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Büscher E, Karpf-Wissel R, Funke F, Darwiche K. [EBUS-guided cryobiopsy in the diagnosis of mediastinal lesions - step by step]. Pneumologie 2024; 78:420-426. [PMID: 38866027 DOI: 10.1055/a-2295-5921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the gold standard in the diagnosis of mediastinal and hilar lesions. For certain purposes, such as the diagnosis and subtyping of lymphoproliferative disorders or molecular pathology, a larger amount of intact sample material is required. EBUS cryobiopsy is a new and efficient tool for this purpose. As it is a new approach, there is still no standardised workflow. In this review, we present the procedure step by step as it is performed at the Ruhrlandklinik in Essen.
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2
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Velez A, DeMaio A, Sterman D. Cryoablation and immunity in non-small cell lung cancer: a new era of cryo-immunotherapy. Front Immunol 2023; 14:1203539. [PMID: 37671163 PMCID: PMC10475831 DOI: 10.3389/fimmu.2023.1203539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Despite remarkable advances in tumor response and patient survival in the past decade, systemic immunotherapies for lung cancer result in an objective response in only around half of patients treated. On the basis of this limitation, combination strategies are being investigated to improve response rates. Cryoablation has been proposed as one such technique to induce immunogenic cell death and synergize with systemic immunotherapies, including immune checkpoint inhibitors. Cryoablation has been traditionally delivered percutaneously with imaging guidance although recent technological advances allow for bronchoscopic delivery. Herein, we review the pre-clinical and clinical evidence for the use of cryoablation in non-small cell lung cancer and potential induction of anti-tumor immunity. We highlight ongoing studies involving this approach and propose areas of future investigation.
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Affiliation(s)
- Antonio Velez
- Pulmonary Oncology Research Team (New York University (NYU) PORT), Section of Interventional Pulmonology, Division of Pulmonary, Critical Care and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
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3
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Menigoz C, Dirou S, Sagan C, Corne F, Moui A, Defrance C, Liberge R, Morla O, Patarin V, Nicolas A, Kandel-Aznar C, Lacoste P, Clarke JP, Cavailles A, Cellerin L, Blanc FX. [Transbronchial lung cryobiopsy in interstitial lung diseases]. Rev Mal Respir 2023; 40:469-478. [PMID: 37308261 DOI: 10.1016/j.rmr.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 06/14/2023]
Abstract
In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.
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Affiliation(s)
- C Menigoz
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France.
| | - S Dirou
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - C Sagan
- Nantes Université, CHU Nantes, service d'anatomopathologie, Nantes, France
| | - F Corne
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France; Clinique Jules Verne, consultation de pneumologie, Nantes, France
| | - A Moui
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - C Defrance
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - R Liberge
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - O Morla
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - V Patarin
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - A Nicolas
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - C Kandel-Aznar
- Nantes Université, CHU Nantes, service d'anatomopathologie, Nantes, France
| | - P Lacoste
- Nantes Université, CHU Nantes, service de chirurgie thoracique et cardiovasculaire, l'institut du thorax, Nantes, France
| | - J P Clarke
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France; Clinique ELSAN Santé Atlantique, consultation de pneumologie, Saint-Herblain, France
| | - A Cavailles
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - L Cellerin
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - F-X Blanc
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
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4
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DeMaio A, Thiboutot J, Yarmus L. Applications of cryobiopsy in airway, pleural, and parenchymal disease. Expert Rev Respir Med 2022; 16:875-886. [PMID: 36069255 DOI: 10.1080/17476348.2022.2122444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION :Cryobiopsy is a novel diagnostic technique for thoracic diseases which has been extensively investigated over the past 20 years. It was originally proposed for the diagnosis of endobronchial lesions and diffuse parenchymal lung disease due to limitations of conventional sampling techniques including small size and presence of artifacts. AREAS COVERED :We will review recent evidence related to the expanding use of cryobiopsy in thoracic diseases. To identify references, the MEDLINE database was searched from database inception until May 2022 for case series, cohort studies, randomized controlled trials, systematic reviews and meta-analyses related to cryobiopsy. EXPERT OPINION Cryobiopsy has expanding applications in the field of thoracic diseases. Evidence to support transbronchial cryobiopsy as an alternative to surgical lung biopsy is increasing and was recently endorsed as a conditional recommendation by the latest American Thoracic Society guideline update for Idiopathic Pulmonary Fibrosis. Developments in technology and technique, in particular the availability of a 1.1 mm flexible cryoprobe, have extended applications to pulmonary diseases, including diagnosis of interstitial lung diseases, peripheral pulmonary lesions, and lung transplant rejection.
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Affiliation(s)
- Andrew DeMaio
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Jeffrey Thiboutot
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.,Division of Pulmonary and Critical Care Medicine
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Perikleous P, Mayer N, Finch J, Beddow E, Anikin V, Asadi N. Treatment of Pulmonary Carcinoid Tumors With Bronchoscopic Cryotherapy: A 28-Year Single-center Experience. J Bronchology Interv Pulmonol 2022; 29:71-82. [PMID: 34261879 DOI: 10.1097/lbr.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pulmonary carcinoids are rare tumors originating from neuroendocrine cells in the lungs. Because of their potentially infiltrative nature, surgical resection remains the treatment of choice. However, not all patients with technically resectable disease will be able to undergo surgery, primarily because of poor lung function or medical co-morbidities. Centrally located, intraluminal tumors have been reported to be amenable to bronchoscopic treatment. We specifically examined the role of cryotherapy in the treatment of bronchial carcinoid tumors. METHODS Sixty-three patients (52.38% female) who underwent a combined total of 243 cryotherapy procedures for treatment of bronchial carcinoid between 1992 and 2020 in our institution were included in the study. Following discussion in multidisciplinary meetings, patients were considered for first-line cryotherapy when lung resection was deemed not possible or when they had rejected surgery. RESULTS Cryotherapy resulted in complete remission in 21 (33.33%) patients with maximum tumor diameter less than 20 mm (mean: 11.08 mm, 95% confidence interval: 8.76-13.40), and allowed 22 (34.92%) patients with larger lesions (mean: 24.04 mm, 95% confidence interval: 18.78-29.30) to proceed with parenchymal sparing resections. Marked symptomatic relief (P<0.001) was reported by 58 (92.06%) patients. The median follow-up was 33 months (range: 0 to 243 mo). One (1.59%) patient was diagnosed with recurrence in a contralateral lobe 3 years after surgery and was treated with radiofrequency ablation. CONCLUSIONS In the absence of a definitive randomized controlled trial comparing bronchoscopic treatment with surgical resection, we provide evidence on the safety and efficacy of cryotherapy and encourage wider adoption of this inexpensive and minimally invasive technique for treatment of bronchial carcinoids.
