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Computed Tomography Bronchus Sign Subclassification during Radial Endobronchial Ultrasound-Guided Transbronchial Biopsy: A Retrospective Analysis. Diagnostics (Basel) 2023; 13:diagnostics13061064. [PMID: 36980372 PMCID: PMC10047045 DOI: 10.3390/diagnostics13061064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
The presence of computed tomography bronchus sign (CT-BS) substantially increases the diagnostic yield of peripheral pulmonary lesions. However, the clinical significance of subdividing CT-BS remains controversial. We classified bronchus types on CT into six subtypes (CT-BS group I: types Ia–Ic with the bronchus connected within the lesion, group II: types IIa–IIc without connection) to clarify the differences in their characteristics and investigate the factors associated with diagnosis during radial endobronchial ultrasound (rEBUS)-guided bronchoscopy. In total, 1021 cases were analyzed. Our findings in diagnostic yields were that in CT-BS group I, penetrating type Ic was inferior to obstructed type Ia and narrowing type Ib (59.0% vs. 80.0% and 76.3%, p < 0.001, p = 0.004); in CT-BS group II, compressed type IIa showed no difference when compared with invisible type IIb and uninvolved type IIc (IIa: 52.8% vs. IIb: 46.3% and IIc: 35.7%, p = 0.253). Multivariable analysis revealed that bronchus type (types Ia and Ib vs. Ic) was a significant independent predictor of successful diagnosis in CT-BS group I (odds ratio, 1.78; 95% confidence interval, 1.04–3.05; p = 0.035), along with known factors such as rEBUS visualization. CT-BS subclassification may provide useful information regarding the bronchoscopic technique to facilitate accurate diagnosis.
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Ou Y, Feng M, Hu B, Dong Y. The impact of alfentanil supplementation on the sedation of bronchoscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e27401. [PMID: 35945737 PMCID: PMC9351902 DOI: 10.1097/md.0000000000027401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The efficacy of alfentanil supplementation for the sedation of bronchoscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of alfentanil supplementation on the sedation during bronchoscopy. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2019 for randomized controlled trials (RCTs) assessing the effect of alfentanil supplementation versus placebo for the sedation during bronchoscopy. This meta-analysis is performed using the random-effect model. RESULTS Five RCTs are included in the meta-analysis. Overall, compared with control group for bronchoscopy, alfentanyl supplementation is associated with significantly reduced coughing scores (Std. MD = -0.55; 95% CI = -0.96 to -0.14; P = 0.009) and dose of propofol (Std. MD = -0.34; 95% CI = -0.64 to -0.04; P = 0.03), but reveals the increase in hypoxemia (RR = 1.56; 95% CI = 1.17 to 2.08; P = 0.002). CONCLUSIONS Alfentanyl supplementation benefits to reduce coughing scores and dose of propofol for bronchoscopy, but increases the incidence of hypoxemia. The use of alfentanyl supplementation for bronchoscopy should be with caution.
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Affiliation(s)
- Yan Ou
- Emergency Department of PLA Army Specialty Medical Center
| | - Malong Feng
- Department of Respiration, Fenghua people’s hospital, Ningbo, Zhejiang, China
| | - Bingqing Hu
- Department of Anesthesiology, Ningbo Yinzhou No. 2 Hospital, Zhejiang, China
| | - Yishan Dong
- Department of General Medicine, Jiangjin Hospital affiliated to Chongqing University
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Nakashima K, Misawa M, Otsuki A, Narita K, Otsuka Y, Matsue K, Aoshima M. Efficacy and Safety of Endobronchial Ultrasonography with a Guide-sheath for Acute Pulmonary Lesions in Patients with Haematological Diseases. Intern Med 2022; 61:623-632. [PMID: 35228474 PMCID: PMC8943388 DOI: 10.2169/internalmedicine.6364-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Acute pulmonary lesions (APLs), defined as an acute infiltrate or nodular lung field, are a major complication in patients with haematological diseases. Recently, endobronchial ultrasonography with a guide-sheath (EBUS-GS) was established as a useful technique for diagnosing pulmonary lesions. This study aimed to evaluate the efficacy and safety of EBUS-GS for managing APLs in patients with haematological diseases. Methods Our single-centre, retrospective, observational, single-arm, descriptive study enrolled 22 consecutive adult (>20-year-old) patients with haematological diseases and concomitant APL who underwent EBUS-GS between January 2011 and June 2016 at Kameda Medical Center, Chiba, Japan. The primary endpoint was the contribution of EBUS-GS to clinical decision-making. Secondary endpoints were an adequate tissue collection rate, diagnostic yield, complication rate, and 30-day mortality. Results The median patient age was 70 years old, and 63.6% were men. Acute myeloid leukaemia was the most frequent underlying disease, accounting for 54.5% of patients. The contribution of EBUS-GS to clinical decision-making was recognised in 11 (50.0%) patients. Adequate tissue collection was achieved in 21 (95.5%) patients. The aetiology of the APL was identified in 9 (40.9%) patients. No complications, including severe haemorrhaging and pneumothorax, were observed in any patients, and the 30-day mortality rate was 0%. Conclusion EBUS-GS may be a suitable diagnostic option for APL in patients with haematological diseases. Further larger-scale and randomised controlled trials are needed to confirm our results.
