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Neuroendocrine Tumor Diagnosed Through Endoscopic Ultrasound-Guided Fine-Needle Biopsy of a Lung Mass. ACG Case Rep J 2022; 9:e00858. [PMID: 36072359 PMCID: PMC9439768 DOI: 10.14309/crj.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/30/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent modality for tissue acquisition and has been shown to be superior to EUS-fine-needle aspiration in several studies. Although tissue sampling of lung nodules using EUS-fine-needle aspiration has been reported in the literature, the use of EUS-FNB for tissue acquisition of parenchymal lung mass has rarely been reported in the literature. Our report highlights that EUS-FNB is safe and effective for lung lesions that are near the esophageal wall.
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CT Guided Needle Biopsy of Peripheral Lesions-Lesion Characteristics That May Increase the Diagnostic Yield and Reduce the Complication Rate. J Clin Med 2021; 10:jcm10092031. [PMID: 34065147 PMCID: PMC8126034 DOI: 10.3390/jcm10092031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022] Open
Abstract
Computed tomography-guided needle biopsy (CT-GNB) has a high diagnostic yield for lung cancer but higher complication rates compared to those of other biopsy modalities. We sought to clarify in which thoracic lesions we could achieve a quick pathological diagnosis using CT-GNB, considering the risks and benefits. We retrospectively enrolled 110 patients who underwent CT-GNB and 547 patients who underwent transbronchial biopsy (TBB) for parenchymal lung lesions in clinical practice. The diagnostic rates of CT-GNB and TBB were 87.3% and 75.3%. After failed diagnosis with other biopsy modalities, 92.3% of patients were finally diagnosed using CT-GNB and 65.8% using TBB. In cases with a negative bronchial sign, there was a statistically higher diagnostic rate with CT-GNB than with TBB (p < 0.001: 89.4% vs. 0%). Complication rates were higher with CT-GNB (50.9%) than with TBB (16.3%). However, there were lower rates of complications in cases with inhomogeneous tumors, subpleural lesions, and when more than 15 mm of the punctured needle length was within the target. We conclude that CT-GNB is an effective biopsy modality with a high diagnostic rate that is especially recommended when the bronchus sign is negative. It can be safely performed if risk factors for complications are taken into account.
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Ni W, Lin S, Bian S, Xiao M, Wang Y, Yang Y, Lu C, Zheng W, Zhou P. Biological testing of chitosan-collagen-based porous scaffolds loaded with PLGA/Triamcinolone microspheres for ameliorating endoscopic dissection-related stenosis in oesophagus. Cell Prolif 2021; 54:e13004. [PMID: 33543561 PMCID: PMC7941226 DOI: 10.1111/cpr.13004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives Endoscopic submucosal dissection (ESD), a preferential approach for early oesophageal neoplasms, inevitably results in oesophageal strictures in patients. Clinical use of glucocorticoids through submucosal injection is beneficial for inhibiting oesophageal stricture following injury; however, it also has limitations, such as dose loss and perforation. Hence, alternatives to glucocorticoid therapy should be developed. Methods A novel porous composite scaffold, ChCo‐TAMS, composed of chitosan, collagen‐I and triamcinolone acetonide (TA) loaded into poly (lactic‐co‐glycolic) acid (PLGA) microspheres (TAMS), was successfully constructed and subjected to biological testing to ameliorate oesophageal ESD‐related stenosis. Results The synthesized biomaterials displayed unique properties in inhibiting the activation of macrophages, chemokine‐mediated cell recruitment and fibrogenesis of fibroblasts. Further application of the scaffolds in the rat dermal defect and porcine oesophageal ESD model showed that these novel scaffolds played a robust role in inhibiting wound contracture and oesophageal ESD strictures. Conclusions The developed composite scaffolds provide a promising clinical medical device for the prevention of post‐operative oesophageal stricture.