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Affiliation(s)
| | - Nora Mayer
- Department of Thoracic Surgery, Harefield Hospital, Middlesex, England, UK
| | - Jonathan Finch
- Department of Thoracic Surgery, Harefield Hospital, Middlesex, England, UK
| | - Emma Beddow
- Department of Thoracic Surgery, Harefield Hospital, Middlesex, England, UK
| | - Vladimir Anikin
- Department of Thoracic Surgery, Harefield Hospital, Middlesex, England, UK
- Department of Oncology and Reconstructive Surgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Nizar Asadi
- Department of Thoracic Surgery, Harefield Hospital, Middlesex, England, UK
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Papaporfyriou A, Domayer J, Meilinger M, Firlinger I, Funk GC, Setinek U, Kostikas K, Valipour A. Bronchoscopic diagnosis and treatment of endobronchial carcinoid: case report and review of the literature. Eur Respir Rev 2021; 30:200115. [PMID: 33408086 PMCID: PMC9488937 DOI: 10.1183/16000617.0115-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/02/2020] [Indexed: 11/05/2022] Open
Abstract
Carcinoid tumours are rare neuroendocrine neoplasms that mostly occur in younger adults with low tendencies to metastasise. Based on their histological characteristics, they are divided into typical and atypical subtypes. The most common presenting symptoms are due to central airway obstruction. The first step in the diagnostic assessment should be a computed tomography (CT) scan, as it provides information both for local tumour extent and lymph node involvement. Bronchoscopy is the main tool for histological confirmation, evaluation of bronchial wall invasion and removal of endobronchial manifestation with subsequent resolution of atelectasis. Endobronchial ultrasound may be necessary to rule out lymph node metastasis. Somatostatin receptor scintigraphy in combination with CT can rule out further metastatic disease.Surgical resection using parenchyma-sparing techniques remains the gold standard for treatment. For selected patients, endobronchial therapy could be an alternative for minimal invasiveness. Long-term follow-up is suggested due to the high likelihood of recurrence.Here, we describe our clinical experience in a 35-year-old male patient who originally presented with haemoptysis and a central polypoid tumour in the left main bronchus revealed by a CT scan. The histological characteristics were indicative of a typical carcinoid. The patient was treated using an endobronchial approach only. No complications and no recurrences have been observed in a follow-up of 2 years.
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Affiliation(s)
- Anastasia Papaporfyriou
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
- Respiratory Medicine Dept, University of Ioannina Medical School, Ioannina, Greece
| | - Julian Domayer
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Michael Meilinger
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Irene Firlinger
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, 4 Medizinische Abteilung, Wilhelminenspital, Vienna, Austria
| | - Ulrike Setinek
- Institute for Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | | | - Arschang Valipour
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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7
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Nishida T, Matsumoto Y, Sasada S, Tanaka M, Nakai T, Fukai R, Ohe Y, Watanabe SI, Motoi N. Feasibility study of cryobiopsy for practical pathological diagnosis of primary lung cancer including immunohistochemical assessment. Jpn J Clin Oncol 2021; 51:271-278. [PMID: 32964232 DOI: 10.1093/jjco/hyaa174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Precision medicine in non-small cell lung cancer requires attainment of a sufficient amount of high-quality tumor tissue. Transbronchial cryobiopsy has emerged as a new diagnostic method for non-neoplastic lung disease with a better potential to assess morphology compared with conventional methods. However, the influence of cryobiopsy on specimen quality, particularly detection of protein expression, is unknown. We performed a comparative immunohistochemical study in specimens obtained by cryobiopsy versus conventional sampling to evaluate the feasibility of cryobiopsy for lung cancer diagnosis. METHODS Pairs of artificial biopsy specimens, collected using a cryoprobe or conventional scalpel, were obtained from 43 surgically resected primary lung tumors. Formalin-fixed, paraffin-embedded blocks were prepared in an ISO15189-certified laboratory. Immunohistochemical staining of thyroid transcription factor-1, p40, Ki67 and programmed death-ligand 1 (22C3) was performed. The H-scores for thyroid transcription factor-1 and p40, labeling index for Ki67 and tumor proportion score for programmed death-ligand 1 were assessed. Pearson's correlation coefficients between two sampling types were calculated. RESULTS The thyroid transcription factor-1 and p40 H-scores showed perfect correlations between the cryobiopsy and conventional scalpel-obtained specimens (R2 = 0.977 and 0.996, respectively). Ki67 labeling index and PD-L1 tumor proportion score also showed strong correlations between the two sample types (R2 = 0.896 and 0.851, respectively). Five cases (11.6%) exhibited differences in tumor proportion score category between sample types, potentially because of intratumoral heterogeneity. CONCLUSIONS Immunohistochemical expression of certain tumor markers showed a high concordance between cryobiopsy and conventional scalpel sampling. Cryobiopsy is feasible for pathological diagnostics including PD-L1 evaluation.
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Affiliation(s)
- Tomoki Nishida
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yuji Matsumoto
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Sasada
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Midori Tanaka
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiyuki Nakai
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Osaka City University Hospital, Osaka, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Motoi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
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8
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Thakore S, Perez Lozada JC. Percutaneous Ablation of Intrathoracic Malignancy. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Saka H, Oki M, Kada A, Saito AM. An Open-label, Single-arm Study of CRYO2 for Debulking at the Site of Central Airway Obstruction or Stenosis. In Vivo 2019; 33:1641-1644. [PMID: 31471417 DOI: 10.21873/invivo.11649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND An open-label, single-arm study was conducted to assess the safety of a cryosurgery unit named CRYO2 for debulking at the site of obstruction or stenosis. PATIENTS AND METHODS In order to treat central airway tumor-related stenosis, debulking at the stenotic site of the airway was performed using CRYO2 under general or local anesthesia. The primary endpoint was the incidence of moderate to massive hemorrhage. RESULTS Incidence of moderate to massive hemorrhage during surgery was 3.8% (1/26) (95% confidence interval(CI)=0.1-19.6%). Technical success was 96.2% (25/26), with a 95% confidence interval of 80.4-99.9%. CONCLUSION CRYO2 for debulking at the site of obstruction or stenosis can be performed safely.