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Affiliation(s)
- Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Japan
| | | | - Ayumu Otsuki
- Department of Pulmonology, Kameda Medical Center, Japan
| | | | | | - Kosei Matsue
- Department of Haematology, Kameda Medical Center, Japan
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Hsu LH, Ko JS, Liu CC, Feng AC, Chu NM. Conventional transbronchial needle aspiration is promising for identifying EGFR mutations in lung adenocarcinoma. Thorac Cancer 2019; 10:856-863. [PMID: 30810282 PMCID: PMC6449271 DOI: 10.1111/1759-7714.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Conventional transbronchial needle aspiration (TBNA) is advantageous for the one‐step diagnosis and staging of lung adenocarcinoma under topical anesthesia and conscious sedation. We examined its efficacy for identifying EGFR mutations. Methods Forty‐seven patients with proven or suspected lung adenocarcinoma indicated for hilar‐mediastinal lymph node (LN) staging between June 2011 and December 2017 were enrolled. The cellblock was prepared using the plasma‐thrombin method. TaqMan PCR was used to detect mutations. Considering cost effectiveness, only the sample with the highest tumor cell fraction in the same patient was chosen for analysis. Results TBNA provided positive results of malignancy in 27 patients. Seventeen patients (63.0%) had cellblocks eligible for mutation testing. Bronchial biopsy (n = 6), neck LN fine needle aspiration (n = 1), and brushing (n = 1), provided higher tumor cell fractions for analysis in eight patients. TBNA was the exclusive method used in nine patients (19.1%). For patients with an inadequate TBNA cellblock, bronchial biopsy (n = 5), neck LN fine needle aspiration (n = 3), computed tomography‐guided transthoracic needle biopsy (n = 1), and brushing (n = 1) were used for analysis. Modification to specimen processing to prevent exhaustion by cytology after June 2016 improved the adequacy of cellblock samples (9/10, 90% vs. 8/17, 47.1%; P = 0.042). Conclusions These findings suggest the promising role of conventional TBNA and highlight the challenges of doing more with less in an era of precision medicine.
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Affiliation(s)
- Li-Han Hsu
- Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary and Critical Care Medicine, Sun Yat-Sen Cancer Center, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University Medical School, Taipei, Taiwan
| | - Jen-Sheng Ko
- Department of Pathology, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - An-Chen Feng
- Department of Research, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Nei-Min Chu
- Department of Medical Oncology, Sun Yat-Sen Cancer Center, Taipei, Taiwan
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Kumar A, Dhillon SS, Patel S, Grube M, Noheria A. Management of cardiac implantable electronic devices during interventional pulmonology procedures. J Thorac Dis 2017; 9:S1059-S1068. [PMID: 29214065 DOI: 10.21037/jtd.2017.07.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increasing number of patients are receiving cardiac implantable electronic devices (CIED) now. Many of them need pulmonary procedures for various indications including, but not limited to, lung cancer and benign endobronchial lesions. Over the last two decades, interventional pulmonology (IP) has expanded its scope to include various modalities that use heat and electrical energy and in the process, create electromagnetic field in the vicinity. This raises concerns for electromagnetic interference (EMI) causing abnormal behavior in the CIEDs. While guidelines and recommendations on the peri-procedural management of CIEDs do exist, none of them directly address the pulmonary procedures. In this paper, we strive to review the available literature pertaining to the management of CIEDs in the context of EMI caused by the various IP procedures.
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Affiliation(s)
- Abhishek Kumar
- Department of Pulmonary Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Samjot Singh Dhillon
- Department of Medicine, Pulmonary and Critical Care, Roswell Park Cancer Institute/University at Buffalo, Buffalo, NY, USA
| | - Spandan Patel
- Hospitalist Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Matthias Grube
- Cardiothoracic Anesthesiology Fellow, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit Noheria
- Cardiovascular Electrophysiology, Washington University School of Medicine, St. Louis, MO, USA
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Nakai T, Matsumoto Y, Suzuk F, Tsuchida T, Izumo T. Predictive factors for a successful diagnostic bronchoscopy of ground-glass nodules. Ann Thorac Med 2017; 12:171-176. [PMID: 28808488 PMCID: PMC5541964 DOI: 10.4103/atm.atm_428_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION: Since the National Lung Screening Trial demonstrated the utility of low-dose computed tomography screening for lung cancer, the detection rate of ground-glass nodules (GGNs) has increased. Endobronchial ultrasound with a guide sheath (EBUS-GS) is widely performed to diagnose peripheral pulmonary lesions, but there are not enough reports on the predictive ability of EBUS-GS in diagnosing GGNs. The aim of this study is to investigate the predictive factors for a successful diagnostic bronchoscopy for GGNs. METHODS: Consecutive patients who underwent diagnostic bronchoscopy for GGNs from September 2012 to January 2016 were enrolled in this study. From these, cases who underwent EBUS-GS were selected. They were reviewed and analyzed to examine the association between the diagnostic yield and the following clinical factors: lesion size, lobar position, location, consolidation-to-tumor ratio, visibility on X-ray, use of virtual bronchoscopy, bronchus sign, guide sheath size, and number of biopsies. RESULTS: We enrolled 254 cases, of which 167 were diagnosed using EBUS-GS (65.7% diagnostic yield). Univariate analysis indicated that a positive bronchus sign was a significant factor for higher diagnostic yield (72.9% vs. 34.0%; P < 0.001). The use of virtual bronchoscopy also tended toward a higher yield, but the result was not significant (69.0% vs. 54.4%; P = 0.058). However, multivariate analysis indicated that both were significantly associated with higher diagnostic yield (P < 0.001, odds ratio [OR]: 5.35; P < 0.001, OR: 1.97, respectively). CONCLUSIONS: Our results suggest that a positive bronchus sign and the use of virtual bronchoscopy are positive predictive factors for successful diagnostic bronchoscopy of GGNs.