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Affiliation(s)
- Wenkai Ni
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, China
| | - Shengli Lin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Saiyan Bian
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, China.,Medical College, Nantong University, Nantong, China
| | - Mingbing Xiao
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Yongjun Wang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Yumin Yang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Cuihua Lu
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, China
| | - Wenjie Zheng
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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4
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Christiansen IS, Svendsen MBS, Bodtger U, Sidhu JS, Nessar R, Salih GN, Høegholm A, Clementsen PF. Characterization of Lung Tumors that the Pulmonologist can Biopsy from the Esophagus with Endosonography (EUS-B-FNA). Respiration 2021; 100:135-144. [PMID: 33477141 DOI: 10.1159/000512074] [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: 07/01/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to guidelines, it is possible to biopsy lung tumors "immediately adjacent to the esophagus" with EUS-B-FNA. However, it is unknown what "immediately adjacent" exactly means. OBJECTIVE to investigate the possibility of achieving EUS-B-FNA biopsies from a lung tumor depending on the distance from the esophagus and to establish the maximal allowable distance between the tumor and the esophagus. METHODS In a prospective observational study, we included patients with a lung tumor located maximum 6 cm from the esophagus and indication of EUS-B-FNA from the tumor. The tumors were of different sizes. In a plot presenting the tumor size-distance relationship in cases with (biopsy) versus without (non-biopsy) successful EUS-B-FNA, a separation line representing the threshold between the groups were identified and a biopsy-index equation established. The maximal tumor-size corrected distance (TSCD) was calculated using the residuals to the separation line. RESULTS In total, 70 patients were included. EUS-B-FNA from the lung tumor was possible in 46 patients. All tumors with a distance from the esophagus below 19 mm could be biopsied. The maximal allowable esophagus-tumor distance depended on tumor size. From the separation line, a biopsy-index equation was established with the sensitivity of 93.5%, a specificity of 100%, and total accuracy of 95.7%. The TSCD was 31 mm (sensitivity: 95.7%, specificity 75.0%, and accuracy: 88.6%). CONCLUSION We established a biopsy-index equation to predict the achievability of a lung tumor using EUS-B-FNA depending on distance to esophagus and tumor size. A general maximal TSCD was 31 mm.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark, .,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark,
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Rafi Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Adler DG, Gabr M, Taylor LJ, Witt B, Pleskow D. Initial report of transesophageal EUS-guided intraparenchymal lung mass core biopsy: Findings and outcomes in two cases. Endosc Ultrasound 2018; 7:413-417. [PMID: 29786035 PMCID: PMC6289011 DOI: 10.4103/eus.eus_13_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
EUS is most commonly used to evaluate and sample lesions of the abdomen but has only been used on rare occasions to evaluate and sample lung lesions. Prior reported cases of EUS sampling of lung lesions were performed by fine-needle aspiration. We present what is believed to be the first reported cases of EUS-guided core biopsy of intraparenchymal lung lesions through two separate case reports. Both patients had the upper lobe lesions not amenable to bronchoscopy or endobronchial ultrasound, and both patients underwent core biopsy without adverse event. This report of two cases shows that EUS-guided core biopsy of intraparenchymal lung lesions is technically possible and may not necessarily result in adverse events such as hemorrhage, pneumothorax, or infection.
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Affiliation(s)
- Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, YSA, USA
| | - Moamen Gabr
- Beth Israel Deaconess Medical Center, Division of Gastroenterology and Hepatology, Harvard Medical School, Boston, MA, USA
| | - Linda Jo Taylor
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, YSA, USA
| | - Benjamin Witt
- Department of Pathology, ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Douglas Pleskow
- Beth Israel Deaconess Medical Center, Division of Gastroenterology and Hepatology, Harvard Medical School, Boston, MA, USA
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Han Y, Guo J, Sun S, Wu W, Wang S, Ge N, Liu X, Wang G, Wang S. Acellular dermal matrix for esophageal stricture prevention after endoscopic submucosal dissection in a porcine model. Gastrointest Endosc 2017; 86:1160-1167. [PMID: 28396274 DOI: 10.1016/j.gie.2017.02.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is considered an effective treatment for early esophageal cancer and precancerous lesions. Esophageal stenosis is closely associated with quasi-circumferential ESD. We examined whether post-ESD esophageal stricture can be prevented by grafting an acellular dermal matrix (ADM) membrane. METHODS Fourteen Bama miniature pigs were randomly divided into an ADM group (n = 7) and a control group (n = 7). Semicircumferential ESD was performed at the distal esophagus in all animals, and in the ADM group an ADM patch graft was placed at the resection site and secured innovatively with metal clips. Animals in the control group underwent ESD only. Endoscopy was performed at 3 days, 1 week, 2 weeks, and 4 weeks post-ESD, and fluoroscopy was performed at 4 weeks for assessment of the degree of stenosis, after which the remodeled esophageal tissues were excised for histologic analysis. RESULTS No animals in the ADM group developed clinically significant esophageal stenosis, whereas 42.8% (3/7) in the control group did. The degree of stenosis was severe in the control group (39.8% vs 17.2%, respectively; P = .01). Animals in the ADM group had less feeding difficulty and lost less weight (-.9 kg vs -4.1 kg, respectively; P = .007). Histologically, complete mucosal epithelium, slight local inflammation, and organized collagenous fibers were observed in the ADM group. CONCLUSIONS ADM patch graft appears, after short-term observation, to be a potentially useful new treatment strategy for prevention of esophageal stricture after ESD. A metal clip fixation technique is effective for endoscopic graft attachment.