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Affiliation(s)
- Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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10
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Gupta A, Harris K, Dhillon SS. Role of bronchoscopy in management of central squamous cell lung carcinoma in situ. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:354. [PMID: 31516900 DOI: 10.21037/atm.2019.04.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Squamous cell carcinoma in situ (SCIS) is the pre-invasive stage of squamous cell carcinoma. Early detection and management of SCIS can prevent further progression. Although surgery and external beam radiation therapy are treatment options for SCIS, smaller lesions can be easily managed by bronchoscopic modalities like photodynamic therapy (PDT), cryotherapy, mechanical debulking with biopsy forceps, electrocautery and argon plasma coagulation (APC). Endobronchial brachytherapy (EBBT) and lasers may be judiciously utilized in selected cases. Although, previous studies of treatment modalities may have inadvertently included cases of invasive carcinomas, the advent of new technologies like radial probe endobronchial ultrasound (RP-EBUS) and optical coherence tomography (OCT) can help accurately determine the of depth of invasion. Superficial extent can also be better demarcated with techniques like auto-fluorescence bronchoscopy and narrow band imaging (NBI). New drugs for PDT with deeper penetration and less phototoxicity are being developed. These advances hopefully will allow us to perform superior clinical trials in future and improve our understanding of diagnosis and management of SCIS.
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Affiliation(s)
- Ankit Gupta
- Division of Pulmonary and Critical Care Medicine, Hartford Healthcare, Norwich, CT, USA
| | - Kassem Harris
- Interventional Pulmonology Section, Pulmonary Critical Care Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Samjot Singh Dhillon
- Pulmonary Critical Care and Sleep Medicine, Interventional Pulmonary, The Permanente Medical Group, Roseville and Sacramento, CA, USA
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11
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Costa ADS, Miotto A, Paulo GAD, Ferrari AP, Ota LH. Experimental study for evaluation of a low-cost spray cryotherapy system. EINSTEIN-SAO PAULO 2019; 17:eAO4533. [PMID: 30970046 PMCID: PMC6449060 DOI: 10.31744/einstein_journal/2019ao4533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/29/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the feasibility and applicability of a low-cost cryotherapy system. Methods Experimental study with 25kg Landrace pigs submitted to a longitudinal cervico-thoraco-abdominal incision for exposure of the trachea, thorax and abdomen. The tissues were frozen by continuous spray application at different periods of time (5, 10 and 15 seconds). Spray cryotherapy was performed using a fluorinated gas (tetrafluorethane) delivered at - 47°C temperature (DermaFreeze®, Emdutos; ANVISA registration 80409950001; price R$ 394,00). via an adapted, disposable 1.8mm cholangiography catheter (Olympus; price R$ 280,00). The specimens were resected for histopathological analysis. Results Thirty samples were obtained from ten different organs and divided according to spray cryotherapy application time. System activation for 5, 10 or 15 seconds led to consumption of 14g, 27g and 40g of gas respectively (average gas consumption, 2.7g/s using a 1.8mm catheter). The system comprising a spray tube and catheter proved user-friendly and effective, with constant gas dispersion and adequate tissue freezing. In spite of effective freezing, microscopy failed to reveal tissue changes. This may have reflected methodological constraints precluding evaluation at tissue damage peak time (48 hours). Conclusion The low-cost spray cryotherapy system proved feasible and safe.
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Abstract
Interstitial lung diseases (ILDs) form one of the most fascinating fields in pulmonary medicine. They also pose one of the greatest challenges for accurate diagnosis and proper treatment. Even within the recommended and warranted multidisciplinary approach, differentiating between one disease and another may lead to frustration, especially when proper lung tissue is not available for adequate pathological review. A surgical lung biopsy (SLB) might render enough tissue for histopathology, but this could come at the expense of high morbidity and even mortality, as in the case of usual interstitial pneumonia (UIP). Could bronchoscopy and its various techniques offer a safer and higher yield alternative? Since the very late 19th century, efforts have been made to better examine the airways, obtain tissue and treat various conditions. This resulted in the successive emergence of bronchoalveolar lavage (BAL), endobronchial and transbronchial forceps biopsies, until recently when transbronchial cryobiopsy surfaced as a nascent technique with much promise. The use of endobronchial ultrasound revolutionized the diagnosis and staging of lung cancer, while adding to the yield of other conditions such as sarcoidosis. Ongoing research, efforts and studies have continuously scrutinized the roles of various techniques in the approach to ILDs. For example, BAL seems to serve mostly to eliminate infection as an etiology or a complicating factor in the acute worsening of a fibrotic lung disease, while a predominant cellular component might be diagnostic, such as eosinophilia in eosinophilic lung disease, or lymphocytosis in hypersensitivity pneumonitis (HP). On the other hand, endobronchial biopsy's (EBB) role appears limited to sarcoidosis. As for transbronchial biopsy by forceps, the small sample size and related artifact appear to be limiting factors in making an accurate diagnosis. Recently, however, the use of cryotherapy via employing a cryoprobe in obtaining transbronchial lung biopsies is unfolding into a refined interventional method which might transform indefinitely our approach to the pathological diagnosis of the various ILDs.