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Affiliation(s)
- Toshiyuki Nakai
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tukiji Chou-ku, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tukiji Chou-ku, Japan
| | - Fumi Suzuk
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tukiji Chou-ku, Japan.,Department of Pulmonary Medicine, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tukiji Chou-ku, Japan
| | - Takehiro Izumo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tukiji Chou-ku, Japan.,Department of Respiratory Medicine, Japanese Red Cross Medical Center, Hiroo, Shibuya-ku, Tokyo, Japan
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Hsu LH, Liu CC, Ko JS, Feng AC, Chu NM. Comparison of 19-gauge eXcelon and WANG MW-319 transbronchial aspiration needles. Thorac Cancer 2015; 7:264-70. [PMID: 27042234 PMCID: PMC4773310 DOI: 10.1111/1759-7714.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 12/25/2022] Open
Abstract
Conventional transbronchial needle aspiration (TBNA) using 19‐gauge needles can obtain larger histological specimens for hilar‐mediastinal diagnosis. A new 19‐gauge eXcelon needle was introduced in Taiwan in July 2012. We prospectively enrolled patients with hilar‐mediastinal lesions and pathology results of suspected benign origin or lymphoproliferative processes, to perform TBNA using a 19‐gauge eXcelon needle, between July 2012 and December 2012. The results were compared with historical control of TBNA using a WANG MW‐319 needle between January 2011 and June 2012. The procedure was performed by the same pulmonologist, and rapid on‐site cytologic evaluation was used. The 19‐gauge eXcelon needle was used in nine patients with 15 lymph nodes aspirated, with a mean diameter of 23.3 ± 10.7 mm. The mean number of needle passes was 2.7 ± 1.4, with a diagnostic accuracy of 77.8%. The MW‐319 needle was used in 12 patients with 18 lymph nodes aspirated, with a mean diameter of 21.3 ± 5.7 mm. The mean number of needle passes was 2.2 ± 0.4, with a diagnostic accuracy of 75.0%. Neither technical nor major clinical complications were noted in either group. We concluded that the 19‐gauge eXcelon needle was as safe and effective as the MW‐319 needle. A more adequate specimen could be obtained and fewer needle passes were required with the MW‐319 needle, although the difference did not reach significance.
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Affiliation(s)
- Li-Han Hsu
- School of Medical Laboratory Science and Biotechnology College of Medical Science and Technology Taipei Medical University Taipei Taiwan; Department of Medicine National Yang-Ming University Medical School Taipei Taiwan; Division of Pulmonary and Critical Care Medicine Sun Yat-Sen Cancer Center Taipei Taiwan
| | - Chia-Chuan Liu
- Division of Thoracic Surgery Sun Yat-Sen Cancer Center Taipei Taiwan
| | - Jen-Sheng Ko
- Department of Pathology Sun Yat-Sen Cancer Center Taipei Taiwan
| | - An-Chen Feng
- Department of Research Sun Yat-Sen Cancer Center Taipei Taiwan
| | - Nei-Min Chu
- Department of Medical Oncology Sun Yat-Sen Cancer Center Taipei Taiwan
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Huang X, Liang QL, Jiang L, Liu QL, Ou WT, Li DH, Zhang HJ, Yuan GL. Primary Pulmonary Paraganglioma: A Case Report and Review of Literature. Medicine (Baltimore) 2015; 94:e1271. [PMID: 26252294 PMCID: PMC4616580 DOI: 10.1097/md.0000000000001271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Primary pulmonary paraganglioma is a rare disease. We report a case of a 37-year old female patient with space-occupying lesions in the right lower pulmonary lobe during a routine examination without any symptoms. The patient underwent video-assisted thoracoscopic surgery (VATS) resection of the right middle lobe and dissection of hilar and mediastinal lymph nodes under general anesthesia. She recovered without recrudescence. Preoperative diagnosis is difficult. Accurate diagnosis requires pathological examination, and immunohistochemical test is particularly important. Complete resection is the first treatment option for solitary primary pulmonary paraganglioma; however, VATS is a better technique. Given the high local control rates and few complications of radiotherapy, it is considered as a standard treatment.
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Affiliation(s)
- Xin Huang
- From the Oncology Center, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
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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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