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Bonhomme O, Heinen V, Louis R, Corhay JL, Duysinx B. [Probe based confocal laser endomicroscopy in thoracic endoscopy]. Rev Mal Respir 2024; 41:145-155. [PMID: 38030554 DOI: 10.1016/j.rmr.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Probe based confocal laser endomicroscopy (pCLE) is a new endoscopic imaging technology. It uses mini probes which can be introduced through the working channels of endoscopes. Whenever applied on the tissue of interest, they allow imaging of tissue at a cellular level. STATE OF ART In the filed of pleuropulmonary malignancies, pCLE showed mostly its ability to guide biopsies samplings. Those results need to be validated in larger prospective studies. In interstitial lung diseases, pCLE provides information complementary to other clinical and paraclinical data. The valuability of these informations need to be investigated further, prospectively in randomized trials. In obstructive pulmonary diseases, pCLE is able to investigate the structural and functional relationships between pulmonary structures. pCLE showed good ability in the identification of acute cellular rejection after lung transplantation. PERSPECTIVES AND CONCLUSION For the time being, pCLE is not part of routine clinical practice. The data available need to be validated in larger randomized prospective trials, before it can be recommended as a guiding tool for biopsies or as a diagnostic tool for pathologic process. New fluorophores are now available. They are specific of some molecular sequences, allowing the enhancement of specific targets within the sample studied.
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Affiliation(s)
- O Bonhomme
- Pneumologues, CHU de Liège, 4000 Liège, Belgique.
| | - V Heinen
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - R Louis
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - J-L Corhay
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - B Duysinx
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
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Wang H, Liu Y, Wang J, Ren T, Luo G, You H, Wang X, Li D, Wang L, Wang M. Rapid on-site evaluation of touch imprints of medical thoracoscopy biopsy tissue for the management of pleural disease. Front Med (Lausanne) 2023; 10:1196000. [PMID: 37359022 PMCID: PMC10288871 DOI: 10.3389/fmed.2023.1196000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objective Medical thoracoscopy (MT) plays an important role in the diagnosis and treatment of pleural diseases, and rapid on-site evaluation (ROSE) has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on ROSE combined with MT for the management of pleural disease has been rarely reported. We aimed to evaluate the diagnostic performance of ROSE for pleura biopsies and visual diagnosis by thoracoscopists for gross thoracoscopic appearance. The secondary objective was to assess the intermodality agreement between ROSE and the final histopathologic diagnosis. Methods A total of 579 patients with exudative pleural effusion (EPE) who underwent MT combined with ROSE from February 2017 to December 2020 at Taihe Hospital were included in the study. Thoracoscopists' visual diagnosis of gross thoracoscopic appearance, ROSE results, histopathologic findings, and the final diagnosis was recorded. Results Thoracoscopic pleural biopsies were performed in 565 patients (97.6%); 183 patients were confirmed to have malignant pleural effusion (MPE), and 382 patients were confirmed to have benign pleural effusion (BPE). The area under the curve of ROSE for the diagnosis of MPE was 0.96 (95% CI: 0.94-0.98, p < 0.001), with a sensitivity of 98.7%, a specificity of 97.2%, a diagnostic accuracy of 97.1%, a positive predictive value of 97.2%, and a negative predictive value of 97.2%. Diagnostic consistency between ROSE and histopathology was good (κ ± SE = 0.93 ± 0.02, p < 0.001). The area under the curve of the thoracoscopists' visual diagnosis of gross thoracoscopic appearance was 0.79 (95% CI: 0.75-0.83, p < 0.01), with a sensitivity of 76.7%, a specificity of 80.9%, a positive predictive value of 62.4%, and a negative predictive value of 89.3%. Conclusion ROSE of touch imprints of MT biopsy tissue during MT showed high accuracy for distinguishing between benign and malignant lesions. In addition, ROSE was in good agreement with the histopathological diagnosis, which may help thoracoscopists perform pleurodesis (talc poudrage) directly during the procedure, especially in patients with malignant results.