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Affiliation(s)
- Jad Kebbe
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Medical Center, Oklahoma, USA
| | - Tony Abdo
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Medical Center, Oklahoma, USA
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13
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Gompelmann D, Herth FJF. [Endoscopic interventions in pulmonology]. Internist (Berl) 2017; 57:763-72. [PMID: 27351790 DOI: 10.1007/s00108-016-0090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchoscopy plays a significant role in the diagnosis and treatment of pulmonary diseases. Hemoptysis, or central airway obstruction, is a common indication for interventional bronchoscopy. In addition, the treatment of early lung cancer is the domain of bronchoscopy in inoperable patients. In recent years, endoscopic techniques have also been established as new therapeutic options in advanced chronic obstructive pulmonary disease and uncontrolled bronchial asthma.
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Affiliation(s)
- D Gompelmann
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland.
- Translational Lung Research Center Heidelberg, Mitglied des deutschen Zentrums für Lungenforschung DZL, Heidelberg, Deutschland.
| | - F J F Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg, Mitglied des deutschen Zentrums für Lungenforschung DZL, Heidelberg, Deutschland
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14
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Preinvasive disease of the airway. Cancer Treat Rev 2017; 58:77-90. [DOI: 10.1016/j.ctrv.2017.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 01/20/2023]
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15
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Guibert N, Mhanna L, Droneau S, Plat G, Didier A, Mazieres J, Hermant C. Techniques of endoscopic airway tumor treatment. J Thorac Dis 2016; 8:3343-3360. [PMID: 28066616 DOI: 10.21037/jtd.2016.11.49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors.
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Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Laurent Mhanna
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Sylvain Droneau
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Alain Didier
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Julien Mazieres
- Pulmonology Department, Larrey University Hospital, Toulouse, France
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Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion. Ann Am Thorac Soc 2016; 13:1405-15. [DOI: 10.1513/annalsats.201601-062fr] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Wurps H, Schönfeld N, Bauer TT, Bock M, Duve C, Sauer R, Mairinger T, Griff S. Intra-patient comparison of parietal pleural biopsies by rigid forceps, flexible forceps and cryoprobe obtained during medical thoracoscopy: a prospective series of 80 cases with pleural effusion. BMC Pulm Med 2016; 16:98. [PMID: 27387441 PMCID: PMC4937596 DOI: 10.1186/s12890-016-0258-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is only few data available on the use of cryotechnique during medical thoracoscopy. METHODS Medical thoracoscopy was performed in consecutive patients with pleural effusion. Prospectively, biopsies were taken by rigid forceps, flexible forceps and cryoprobe. Specimen size, depth and diagnostic yield were compared. RESULTS 80 Patients were included. 408 biopsies were taken (205 rigid biopsies, 104 flexible biopsies, 99 cryobiopsies). Mean surface area of rigid biopsies was 22.6 ± 20.4 mm(2) (flexible biopsies: 7.1 ± 9.3 mm(2), cryobiopsies: 14.4 ± 12.8 mm(2)). Rigid biopsies were significantly larger than cryobiopsies (p < 0.001) and flexible biopsies (p < 0.001), crybiopsies were significantly larger than flexible biopsies (p < 0.01). A deep biopsy containing fatty tissue was harvested in 63 % of rigid biopsies (cryobiopsy: 49.5 % flexible biopsy: 39.5 %). In 79/80 cases (98.7 % 95 % CI cannot be calculated) a diagnosis was obtained by rigid biopsy (cryobiopsy: 73/80 cases (91.3 % 95 % CI 86.0 - 96.5 %), flexible biopsy: 74/80 cases (92.5 % 95 % CI 88.6 - 97.4 %)). Diagnostic yield achieved with cryobiopsies was inferior to the yield of rigid biopsies (Difference: 12.7 %), but non-inferior to flexible biopsies (Difference: 6.5 %). CONCLUSION Cryobiopsies in medical thoracoscopy are safe with high diagnostic yield, non-inferior to flexible biopsies with increased tissue quantity and quality. Cryotechnique can develop an important role in medical thoracoscopy in the near future when rigid thoracoscopy is not available.
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Affiliation(s)
- H Wurps
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
| | - N Schönfeld
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - T T Bauer
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - M Bock
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - C Duve
- Department of Respiratory Medicine, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - R Sauer
- Department of Pneumology and Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - T Mairinger
- Department of Pneumology and Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - S Griff
- Department of Pneumology and Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
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Abstract
Cryosurgery, a method of treating disease by the production of freezing temperatures in the tissue, is a useful technique for the treatment of tumors. When the modern era of cryosurgery began in the mid 1960's, the technique was used only for tumors easily accessible by direct observation or via endoscopy, such as those of the skin, oral cavity, and prostate gland. In general, the technique had limited usefulness in the next two decades. However, with the advent of intraoperative ultrasound as a method of monitoring the process of freezing and with the development of more effective cryosurgical apparatus, the cryosurgical treatment of tumors of the viscera and other deep tissues became practical in the 1990's. This review assesses the present day status of cryosurgery in the management of diverse tumors.
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Affiliation(s)
- Andrew A Gage
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 14214, USA.
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Sachdeva A, Pickering EM, Lee HJ. From electrocautery, balloon dilatation, neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser to argon plasma coagulation and cryotherapy. J Thorac Dis 2016; 7:S363-79. [PMID: 26807284 DOI: 10.3978/j.issn.2072-1439.2015.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past decade, there has been significant advancement in the development/application of therapeutics in thoracic diseases. Ablation methods using heat or cold energy in the airway is safe and effective for treating complex airway disorders including malignant and non-malignant central airway obstruction (CAO) without limiting the impact of future definitive therapy. Timely and efficient use of endobronchial ablative therapies combined with mechanical debridement or stent placement results in immediate relief of dyspnea for CAO. Therapeutic modalities reviewed in this article including electrocautery, balloon dilation (BD), neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser, argon plasma coagulation (APC), and cryotherapy are often combined to achieve the desired results. This review aims to provide a clinically oriented review of these technologies in the modern era of interventional pulmonology (IP).
