892665 DOI: 10.18999/nagjms.81.4.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although endobronchial ultrasound guided transbronchial biopsy (TBB) with a guide sheath (EBUS-GS) is widely used for diagnosis of peripheral pulmonary lesions, the diagnostic contribution of cytology (bronchial brushing, bronchial washing and biopsy forceps rinse) has not been established. To determine the diagnostic contribution of cytological examination to EBUS-GS-TBB, we reviewed medical records of patients with lung malignancies who had undergone TBB with EBUS-GS (EBUS-GS group, n=187) or TBB without EBUS-GS (conventional TBB [CTBB] group, n=197) at Nagoya University Hospital. Although the mean size of target lesions was significantly larger in the CTBB group than the EBUS-GS group, the total diagnostic rate was equivalent between two groups (EBUS-GS: 73.3%, CTBB: 66.0%). In the EBUS-GS group, cytological procedures increased the diagnostic rate by 9.1% (17/137), compared with only 4.1% (8/130) in the CTBB group. Sensitivity of cytology among biopsy-negative patients was significantly higher in EBUS-GS group than CTBB group (P=0.022). Furthermore, in the EBUS-GS group, among 17 patients whose malignant diagnoses could only be established cytologically, bronchial brushing contributed to the malignant diagnosis in 64.7% (11/17). These data may suggest that cytological examination, especially bronchial brushing, may be an important diagnostic contributor in EBUS-GS-TBB.
Collapse
Affiliation(s)
- Shigehisa Kajikawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Naoyuki Imai
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Shotaro Okachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Yatsuya
- Departments of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomohide Souma
- Departments of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Toshikazu Watanabe
- Departments of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yasuhiro Goto
- Departments of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyuki Minezawa
- Departments of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Imaizumi
- Departments of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
2
|
Ali MS, Trick W, Mba BI, Mohananey D, Sethi J, Musani AI. Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Respirology 2017; 22:443-453. [DOI: 10.1111/resp.12980] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Muhammad S. Ali
- Division of Pulmonary, Critical Care and Sleep Medicine; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - William Trick
- Department of Medicine; John H. Stroger, Jr. Hospital of Cook County; Chicago Illinois USA
| | - Benjamin I. Mba
- Department of Medicine; John H. Stroger, Jr. Hospital of Cook County; Chicago Illinois USA
| | | | - Jaskaran Sethi
- Department of Medicine; John H. Stroger, Jr. Hospital of Cook County; Chicago Illinois USA
| | - Ali I. Musani
- Division of Pulmonary, Critical Care and Sleep Medicine; Medical College of Wisconsin; Milwaukee Wisconsin USA
| |
Collapse
|
3
|
Ye J, Zhang R, Ma S, Wang L, Jin W. Endobronchial ultrasound plus fluoroscopy-guided biopsy compared to fluoroscopy-guided transbronchial biopsy for obtaining samples of peripheral pulmonary lesions: A systematic review and meta-analysis. Ann Thorac Med 2017; 12:114-120. [PMID: 28469722 PMCID: PMC5399685 DOI: 10.4103/atm.atm_298_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: We report a meta-analysis of recent studies comparing the diagnostic yields of endobronchial ultrasonography plus fluoroscopically-guided transbronchial biopsy (EBUS + TBB) with that of conventional fluoroscopically-guided TBB for peripheral pulmonary lesions (PPLs). METHODS: We searched Medline, the Cochrane Library, PubMed, and Google Scholar through 31 March 2013 using the keywords: lung neoplasm, pulmonary lesions, diagnosis, endobronchial ultrasound, fluoroscopy, and fluoroscopic. RESULTS: Four studies were included in the study with a total of 461 patients, 222 in the EBUS + TBB group and 239 in the TBB only group. The meta-analysis revealed that the group with EBUS + TBB was more favored in terms of positive diagnostic yield than the group diagnosed with only conventional TBB (odds ratio [OR] = 2.211, 95% confidence interval [CI] = 1.422–3.438, P < 0.001). Subgroup analysis based on lesion size found that smaller PPLs had higher accuracy (OR = 4.502, 95% CI = 2.002–10.126, P < 0.001) than PPLs of large size (OR = 1.849, 95% CI = 1.033–3.311, P = 0.039). CONCLUSION: Obtaining TBB samples for histopathological diagnosis is enhanced by the addition of EBUS to conventional fluoroscopic guidance; this is, especially important for patients with small peripheral lung lesions who benefit greatly from early diagnosis.
Collapse
Affiliation(s)
- Jian Ye
- Department of Pulmonary Medicine, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Ruifeng Zhang
- Department of Pulmonary Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Shenglin Ma
- Department of Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Limin Wang
- Department of Pulmonary Medicine, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Weizhong Jin
- Department of Pulmonary Medicine, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| |
Collapse
|
4
|
Zhang L, Wu H, Wang G. Endobronchial ultrasonography using a guide sheath technique for diagnosis of peripheral pulmonary lesions. Endosc Ultrasound 2017; 6:292-299. [PMID: 29063872 PMCID: PMC5664849 DOI: 10.4103/eus.eus_48_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Endobronchial ultrasonography using a guide sheath (EBUS-GS) is a novel method used for collecting peripheral pulmonary lesion (PPL) samples. EBUS-GS is performed by introducing a guide sheath-covered miniprobe into the target bronchus and then withdrawing the miniprobe after lesion detection, leaving the guide sheath in situ as a working channel for obtaining lesion samples. EBUS-GS can improve PPL diagnosis rates and be used for obtaining specimens for molecular analysis. In this review, we discuss the clinical applications of EBUS-GS, the factors that affect its diagnostic sensitivity, and potential complications. We also compare EBUS-GS with other available diagnostic techniques and discuss the strengths and limitations of this method.