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Affiliation(s)
- Hansheng Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yan Liu
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jiankun Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Tao Ren
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Guoshi Luo
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hui You
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xiao Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dan Li
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Lei Wang
- Department of Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Meifang Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Désage AL, Mismetti V, Jacob M, Pointel S, Perquis MP, Morfin M, Guezara S, Langrand A, Galor C, Trouillon T, Diaz A, Karpathiou G, Froudarakis M. Place du pneumologue interventionnel dans la gestion des pleurésies métastatiques. Rev Mal Respir 2022; 39:778-790. [DOI: 10.1016/j.rmr.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
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Inflammatory appearance of the parietal pleura at thoracoscopy – What does it hide? Respir Med 2022; 199:106883. [DOI: 10.1016/j.rmed.2022.106883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022]
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Grosu HB, Kern R, Maldonado F, Casal R, Andersen CR, Li L, Eapen G, Ost D, Jimenez C, Frangopoulos F, Sabath B, Vakil E, Schwalk A, Marcoux M, Sagar AE, Nasim F, Lin J, Salahudin M, Arain HM, Noor L, Montanez D, Stewart J, Mullon J, Michael M, Porfyridis I. Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study. Respirology 2022; 27:350-356. [PMID: 35178828 DOI: 10.1111/resp.14232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. METHODS A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. RESULTS Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17-131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85-35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97-22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91-0.97). CONCLUSION A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.
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Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Kern
- Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary And Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Roberto Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Georgie Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Bruce Sabath
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erik Vakil
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Audra Schwalk
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mathieu Marcoux
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ala Eddin Sagar
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Faria Nasim
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julie Lin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Moiz Salahudin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hasan Muhammad Arain
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laila Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Montanez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Mullon
- Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michalis Michael
- Cytopathology Department, Nicosia General Hospital, Nicosia, Cyprus
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Liu W, Xu C, Li L, Yuan Q, Wang W, Zou J. The Value of Computed Tomography-Guided Percutaneous Lung Biopsy Combined With Rapid On-Site Evaluation in Diagnosis of Peripheral Pulmonary Nodules. Technol Cancer Res Treat 2022; 21:15330338221118718. [PMID: 35930585 PMCID: PMC9358554 DOI: 10.1177/15330338221118718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the value of computed tomography-guided percutaneous lung biopsy (CT-PLB) combined with rapid on-site evaluation (ROSE) in the diagnosis of peripheral pulmonary lesions (PPLs). Methods: A total of 108 patients who diagnosed with PPLs by chest CT examination were prospectively collected and randomly divided into ROSE group (n = 56) and No-ROSE group (n = 52). Both groups received CT-PLB and pathological examination. The smear submitted for ROSE was stained using Diff Quik dye. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), number of punctures, puncture time and incidence of complications were compared between the two groups. Results: The accuracy, sensitivity, specificity, PPV, and NPV of the ROSE group were 89.29%, 87.50%, 91.67%, 93.33%, and 84.62%, respectively. The number of punctures in the ROSE group was significantly lower than that in the No-ROSE group (P < .05). The incidence of pneumothorax and hemoptysis in the ROSE group were lower than those in the No-ROSE group, but there was no statistical difference between the two groups (P > .05). ROSE has good concordance with routine pathological examination in the diagnosis of unidentified PPLs (Kappa = 0.786, P < .01). Conclusions: CT-PLB combined with ROSE is a safe and effective method for the diagnosis of PPLs.
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Affiliation(s)
- Wei Liu
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunhua Xu
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Li Li
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Qi Yuan
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Wei Wang
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Jue Zou
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Grosu HB, Stewart J. Pleural Touch Preparations for Medical Thoracoscopy: Are We There Yet? J Bronchology Interv Pulmonol 2021; 28:93-94. [PMID: 33753702 DOI: 10.1097/lbr.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine and Cytopathology, University of Texas MD Anderson Cancer Center, Houston, TX
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Imprint Cytology of Thoracoscopic Pleural Biopsy Tissue for Early Etiological Diagnosis of Pleural Effusion: A Pilot Study From India. J Bronchology Interv Pulmonol 2020; 28:98-102. [PMID: 33122599 DOI: 10.1097/lbr.0000000000000724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
Thoracoscopic pleural biopsy provides the highest diagnostic yield in both malignant and tubercular pleural effusions. However histopathologic report takes 3 to 5 days to provide the diagnosis, resulting in a delay of further management plans like pleurodesis or chest tube removal. Imprint cytology of biopsy tissue can provide early information about the etiological diagnosis. Thus, we conducted this pilot study in 66 patients of exudative pleural effusions undergoing medical thoracoscopy. One or 2 biopsy pieces obtained during medical thoracoscopy from pleural nodules were used to prepare imprint cytology slides in the thoracoscopy suite. In comparison to thoracoscopic pleural biopsy, the diagnostic yield of imprint cytology of pleural tissue was 92% (49 of 53 cases) in cases of malignant pleural effusion and 75% (9 of 12 cases) in cases of tuberculosis pleural effusions. Imprint cytology provided a definite idea about the type of diagnosis, about 2.5 days before the histopathology results. By providing early etiological diagnosis, it may also decrease the duration of hospital stay and health care expenditure. A large prospective trial has been planned in our center to confirm this hypothesis.