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Affiliation(s)
- Ashutosh Sachdeva
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Edward M Pickering
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Hans J Lee
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
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Chawla RK, Madan A, Chawla A, Arora HN. Cryo-recanalization in a case of carcinoid tumor - An interesting case report. Lung India 2015; 32:511-4. [PMID: 26628773 PMCID: PMC4587013 DOI: 10.4103/0970-2113.164161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The term “cryotherapy” comes from the Greek cryo (κρύο) meaning cold, and therapy (θεραπεία) meaning cure. Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. Carcinoid tumors of the lung are a fascinating but uncommon group of pulmonary neoplasms. In the past, these tumors were grouped with benign or less aggressive malignant pulmonary tumors, namely bronchial adenomas. Recent studies have revealed that carcinoid lung tumors are the most indolent form of a spectrum of bronchopulmonary neuroendocrine tumors that, at its extreme, include small cell carcinoma of the lung as its most malignant member. They commonly present as endobronchial obstructions, and if complete, can be life-threatening and require immediate intervention.[1] Recently, we have treated a patient of carcinoid tumor of lung who was managed with cryo-recanalization with excellent response.
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Affiliation(s)
- Rakesh K Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital, Delhi, India
| | - Arun Madan
- Department of Pulmonary Medicine, Sharda Medical College and Hospital, Sharda University, Noida, India
| | - Aditya Chawla
- Department of Pulmonary Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Harsh Nandini Arora
- Department of Internal Medicine, ESI Medical College, Faridabad, Haryana, India
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21
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Montero Fernández MÁ. Transbronchial Cryobiopsy in Interstitial Lung Disease: Advantageous Costs to Benefits Ratio. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.arbr.2015.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Transbronchial cryobiopsy in interstitial lung disease: advantageous costs to benefits ratio. Arch Bronconeumol 2015; 51:257-8. [PMID: 25934473 DOI: 10.1016/j.arbres.2015.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
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23
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Borghol S, Alberti N, Frulio N, Crombe A, Marty M, Rolland A, Trillaud H. Pulmonary artery pseudoaneurysm after radiofrequency ablation: Report of two cases. Int J Hyperthermia 2015; 31:1-4. [DOI: 10.3109/02656736.2014.995239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Rozman A, Camlek L, Marc Malovrh M, Kern I, Schönfeld N. Feasibility and safety of parietal pleural cryobiopsy during semi-rigid thoracoscopy. CLINICAL RESPIRATORY JOURNAL 2015; 10:574-8. [DOI: 10.1111/crj.12256] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/27/2014] [Accepted: 12/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Aleš Rozman
- Endoscopy/Pulmonology Department; University Clinic of Pulmonary and Allergic Diseases Golnik; Golnik Slovenia
| | - Luka Camlek
- Intensive Care Unit; University Clinic of Pulmonary and Allergic Diseases Golnik; Golnik Slovenia
| | - Mateja Marc Malovrh
- Department of Interventional Pulmonology; University Clinic of Pulmonary and Allergic Diseases Golnik; Golnik Slovenia
| | - Izidor Kern
- Department of Pathology; University Clinic of Pulmonary and Allergic Diseases Golnik; Golnik Slovenia
| | - Nicolas Schönfeld
- Oberarzt Klinik für Pneumologie; Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring GmbH; Berlin Germany
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25
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26
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MR Imaging–Guided Percutaneous Cryotherapy for Lung Tumors: Initial Experience. J Vasc Interv Radiol 2014; 25:1456-62. [DOI: 10.1016/j.jvir.2014.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/24/2022] Open
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27
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Mitchell PD, Kennedy MP. Bronchoscopic management of malignant airway obstruction. Adv Ther 2014; 31:512-38. [PMID: 24849167 DOI: 10.1007/s12325-014-0122-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Indexed: 12/17/2022]
Abstract
Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through meta stases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.
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Affiliation(s)
- Patrick D Mitchell
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland
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28
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Lazarus DR, Eapen GA. Bronchoscopic Interventions for Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Alberti N, Ferretti G, Buy X, Desjardin M, Al Ammari S, Cazzato RL, Monnin-Bares V, Bechade D, Desolneux G, Michot A, Palussiere J. Diaphragmatic hernia after lung percutaneous radiofrequency ablation: incidence and risk factors. Cardiovasc Intervent Radiol 2014; 37:1516-22. [PMID: 24519640 DOI: 10.1007/s00270-014-0854-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/12/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate diaphragmatic hernias (DH) after percutaneous radiofrequency ablation (PRFA) for basal lung nodules and to detect risk factors. MATERIALS AND METHODS Between January 2009 and December 2012, the presence of DH was retrospectively recorded in all of the patients who underwent PRFA with multitine expandable electrodes for ablation of nodules in the lower lobe. All nodules were classified into three groups according to the location of the tines after deployment relative to the diaphragm: In group 1, the tines were at a distance of >1 cm from the diaphragm; in group 2, at least one tine was in contact with the diaphragm without perforation; and in group 3, at least one tine was perforating the diaphragm. RESULTS We recorded 4 cases of DH (3 on the left side, 1 on the right side) in 156 patients (2.3% of procedures). The delay of onset was 7.8 months. DH occurred in groups 2 (n = 1) and 3 (n = 3). Only the 3 cases that occurred on the left side were symptomatic (2 intussusceptions and 1 gastroesophageal reflux) and were surgically repaired. The electrode was positioned in the center of the diaphragm in all cases. CONCLUSION The central position of the electrode and the contact of at least one tine with the diaphragm after deployment seem to be a risk factor to develop DH.
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Affiliation(s)
- Nicolas Alberti
- Department of Interventional Radiology, Institut Bergonié, Comprehensive Cancer Centre, 229 cours de l'Argonne, 33000, Bordeaux, France,
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31
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Wisnivesky JP, Yung RCW, Mathur PN, Zulueta JJ. Diagnosis and treatment of bronchial intraepithelial neoplasia and early lung cancer of the central airways: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e263S-e277S. [PMID: 23649442 DOI: 10.1378/chest.12-2358] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bronchial intraepithelial lesions may be precursors of central airway lung carcinomas. Identification and early treatment of these preinvasive lesions might prevent progression to invasive carcinoma. METHODS We systematically reviewed the literature to develop evidence-based recommendations regarding the diagnosis and treatment of intraepithelial lesions. RESULTS The risk and timeline for progression of bronchial intraepithelial lesions to carcinoma in situ (CIS) or invasive carcinoma are not well understood. Multiple studies show that autofluorescence bronchoscopy (AFB) is more sensitive that white light bronchoscopy (WLB) to identify these lesions. In patients with severe dysplasia or CIS in sputum cytology who have chest imaging studies showing no localizing abnormality, we suggest use of WLB; AFB may be used as an adjunct when available. Patients with known severe dysplasia or CIS of central airways should be followed with WLB or AFB, when available. WLB or AFB is also suggested for patients with early lung cancer who will undergo resection for delineation of tumor margins and assessment of synchronous lesions. However, AFB is not recommended prior to endobronchial therapy for CIS or early central lung cancer. Several endobronchial techniques are recommended for the treatment of patients with superficial limited mucosal lung cancer who are not candidates for resection. CONCLUSION Additional information is needed about the natural history and rate of progression of preinvasive central airway lesions. Patients with severe dysplasia or CIS may be treated endobronchially; however, it remains unclear if these therapies are associated with improved patient outcomes.