Collapse
Affiliation(s)
- Lei Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxu Wu
- Airforce General Hospital, PLA, Beijing, China
| | - Guiqi Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Deng C, Cao X, Wu D, Ding H, You R, Chen Q, Chen L, Zhang X, Zhang Q, Wu Y. Small lung lesions invisible under fluoroscopy are located accurately by three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields. BMC Pulm Med 2016; 16:166. [PMID: 27894283 PMCID: PMC5126832 DOI: 10.1186/s12890-016-0328-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Background Nowadays, small peripheral pulmonary lesions (PPLs) are frequently detected and the prognosis of lung cancer depends on the early diagnosis. Because of the high fee and requiring specialized training, many advanced techniques are not available in many developing countries and rural districts. Methods Three sets of opaque soft copper wires visible under the fluoroscopy (Flu) in the Flu-flexible bronchoscopy (FB) group (n = 24), which determined the three planes of the lesion, were respectively placed firmly on the surface of the chest wall with adhesive tape on the chest wall. The FB tip was advanced into the bronchus toward the crosspoint of the three perpendicular planes under Flu with careful rotation of a C-arm unit. Then the specimen were harvested focusing around the crosspoint for pathologic diagnosis. The rapid on-site evaluation (ROSE) procedure was also performed. The average Flu time during FB procedures were recorded and diagnostic accuracy rates in the Flu-FB group were compared with the other group guided by radial endobronchial ultrasound (R-EBUS) (n = 23). Results The location of the core point of the lesion, whether it was visible or not under the fluoroscopy could be recognized by three-dimensional localization technique. The accuracy rates of diagnostic yields were 62.5% in the Flu-FB group, and was similar as 65.2% in the R-EBUS group (P > 0.05). However, in the Flu-FB group, there was a decreasing tendency on accurate diagnosis rates of lower lobe (LL) lesions when comparing with non-LL lesions (3/8 = 37.5% vs 12/16 = 75%, P = 0.091) while in the R-EBUS group it was similar (9/12 = 75% vs 6/11 = 54.6%, P = 0.278). In the Flu-FB group, fluoroscopy time was negatively correlated with the lesion length (r = −0.613, P = 0.001), however, there was no significant difference between the lesions invisible or not (5.83 ± 1.45 min vs 7.67 ± 2.02 min, P = 0.116) under the fluoroscopy, as well as no significant difference among SPN, mGGO and GGO (6.12 ± 2.05 min, 7.25 ± 1.33 min and 7.80 ± 2.02 min, P > 0.05). Conclusions Small PPL whether it is visible or not under fluoroscopy can be located accurately by our three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields. It is more convenient, economical and reliable with the similar diagnostic yields than R-EBUS guided method. Trial registration Current Controlled Trials ChiCTR-DDD-16009715. The date of registration: 3rd Nov, 2016. Retrospectively registered.
Collapse
Affiliation(s)
- Chaosheng Deng
- Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China.
| | - Xiaoming Cao
- Department of Respiratory Disease, First Hospital of Longyan City, 364000, Fujian, China
| | - Dawen Wu
- Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Haibo Ding
- Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Ruixiong You
- Department of Medical Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Qunlin Chen
- Department of Medical Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Linying Chen
- Department of Pathology, First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Xin Zhang
- Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Qiaoxian Zhang
- Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Yongquan Wu
- Department of Respiratory Disease, First Hospital of Longyan City, 364000, Fujian, China
| |
Collapse
|
6
|
Katsurada M, Izumo T, Nagai Y, Chavez C, Kitagawa M, Torii J, Iwase T, Aso T, Tsuchida T, Sasada S. The Dose and Risk Factors for Radiation Exposure to Medical Staff during Endobronchial Ultrasonography with a Guide Sheath for Peripheral Pulmonary Lesions under X-ray Fluoroscopy. Jpn J Clin Oncol 2014; 44:257-62. [DOI: 10.1093/jjco/hyt224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
7
|
Narula T, Machuzak MS, Mehta AC. Newer modalities in the work-up of peripheral pulmonary nodules. Clin Chest Med 2013; 34:395-415. [PMID: 23993812 DOI: 10.1016/j.ccm.2013.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Technological advances in recent years have translated into the availability of newer modalities to establish the cause of peripheral pulmonary nodules (PPN). Even though the verdict is still out on the ideal diagnostic modality, there is no doubt that the bronchoscope is becoming a popular tool in the armamentarium of physicians who deal with PPN. This article focuses on newer bronchoscopic modalities being studied for the work-up of PPN. The authors also summarize the value of established diagnostic modalities to provide a balanced perspective.
Collapse
Affiliation(s)
- Tathagat Narula
- Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | | |
Collapse
|