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Hantera ME, Ganna SA, Elsaka AM, El-Lawaty WM. Role of imprint cytology in thoracic endoscopy suite. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fiberoptic bronchoscopy and medical thoracoscopy are basic interventional modalities for the diagnosis of a wide variety of pleuropulmonary diseases. In some cases, we need fast and accurate results for decision-making. We aimed to evaluate the diagnostic accuracy of imprint cytology and its added value to the pulmonologist.
Results
Multiple biopsies were taken from 54 patients included 31 patients with lung masses subjected to fiberoptic bronchoscopy and 23 patients with undiagnosed exudative pleural effusion subjected to medical thoracoscopy. Imprint cytology was done to all biopsies which are later examined histopathologically. Regarding fiberoptic bronchoscopy biopsies, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of imprint cytology were 93.33, 100, 100, 33.33, and 93.55%, respectively. While in medical thoracoscopy biopsies, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of imprint cytology were 94.74, 100, 100, 80, and 95.65%, respectively.
Conclusion
Imprint cytology is an easy, rapid, and reliable method that has a high sensitivity and specificity in the diagnosis of lung and pleural malignancies compared with histopathology.
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Weng X, Zhi L, An X, Xu M, Zhang H, Long K, Gao P. Diagnostic value of rapid on-site evaluation in interventional pulmonology: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21168. [PMID: 32702873 PMCID: PMC7373600 DOI: 10.1097/md.0000000000021168] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) is a kind of rapid evaluation of specimen satisfaction, preliminary diagnosis and priority strategy, the diagnostic accuracy of ROSE in the field of pulmonary intervention shows wide variation. The aim of the study was to further clarify the accuracy and diagnostic efficacy of ROSE in interventional pulmonology. METHODS This review summarizes and meta-analyzes studies of ROSE in interventional pulmonology, the ROSE diagnoses would be compared with the final pathologic diagnoses. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, Web of science, CNKI, and WANFANG DATA. The methodologic quality of studies has been assessed using the Quality of Diagnostic Studies (QUADAS-2) instrument. This review is conducted using standard methods for systematic reviews of diagnostic accuracy studies. STATA SE 12.0 is used for data synthesis and analysis. RESULTS This review evaluates the accuracy and diagnostic efficacy of ROSE in interventional pulmonology, and the process factors that may influence the ROSE diagnosis are analyzed, such as Smear method, profession of smear technician, staining method, Profession of stain technician, Profession of reading slides, invasive procedure, Anesthesia method and etc. CONCLUSION:: This review will stimulate proper evaluation of ROSE and provide assistance for clinical practice.
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Affiliation(s)
- Xiangwen Weng
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
| | - Lijia Zhi
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Xing An
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
- Respiratory department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Meixin Xu
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
| | - Hua Zhang
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
| | - Kunlan Long
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Peiyang Gao
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
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Affiliation(s)
- Fei Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Enshuo Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Immunocytochemistry Based on a Cell-Type-Specific Aptamer for Rapid Immunostaining of Adenocarcinoma Cells in Clinical Serosal Fluids. Pathol Oncol Res 2018; 25:1143-1152. [PMID: 30478720 DOI: 10.1007/s12253-018-0555-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/19/2018] [Indexed: 12/26/2022]
Abstract
All too often, conventional immunocytochemistry (ICC) via an antibody on cytological samples is limited to a few smears due to scant cellularity. To circumvent these limitations, this study employed a cell-type-specific aptamer as the core tool in ICC protocols for a timely and highly specific ICC diagnosis. S6, an aptamer against A549 lung carcinoma cells, was adopted instead of antibodies in this study for differentiating cancer cells in serosal fluids. Here, we developed three different strategies for discriminating the adenocarcinoma cells in effusion cytology specimens using the S6 aptamer in ICC. These strategies included a biotin-labeled S6 aptamer, an FAM-labeled S6 aptamer, and an activatable S6 aptamer. A total of 112 serosal fluid specimens with known diagnoses were evaluated by all three modes of use of the S6 aptamer. ICC procedures based on biotin-labeled or FAM-labeled S6 aptamers required time-consuming washing to avoid interference from nonspecific adsorption. ICC procedures based on an activatable S6 aptamer probe showed a weak fluorescence signal in the absence of target cells, but the procedures showed a strong fluorescence signal due to alteration of the conformation without any complicated washing steps, in the presence of targets. The specificity and sensitivity are higher in all three different ICC protocols based on the S6 aptamer than those for antibody protocols for differentiating adenocarcinoma cells in clinical effusion cytology. ICC based on cell-type-specific aptamers, instead of on a panel of a set of antibodies, is promising as an auxiliary method for the diagnosis of cancer.