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Affiliation(s)
- Ye Han
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jintao Guo
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Siyu Sun
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weichao Wu
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sheng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiang Liu
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoxin Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shupeng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
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Li P, Wu C, Zheng W, Zhao L. Pathway and application value of exploration of the pulmonary artery by endobronchial ultrasound. J Thorac Dis 2017; 9:5345-5351. [PMID: 29312744 DOI: 10.21037/jtd.2017.12.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The current standard methods for detecting pulmonary artery diseases are pulmonary artery enhanced computed tomography (CT) scan and pulmonary arteriography. However, some patients cannot tolerate these procedures for various reasons. The present study aimed to investigate the feasibility and operation process of endobronchial ultrasound (EBUS) in exploring the pulmonary artery. Methods Based on normal contrast-enhanced chest CT images, the sites and process for exploring the pulmonary arteries were established. Then the feasibility of the exploration by the convex probe EBUS were evaluated, and roadmaps for exploration of the pulmonary arteries were drawn. Results Among patients who underwent pulmonary artery exploration, sonograms of the left and right pulmonary artery were obtained by the convex probe EBUS. The above-mentioned pulmonary artery branches can be positioned by means of anatomical markers under the bronchoscopic view and follow a certain route for continuous exploration. Sonograms had a certain degree of identification and can be used as an auxiliary tool for pulmonary artery exploration. Conclusions EBUS can be used to explore the main branches of the pulmonary artery continuously. Therefore, EBUS could be considered as a candidate for the diagnosis of pulmonary artery diseases in a selected group of patients, i.e., patient with contrast allergy or renal failure.
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Affiliation(s)
- Peng Li
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Cen Wu
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Zheng
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Li Zhao
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
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8
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Yu Y, Qi SL, Zhang Y. Role of combined propofol and sufentanil anesthesia in endoscopic injection sclerotherapy for esophageal varices. World J Gastroenterol 2017; 23:7875-7880. [PMID: 29209128 PMCID: PMC5703916 DOI: 10.3748/wjg.v23.i44.7875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/04/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs).
METHODS Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 μg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists (ASA) physical status, Child-Turcotte-Pugh (CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted.
RESULTS Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1 ± 11.7 years (range, 25-83 years). The patients weighed 71.4 ± 10.7 kg (range, 45-95 kg) and had ASA physical status classifications of II (79 patients) or III (103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients (1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient (0.5%, 1/182), and hypoxia occurred in one patient (0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully.
CONCLUSION The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.
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Affiliation(s)
- Yang Yu
- Department of Anesthesiology, the Sixth People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
| | - Sheng-Lin Qi
- Endoscopy Center, the Sixth People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
| | - Yong Zhang
- President Office, the Sixth People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
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Zamora FD, Moughrabieh A, Gibson H, Podgaetz E, Dincer HE. An Expectorated "Stent": An Unexpected Complication of EBUS-TBNA. J Bronchology Interv Pulmonol 2017; 24:250-252. [PMID: 27479014 DOI: 10.1097/lbr.0000000000000306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration has a low complication rate and is a cost-effective procedure for mediastinal staging and diagnosis when compared with the more invasive mediastinoscopy. There are increasing case reports of unexpected complications including equipment failures with and without significant medical consequences. Knowledge of complications, including those that are rare, is essential for the physician performing this minimally invasive procedure. We report a case of a retained foreign body from the unexpected separation of a distal spring/coil mechanism from the Olympus ViziShot Aspiration needle following early needle deployment within the working channel of the bronchoscope.