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Affiliation(s)
- Juan P Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Rex Chin-Wei Yung
- Division of Pulmonary Medicine and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Praveen N Mathur
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
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Daniels JMA, Sutedja TG. Detection and minimally invasive treatment of early squamous lung cancer. Ther Adv Med Oncol 2013; 5:235-48. [PMID: 23858332 DOI: 10.1177/1758834013482345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. The majority of patents presenting with NSCLC have advanced disease, which precludes curative treatment. Early detection and treatment might result in the identification of more patients with early central lung cancer and improve survival. In addition, the study of early lung cancer improves understanding of lung carcinogenesis and might also reveal new treatment targets for advanced lung cancer. Bronchoscopic investigation of the central airways can reveal both early central lung cancer in situ (stage 0) and other preinvasive lesions such as dysplasia. In the current review we discuss the detection of early squamous lung cancer, the natural history of preinvasive lesions and whether biomarkers can be used to predict progression to cancer. Finally we will review the staging and management of preinvasive lung cancer lesions and the different therapeutic modalities that are available.
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Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Diseases, Z 4A48, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
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Nam SJ, Oak CH, Jang TW, Jung MH, Chun BK. Successful treatment of a tracheal squamous cell carcinoma with a combination of cryoablation and photodynamic therapy. Thorac Cancer 2013; 4:191-194. [PMID: 28920198 DOI: 10.1111/j.1759-7714.2012.00126.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Malignant tumors of the trachea are rare, and account for less than 0.1% of all malignancies. Because there are no guidelines based on randomized clinical trials, the choice of treatment modalities and optimal sequences have not yet been established. In most cases of malignant airway obstruction, a single modality is chosen as the treatment of choice for management, but complete ablation becomes increasingly problematic with minimal residual lesions that require additional treatment. There were few case reports of the combined use of cryoablation and photodynamic therapy to treat tracheal cancer. Therefore, we present our experience of successful tracheal cancer treatment using this combination therapy. A bronchoscopic complete regression was obtained using these two modalities, and the procedures proved to be a safe and effective treatment option based on a one-year follow-up.
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Affiliation(s)
- Sung-Jin Nam
- Department of Internal Medicine, Kosin University College of Medicine, Busan, KoreaDepartment of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Chul-Ho Oak
- Department of Internal Medicine, Kosin University College of Medicine, Busan, KoreaDepartment of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Tae-Won Jang
- Department of Internal Medicine, Kosin University College of Medicine, Busan, KoreaDepartment of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Mann-Hong Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, KoreaDepartment of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Bong-Kwon Chun
- Department of Internal Medicine, Kosin University College of Medicine, Busan, KoreaDepartment of Pathology, Kosin University College of Medicine, Busan, Korea
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Abstract
It has been proposed that invasive carcinoma of the bronchus develops through a transition from preinvasive lesions to overt malignancy. Newer diagnostic technologies have provided a more sensitive way to diagnose preinvasive lesions and a better understanding of the prevalence of such lesions. The natural history of preinvasive lesions has not been well defined; however, there is evidence that high-grade lesions are at a higher risk of progression to carcinoma. Molecular alterations have been described in preinvasive lesions and may help better predict which lesions will progress. Several noninvasive techniques are available for the treatment of high-grade lesions.
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Affiliation(s)
- M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 4133 Bioinformatics Building, Mason Farm Road, CB # 7020, Chapel Hill, NC 27516, USA.
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Zhang X, Tian J, Zhao L, Wu B, Kacher DS, Ma X, Liu S, Ren C, Xiao YY. CT-guided conformal cryoablation for peripheral NSCLC: initial experience. Eur J Radiol 2012; 81:3354-62. [PMID: 22626572 DOI: 10.1016/j.ejrad.2012.04.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/29/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the feasibility of CT-guided and monitored percutaneous conformal cryoablation of Non-Small Cell Lung Cancer for patients who are not suitable for surgical resection. MATERIALS AND METHOD CT-guided percutaneous conformal cryoablation was performed on 46 patients with peripheral Non-Small Cell Lung Cancer. Patients with tumor sizes less than 3 cm in diameter were treated with double-needle clamping cryoablation, while the patients with 3-5 cm tumor sizes were treated with multiple-needle conformal cryoablation. CT was used to monitor the extent of cryoablation during the procedures. At month 1, 3, 6, 12, and 24 post-procedure, enhanced CT scans and/or PET-CT scans were performed to evaluate the impact of the therapy. RESULTS The average tumor CT values were 32±10 HU and -21±8 HU before and after cryoablation, respectively. The largest diameters of the lesions at month 1, 3, 6, 12, and 24 post-procedure were 2.63±0.56 cm, 1.93±0.51 cm, 1.55±0.39 cm, 1.43±0.40 cm, and 1.38±0.38 cm, respectively, in patients with tumor diameter less than 3 cm, and 3.63±0.39 cm, 2.98±0.31 cm, 2.62±0.32 cm, 2.54±0.34 cm, and 2.56±0.37 cm respectively in patients with the tumor diameters between 3 and 5 cm. At the 24th month, there were 36 cases of complete response (83.7%), 7 cases of partial response (16.3%), and no cases of stable disease or progressive disease. 3 patients died due to multiple metastases. CONCLUSION CT-guided percutaneous conformal cryoablation is a safe, effective, and minimally invasive therapeutic method for peripheral lung cancer.