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Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy. Ann Am Thorac Soc 2018; 14:1326-1331. [PMID: 28406718 DOI: 10.1513/annalsats.201701-056oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
RATIONALE During diagnostic thoracoscopy, talc pleurodesis after biopsy is appropriate if the probability of malignancy is sufficiently high. Findings on direct visual assessment of the pleura during thoracoscopy, rapid onsite evaluation (ROSE) of touch preparations (touch preps) of thoracoscopic biopsy specimens, and preoperative imaging may help predict the likelihood of malignancy; however, data on the performance of these methods are limited. OBJECTIVES To assess the performance of ROSE of touch preps, direct visual assessment of the pleura during thoracoscopy, and preoperative imaging in diagnosing malignancy. METHODS Patients who underwent ROSE of touch preps during thoracoscopy for suspected malignancy were retrospectively reviewed. Malignancy was diagnosed on the basis of final pathologic examination of pleural biopsy specimens. ROSE results were categorized as malignant, benign, or atypical cells. Visual assessment results were categorized as tumor studding present or absent. Positron emission tomography (PET) and computed tomography (CT) findings were categorized as abnormal or normal pleura. Likelihood ratios were calculated for each category of test result. RESULTS The study included 44 patients, 26 (59%) with a final pathologic diagnosis of malignancy. Likelihood ratios were as follows: for ROSE of touch preps: malignant, 1.97 (95% confidence interval [CI], 0.90-4.34); atypical cells, 0.69 (95% CI, 0.21-2.27); benign, 0.11 (95% CI, 0.01-0.93); for direct visual assessment: tumor studding present, 3.63 (95% CI, 1.32-9.99); tumor studding absent, 0.24 (95% CI, 0.09-0.64); for PET: abnormal pleura, 9.39 (95% CI, 1.42-62); normal pleura, 0.24 (95% CI, 0.11-0.52); and for CT: abnormal pleura, 13.15 (95% CI, 1.93-89.63); normal pleura, 0.28 (95% CI, 0.15-0.54). CONCLUSIONS A finding of no malignant cells on ROSE of touch preps during thoracoscopy lowers the likelihood of malignancy significantly, whereas finding of tumor studding on direct visual assessment during thoracoscopy only moderately increases the likelihood of malignancy. A positive finding on PET and/or CT increases the likelihood of malignancy significantly in a moderate-risk patient group and can be used as an adjunct to predict malignancy before pleurodesis.
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Vial MR, Eapen GA, Casal RF, Sarkiss MG, Ost DE, Vakil E, Grosu HB. Combined pleuroscopy and endobronchial ultrasound for diagnosis and staging of suspected lung cancer. Respir Med Case Rep 2017; 23:49-51. [PMID: 29276672 PMCID: PMC5734695 DOI: 10.1016/j.rmcr.2017.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022] Open
Abstract
The standard approach to staging of lung cancer in patients with pleural effusion (clinical M1a) is thoracentesis followed by pleural biopsies if the cytologic analysis is negative. If pleural biopsy findings are negative, endobronchial ultrasound-guided transbronchial needle aspiration is used to complete the staging process and, in some cases, obtain diagnosis. In this case series we report 7 patients in which a combined procedure was performed for staging of known or suspected lung cancer. We found that the combined approach was both feasible and safe in this case series.