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Affiliation(s)
- Felix D Zamora
- *Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine ‡Department of Cardiopulmonary Services §Division of Cardiothoracic Surgery, Section of Thoracic and Foregut Surgery, University of Minnesota; Minneapolis, MN †Division of Pulmonary, Critical Care, and Sleep Medicine, Harper University Hospital, Detroit, MI
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10
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Pulmonologist-Performed Per-Esophageal Needle Aspiration of Parenchymal Lung Lesions Using an EBUS Bronchoscope: Diagnostic Utility and Safety. J Bronchology Interv Pulmonol 2017; 24:117-124. [PMID: 28005836 DOI: 10.1097/lbr.0000000000000350] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transesophageal introduction of the endobronchial ultrasound (EBUS) videobronchoscope allows pulmonologists to perform endoscopic ultrasound fine-needle aspiration (EUS-B-FNA) of mediastinal lesions. Safety, diagnostic accuracy, and feasibility of EUS-B-FNA in evaluation of pulmonary parenchymal lesions are not established. METHODS All patients undergoing pulmonologist-performed EUS-B-FNA of parenchymal lung lesions at 2 tertiary centers were included in this prospective observational cohort study. RESULTS EUS-B-FNA sampling of parenchymal lesions was performed in 27 patients. Mean (±SD) lesion size was 36±16 mm. Seven lesions were ≤18 mm. Pneumothorax occurred in 1 patient (3.7%, 95% confidence interval, 0.001%-19%). Ten target lesions (36%) were in locations inaccessible to bronchoscopic sampling via the airways, and 9 lesions were inaccessible to EBUS-guided transbronchial needle aspiration and in locations associated with low diagnostic yield from radial EBUS. EUS-B-FNA was diagnostic in 26 patients (96%), and sensitivity of EUS-B-FNA was 100% (95% confidence interval, 87%-100%) for both lung cancer (n=21) and for pulmonary metastatic lesions (n=5). CONCLUSIONS Pulmonologist-performed EUS-B-FNA is safe and accurate in the evaluation parenchymal lung lesions. Diagnostic accuracy is high. EUS-B-FNA may achieve access to sites not amenable to other forms of bronchoscopic sampling, or increase diagnostic accuracy in patients where anatomic position predicts a low diagnostic yield.
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Li P, Zheng W, Liu H, Zhang Z, Zhao L. Endobronchial ultrasound-guided transbronchial needle aspiration for thyroid cyst therapy: A case report. Exp Ther Med 2017; 13:1944-1947. [PMID: 28565791 PMCID: PMC5443205 DOI: 10.3892/etm.2017.4213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/23/2016] [Indexed: 12/29/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is of limited usefulness for diagnosing thyroid disease, and few studies have reported its use in diagnosing and treating thyroid cysts. The present study investigated a unique case of diagnosis and treatment of a thyroid cyst by EBUS-TBNA. A 67-year-old male presented with back pain. Positron emission tomography/computed tomography scanning revealed low-density signals in the right lobe of the thyroid. Needle aspiration biopsies and drainage at this site was performed, and EBUS was used for guidance in diagnosing the thyroid cyst. A follow-up chest computed tomography scan indicated that the thyroid lesion had subsequently disappeared. The present study concludes that EBUS-TBNA provides an alternative approach for diagnosing and treating deep thyroid cysts located close to the airway. In all other cases, percutaneous needle aspiration or surgery should be the first choice.
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Affiliation(s)
- Peng Li
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Wei Zheng
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Hongbo Liu
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhenyong Zhang
- Department of Medical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110022, P.R. China
| | - Li Zhao
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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12
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Chen R, Liu X, Sun S, Wang S, Ge N, Wang G, Guo J. Comparison of Endoscopic Mucosal Resection With Circumferential Incision and Endoscopic Submucosal Dissection for Rectal Carcinoid Tumor. Surg Laparosc Endosc Percutan Tech 2017; 26:e56-61. [PMID: 27213787 DOI: 10.1097/sle.0000000000000266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) has been a valuable treatment of choice for rectal carcinoid tumors that are endoscopically treatable because of its satisfactory resection rate and low recurrence rate. For treatment of small rectal carcinoids, endoscopic mucosal resection (EMR) is more often chosen by endoscopists because of its safety and time efficiency. We applied circumferential incision and endoscopic mucosal resection (CI-EMR), which is a modification of EMR, to treat rectal carcinoid tumors and compared their efficacy and safety. METHODS Between January 2008 and December 2013, we enrolled 66 patients (30 in the ESD group and 36 in the CI-EMR group) at Shengjing Hospital who were pathologically diagnosed with rectal carcinoid tumors <15 mm in diameter. We retrospectively analyzed en bloc resection rates, pathologic complete resection rates, incidences of complications, follow-up outcomes, and procedure times. RESULTS The en bloc resection rate and the histologic complete resection rate were similar, but the procedure time was longer in the ESD group than in the CI-EMR group. In cases that were incompletely resected, neither local recurrence nor distant metastasis was detected during follow-up. Similarly minor bleeding occurred in both groups, and no perforation occurred after either procedure. CONCLUSIONS CI-EMR showed comparable en bloc resection and histologically complete resection rates and is technically simpler and minimally invasive compared with ESD. Because of its easier performance and shorter procedure time, CI-EMR may be preferable to ESD for resection of rectal carcinoid tumors <15 mm in diameter without invasion or distant metastases.