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Affiliation(s)
- Xiao Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China.
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Cryorecanalization: keys to success. Surg Endosc 2012; 26:2969-74. [DOI: 10.1007/s00464-012-2260-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 03/16/2012] [Indexed: 12/17/2022]
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Percutaneous cryoablation as a salvage therapy for local recurrence of lung cancer. Ann Thorac Surg 2012; 94:e31-3. [PMID: 22579884 DOI: 10.1016/j.athoracsur.2012.01.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 01/19/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
A 66-year-old male was diagnosed with inoperable non-small cell lung cancer, and underwent chemoradiotherapy, to which he achieved a partial response. During subsequent follow-up, positron emission tomography showed a fluorodeoxyglucose uptake lesion within the primary tumor, without evidence of metastatic foci elsewhere in the body. As local disease progression was most suspected, cryoablation was performed for the lesion with high fluorodeoxyglucose uptake. After treatment, there has been no evidence of recurrence for 12 months. Herein, we present a case of percutaneous cryoablation as a salvage therapy for recurrent lung cancer after chemoradiotherapy.
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van der Leest C, Amelink A, van Klaveren RJ, Hoogsteden HC, Sterenborg HJCM, Aerts JGJV. Optical detection of preneoplastic lesions of the central airways. ISRN ONCOLOGY 2012; 2012:957835. [PMID: 22550600 PMCID: PMC3324886 DOI: 10.5402/2012/957835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/16/2012] [Indexed: 01/01/2023]
Abstract
Current routine diagnosis of premalignant lesions of the central airways is hampered due to a limited sensitivity (white light bronchoscopy) and resolution (computer tomography (CT), positron emission tomography (PET)) of currently used techniques. To improve the detection of these subtle mucosal abnormalities, novel optical imaging bronchoscopic techniques have been developed over the past decade. In this review we highlight the technological developments in the field of endoscopic imaging, and describe their advantages and disadvantages in clinical use.
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Affiliation(s)
- C van der Leest
- Department of Respiratory Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
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Porpodis K, Karanikas M, Zarogoulidis P, Kontakiotis T, Mitrakas A, Esebidis A, Konoglou M, Domvri K, Iordanidis A, Katsikogiannis N, Courcoutsakis N, Zarogoulidis K. A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy. J Multidiscip Healthc 2012; 5:47-51. [PMID: 22396625 PMCID: PMC3292401 DOI: 10.2147/jmdh.s29709] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carcinoid bronchopulmonary tumors represent approximately 25% of all carcinoid tumors and 1%-2% of all lung neoplasms. The most common symptoms are: persistent cough, asthma-like wheezing, chest pain, dyspnea, hemoptysis and obstructive pneumonitis. We present a case of a young adult diagnosed with a typical carcinoid tumor. The diagnosis was established on the basis of imaging examination and bronchoscopic biopsy. The patient was treated with bronchoscopic electrocautery therapy to relieve the obstructed airway, followed by surgical lobectomy in order to entirely remove the exophytic damage. This approach was not only a palliative management to bronchial obstruction but also avoided pneumonectomy. Recent studies support the use of such interventional resection methods, as they may result in a more conservative surgical resection.
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Affiliation(s)
- Konstantinos Porpodis
- Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece
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Yamauchi Y, Izumi Y, Kawamura M, Nakatsuka S, Yashiro H, Tsukada N, Inoue M, Asakura K, Nomori H. Percutaneous cryoablation of pulmonary metastases from colorectal cancer. PLoS One 2011; 6:e27086. [PMID: 22096520 PMCID: PMC3212539 DOI: 10.1371/journal.pone.0027086] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/10/2011] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of cryoablation for metastatic lung tumors from colorectal cancer. METHODS The procedures were performed on 24 patients (36-82 years of age, with a median age of 62; 17 male patients, 7 female patients) for 55 metastatic tumors in the lung, during 30 sessions. The procedural safety, local progression free interval, and overall survival were assessed by follow-up computed tomographic scanning performed every 3-4 months. RESULTS The major complications were pneumothorax, 19 sessions (63%), pleural effusion, 21 sessions (70%), transient and self-limiting hemoptysis, 13 sessions (43%) and tract seeding, 1 session (3%). The 1- and 3-year local progression free intervals were 90.8% and 59%, respectively. The 3-years local progression free intervals of tumors ≤15 mm in diameter was 79.8% and that of tumors >15 mm was 28.6% (p = 0.001; log-rank test). The 1- and 3-year overall survival rates were 91% and 59.6%, respectively. CONCLUSION The results indicated that percutaneous cryoablation is a feasible treatment option. The local progression free interval was satisfactory at least for tumors that were ≤15 mm in diameter.
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Affiliation(s)
- Yoshikane Yamauchi
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
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Lee SH, Choi WJ, Sung SW, Kim YK, Kim CH, Zo JI, Park KJ. Endoscopic cryotherapy of lung and bronchial tumors: a systematic review. Korean J Intern Med 2011; 26:137-44. [PMID: 21716589 PMCID: PMC3110845 DOI: 10.3904/kjim.2011.26.2.137] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS We made a systematic review and evaluation of endoscopic cryotherapy of endobronchial tumors, investigating safety and efficacy. METHODS Qualified studies regarding endoscopic cryotherapy of lung tumors were systemically evaluated using available databases according to predefined criteria. RESULTS In total, 16 publications were included in the final assessment. A narrative synthesis was performed because a formal meta-analysis was not viable due to the lack of controlled studies and study heterogeneity. Overall success rates for significant recanalization of the obstruction were approximately 80%, although they varied, depending on disease status in the patient population. Complications from the procedure developed in 0-11.1% of cases, most of which were minor and controlled by conservative management. Although limited data were available on comprehensive functional assessment, some studies showed that respiratory symptoms, pulmonary function tests, and performance status were significantly improved. CONCLUSIONS Endoscopic cryotherapy was found to be a safe and useful procedure in the management of endobronchial tumors although its efficacy and appropriate indications have yet to be determined in well-designed controlled studies.