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Affiliation(s)
- Macarena R Vial
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Pulmonary Medicine, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mona G Sarkiss
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erik Vakil
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Murthy V, Bessich JL. Medical thoracoscopy and its evolving role in the diagnosis and treatment of pleural disease. J Thorac Dis 2017; 9:S1011-S1021. [PMID: 29214061 DOI: 10.21037/jtd.2017.06.37] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Establishing the etiology of exudative pleural effusions in the setting of an unrevealing pleural fluid analysis often requires biopsies from the parietal pleura. While closed pleural biopsy (CPB) has been a popular minimally-invasive approach, it has a poor diagnostic yield, barring a diagnosis of tuberculous pleurisy. Medical thoracoscopy (MT) is a minimally-invasive ambulatory procedure performed under local anesthesia or moderate sedation which allows for direct visualization of biopsy targets as well as simultaneous therapeutic interventions, including chemical pleurodesis and indwelling tunneled pleural catheter (ITPC) placement. The excellent yield and favorable safety profile of MT has led to it replacing CPB for many indications, particularly in the management of suspected malignant pleural effusions. As experience with MT amongst interventional pulmonologists has grown, there is an increased appreciation for its important role alongside percutaneous and surgical approaches in the diagnosis and treatment of pleural disease.
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Affiliation(s)
- Vivek Murthy
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, NY, USA
| | - Jamie L Bessich
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, NY, USA
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Restrepo MI, Chalmers JD, Song Y, Mallow C, Hewlett J, Maldonado F, Yarmus L. Year in review 2016: Respiratory infections, acute respiratory distress syndrome, pleural diseases, lung cancer and interventional pulmonology. Respirology 2017; 22:602-611. [PMID: 28244617 PMCID: PMC5889848 DOI: 10.1111/resp.13016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Marcos I Restrepo
- South Texas Veterans Health Care System and University of Texas Health, San Antonio, TX, USA
| | - James D Chalmers
- Scottish Centre for Respiratory Research, Dundee, UK
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Justin Hewlett
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Lonny Yarmus
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Porcel JM, Lui MMS, Lerner AD, Davies HE, Feller-Kopman D, Lee YCG. Comparing approaches to the management of malignant pleural effusions. Expert Rev Respir Med 2017; 11:273-284. [PMID: 28271728 DOI: 10.1080/17476348.2017.1300532] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Management of symptomatic malignant pleural effusions is becoming more complex due to the range of treatment options, which include therapeutic thoracenteses, thoracoscopic talc pleurodesis, bedside pleurodesis with talc or other sclerosing agents via small-bore chest catheters, indwelling pleural catheters, surgery, or a combination of some of these procedures. Areas covered: Recent advances for the expanding range of treatment options in malignant pleural effusions are summarized, according to the best available evidence. Expert commentary: Selection of a treatment approach in malignant pleural effusions should take into account patient preferences and performance status, tumor type, predicted prognosis, presence of a non-expandable lung, and local experience or availability. The role of pleurodesis has decreased with the advent of indwelling pleural catheters, which provide a high degree of symptomatic relief on an outpatient basis and, therefore, are being positioned as a first choice therapy in many centers. Talc poudrage pleurodesis should probably be reserved for those situations in which pleural tumor invasion is discovered during diagnostic thoracoscopy. Ongoing randomized controlled trials will offer solid evidence on which of the available palliative approaches should be selected for each particular patient.
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Affiliation(s)
- José M Porcel
- a Pleural Medicine Unit, Department of Internal Medicine , Arnau de Vilanova University Hospital , Lleida , Spain.,b Institute for Biomedical Research Dr Pifarre Foundation, IRBLLEIDA , Lleida , Spain
| | - Macy Mei-Sze Lui
- c Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Andrew D Lerner
- d Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Helen E Davies
- e Department of Respiratory Medicine , Cardiff and Vale University Health Board , Cardiff , Wales , UK
| | - David Feller-Kopman
- d Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Y C Gary Lee
- f Respiratory Department , Sir Charles Gairdner Hospital , Western Australia , Perth , Australia.,g Respiratory Medicine , Sir Charles Gairdner Hospital , Perth , Western Australia , Australia.,h Pleural Medicine Unit , Institute of Respiratory Health , Western Australia , Perth , Australia.,i Centre for Respiratory Health, School of Medicine , University of Western Australia , Perth , Australia
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