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Affiliation(s)
- Ru Chen
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
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13
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Linear endobronchial and endoesophageal ultrasound: a practice change in thoracic medicine. Curr Opin Pulm Med 2016; 22:281-8. [PMID: 26989819 DOI: 10.1097/mcp.0000000000000269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Linear endosonography, including intrathoracic lymph nodal sampling by endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and endoesophageal ultrasound fine-needle aspiration (EUS-FNA), has an important role in the diagnosing and staging of lung cancer. Furthermore, endosonography is applied in the mediastinal evaluation of sarcoidosis, lymphoma, cysts, and nodal metastases of extrathoracic malignancies. Endosonography-related complications as well as sedation and training strategies are discussed. The purpose of this review is to summarize current practice, recent advances, and future directions. RECENT FINDINGS Lung cancer guidelines recommend endosonography - above mediastinoscopy - as the initial test for mediastinal nodal tissue staging. By introducing the EBUS-scope into the esophagus (EUS-B) - following an EBUS procedure - the complete mediastinum and the left adrenal gland can be investigated in a single scope procedure by one operator. In patients with suspected stage I/II sarcoidosis, EBUS-TBNA/EUS-FNA is the test with the highest granuloma detection rate. Diagnosing (recurrent) lymphoma is an increasingly accepted indication for endosonography. Systematic surveys showed that endosonography has a low complication rate. Simulator-based training and assessment tools measuring competency are important instruments to provide standardized and optimal implementation. SUMMARY Endosonography is generally accepted as a powerful and safe diagnostic test for various diseases affecting the mediastinum. Large-scale implementation is needed.
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Dietrich CF, Horn R, Morf S, Chiorean L, Dong Y, Cui XW, Atkinson NSS, Jenssen C. Ultrasound-guided central vascular interventions, comments on the European Federation of Societies for Ultrasound in Medicine and Biology guidelines on interventional ultrasound. J Thorac Dis 2016; 8:E851-E868. [PMID: 27747022 DOI: 10.21037/jtd.2016.08.49] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Central venous access has traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. There is substantial evidence demonstrating significant improvement in effectiveness and safety of vascular access by realtime ultrasound (US)-guidance, as compared to the anatomical landmark-guided approach. This review comments on the evidence-based recommendations on US-guided vascular access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Rudolf Horn
- Notfallstation, Kantonsspital Glarus, Glarus, Switzerland
| | - Susanne Morf
- Intensivmedizin Kantonsspital Graubünden, Chur, Switzerland
| | - Liliana Chiorean
- Department of Medical Imaging, des Cévennes Clinic, Annonay, France
| | - Yi Dong
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Xin-Wu Cui
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Nathan S S Atkinson
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany
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15
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Dietrich CF, Mathis G, Blaivas M, Volpicelli G, Seibel A, Wastl D, Atkinson NSS, Cui XW, Fan M, Yi D. Lung B-line artefacts and their use. J Thorac Dis 2016; 8:1356-65. [PMID: 27293860 DOI: 10.21037/jtd.2016.04.55] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The analysis of lung artefacts has gained increasing importance as markers of lung pathology. B-line artefact (BLA), caused by a reverberation phenomenon, is the most important lung artefact. In this review, we discuss the current role of BLA in pneumology and explore open questions of the published consensus. METHODS We summarized current literature about BLA. Also, we presented observations on healthy subjects and patients with interstitial syndrome (pulmonary fibrosis and edema), to investigate technical factors influencing BLA visualization. RESULTS BLA imaging is influenced by more factors than recently assumed. When multiple BLA is visualized in the lung, they represent a sign of increased density due to the loss of aeration in the lung periphery. This condition may indicate different diseases including cardiogenic pulmonary edema, diffuse or focal interstitial lung diseases (ILD), infections and acute respiratory distress syndrome (ARDS). Correct interpretation of BLA in lung ultrasound is strongly influenced by associated sonographic signs and careful integration of all relevant clinical information. CONCLUSIONS BLA is useful to monitor clinical response, and may become crucial in directing the diagnostic process. Further research is warranted to clarify technical adjustments, different probe and machine factors that influence the visualization of BLA.