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Affiliation(s)
- Seon-Heui Lee
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Won-Jung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Sook-Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Young-Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Chi-Hong Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Jae-Il Zo
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kwang-Joo Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
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Xiao Y, Wu B, Zhang X, Tian J. Abstract No. 122: Peripheral NSCLC treated with CT-guided conformal cryoablation. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Bronchoscopy in the new millennium spells an exciting time for the pulmonologist, which likens to Alice peering through the looking glass into a wonderland of miniaturized probes, optics, and technology that are advancing at a maddening pace. Although scientists continue to push the envelope using nanotechnology that may facilitate further miniaturization of probes to allow imaging at the cellular or molecular level, it is opportune to evaluate the strengths and weaknesses of available technologies and bronchoscopic techniques for the diagnosis and staging of lung cancer, in its early detection and palliation. We appraise current technologies and what they hold for the future.
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The use of PTC and RFA as treatment alternatives with low procedural morbidity in non-small cell lung cancer. Eur J Cancer 2009; 45:1773-9. [DOI: 10.1016/j.ejca.2009.02.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/10/2009] [Accepted: 02/11/2009] [Indexed: 11/20/2022]
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Abstract
Preinvasive lesions are considered the precursors of squamous cell carcinoma of the bronchus. Treatment at the preinvasive stage, before the potential for metastasis, may improve survival from squamous cell carcinoma. An understanding of the natural history and outcome of preinvasive lesions is essential for the accurate interpretation studies of their treatment, and decisions regarding the management of individual lesions. The natural history of preinvasive lesions has only been reported in a small number of highly selected patients and uses different inclusion criteria, treatment criteria. and time-periods of follow-up, making it difficult to draw definitive conclusions. High-grade preinvasive lesions carry a risk of progression to carcinoma but most patients have multiple lesions and a significant probability of developing new lesions over time. Distinguishing lesions with malignant potential, the targets for therapy, from those that will regress or remain indolent is difficult. The American College of Chest Physicians guidelines recommend bronchoscopic follow-up of severe dysplasia and carcinoma-in situ. This review of the evidence regarding the natural history and outcome of preinvasive lesions supports this view, but also shows that further studies in individuals at risk for lung cancer are necessary before guidelines for the management of preinvasive lesions can be developed.
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Franke KJ, Szyrach M, Nilius G, Hetzel J, Hetzel M, Ruehle KH, Enderle MD. Experimental study on biopsy sampling using new flexible cryoprobes: influence of activation time, probe size, tissue consistency, and contact pressure of the probe on the size of the biopsy specimen. Lung 2009; 187:253-9. [PMID: 19548030 DOI: 10.1007/s00408-009-9156-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 06/02/2009] [Indexed: 12/19/2022]
Abstract
Cryoextraction is a procedure for recanalization of obstructed airways caused by exophytic growing tumors. Biopsy samples obtained with this method can be used for histological diagnosis. The objective of this study was to evaluate the parameters influencing the size of cryobiopsies in an in vitro animal model. New flexible cryoprobes with different diameters were used to extract biopsies from lung tissue. These biopsies were compared with forceps biopsy (gold standard) in terms of the biopsy size. Tissue dependency of the biopsy size was analyzed by comparing biopsies taken from the lung, the liver, and gastric mucosa. The effect of contact pressure exerted by the tip of the cryoprobe on the tissue was analyzed on liver tissue separately. Biopsy size was estimated by measuring the weight and the diameter. Weight and diameter of cryobiopsies correlated positively with longer activation times and larger diameters of the cryoprobe. The weight of the biopsies was tissue dependent: lung < liver < stomach. Only little tissue dependency was found for the biopsy diameter. The biopsy size increased when the probe was pressed on the tissue during cooling. Cryobiopsies can be taken from different tissue types with flexible cryoprobes. The size of the samples depends on tissue type, probe diameter, application time, and pressure exerted by the probe on the tissue. Even the cryoprobe with the smallest diameter can provide larger biopsies than a forceps biopsy in lung. It can be expected that the same parameters influence the sample size of biopsies in vivo.
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Affiliation(s)
- Karl-Josef Franke
- Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, University of Witten/Herdecke, Hagen, Germany.
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Cho S, Zanati S, Yong E, Cirocco M, Kandel G, Kortan P, May G, Marcon N. Endoscopic cryotherapy for the management of gastric antral vascular ectasia. Gastrointest Endosc 2008; 68:895-902. [PMID: 18640673 DOI: 10.1016/j.gie.2008.03.1109] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 03/25/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic GI bleeding. OBJECTIVE To assess the efficacy and safety of cryotherapy for endoscopic treatment of GAVE. DESIGN Patients received 3 sessions of endoscopic cryotherapy at 3-week to 6-week intervals and had a follow-up endoscopy 4 weeks thereafter. They were followed prospectively in terms of clinical and endoscopic response. SETTING Tertiary-care center, between October 2004 and April 2006. PATIENTS The patients were 43 to 89 years of age, with a diagnosis of GAVE and documented iron deficiency anemia. Eight patients had a history of overt GI bleeding. Eight patients (67%) had previously been treated with argon plasma coagulation (APC) (median 6 sessions, range 1-10 sessions) and failed to respond or had a recurrence. RESULTS Twelve patients were enrolled. Six patients (50%) had a complete response, and 6 patients had a partial response. The mean number of units of blood transfused in the period of 3 months before cryotherapy and during the period of follow-up of 3 months was 4.6 and 1.7 units, respectively. An increased mean Hb level, from 9.9 to 11.3 g/dL, was noted. The average duration of the cryotherapy was 5 minutes (range 1-15 minutes). In 32 of 36 cryotherapy treatment sessions performed (89%), it was technically possible to treat more than 90% of GAVE lesions. There were no immediate cryotherapy-related complications, and none of the patients required admission after the procedure. LIMITATIONS A pilot study from a single center. CONCLUSIONS Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to APC therapy. Optimal cryogen, delivery device, and treatment protocols are yet to be determined.
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Affiliation(s)
- Sarah Cho
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Thomadsen BR, Williamson JF, Rivard MJ, Meigooni AS. Anniversary Paper: Past and current issues, and trends in brachytherapy physics. Med Phys 2008; 35:4708-23. [DOI: 10.1118/1.2981826] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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