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Affiliation(s)
- Christoph F Dietrich
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Gebhard Mathis
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Michael Blaivas
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Giovanni Volpicelli
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Armin Seibel
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Daniel Wastl
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Nathan S S Atkinson
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin-Wu Cui
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mei Fan
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dong Yi
- 1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Dincer HE, Andrade R, Zamora F, Podgaetz E. A new needle on the block: EchoTip ProCore endobronchial ultrasound needle. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:467-73. [PMID: 27099535 PMCID: PMC4821381 DOI: 10.2147/mder.s62724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Endobronchial ultrasound has become the first choice standard of care procedure to diagnose benign or malignant lesions involving mediastinum and lung parenchyma adjacent to the airways owing to its characteristics of being real-time and minimally invasive. Although the incidence of lung cancer has been decreasing, it is and will be the leading cause of cancer-related mortality in the next few decades. When compared to other cancers, lung cancer kills more females than breast and colon cancers combined and more males than colon and prostate cancers combined. The type of lung cancer has changed in recent decades and adenocarcinoma has become the most frequent cell type. Prognosis of lung cancer depends upon the cell type and the staging at the time of diagnosis. The cell type and molecular characteristics of adenocarcinoma may allow individualized targeted treatment. Other malignant conditions in the mediastinum and lung (eg, metastatic lung cancers and lymphoma) can be biopsied using endobronchial ultrasound needles. Endobronchial ultrasound needle biopsies provides mostly cytology specimens due to its small sizes of needles (22 gauge or larger) which may not give enough tissue to make a definitive diagnosis in malignant (eg, lymphoma) or benign conditions (eg, sarcoidosis). EchoTip ProCore endobronchial needle released in early 2014 provides histologic biopsy material. Larger tissue biopsies may potentially provide a higher diagnostic yield and it eliminates mediastinoscopy or other surgical interventions. Here we aim to review bronchoscopic approach in the diagnosis of mediastinal lesions with emphasis of EchoTip ProCore needles.
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Affiliation(s)
- H Erhan Dincer
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Rafael Andrade
- Section of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Felix Zamora
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Eitan Podgaetz
- Section of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
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17
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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18
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Fernández-Villar A, Mouronte-Roibás C, Botana-Rial M, Ruano-Raviña A. Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness. Arch Bronconeumol 2015; 52:96-102. [PMID: 26565072 DOI: 10.1016/j.arbres.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022]
Abstract
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.
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Affiliation(s)
- Alberto Fernández-Villar
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España.
| | - Cecilia Mouronte-Roibás
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Maribel Botana-Rial
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España; CIBER de Epidemiología y Salud Pública, CIBERESP, España
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19
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Dietrich CF, Annema JT, Clementsen P, Cui XW, Borst MM, Jenssen C. Ultrasound techniques in the evaluation of the mediastinum, part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques. J Thorac Dis 2015; 7:E311-25. [PMID: 26543620 DOI: 10.3978/j.issn.2072-1439.2015.09.40] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christoph Frank Dietrich
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Jouke Tabe Annema
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Paul Clementsen
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Xin Wu Cui
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Mathias Maximilian Borst
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Christian Jenssen
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
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Li P, Zheng W, Zhao L. Convex probe endobronchial ultrasound: applications beyond conventional indications. J Thorac Dis 2015; 7:E289-97. [PMID: 26543618 DOI: 10.3978/j.issn.2072-1439.2015.09.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is maturing and gaining acceptance by more and more clinicians for lymph node staging of lung cancer and diagnosis of mediastinal and hilar masses or lymph node enlargement by convex probe endobronchial ultrasound (CP-EBUS). The application of CP-EBUS, however, is not limited to conventional indications. Diagnostically, elastography is a new technology for the differentiation of benign and malignant lymph nodes before aspiration. CP-EBUS can also be used for pulmonary vascular diseases, such as pulmonary embolism (PE) and non-thrombotic endovascular lesions (NELs). Therapeutically, CP-EBUS can be used for cyst drainage and drug injections. CP-EBUS is not limited to observation and aspiration of mediastinal masses and lymph nodes, but is also suitable for exploration of other tissues external to the central airway, which necessitates unprecedented skills for the bronchoscopist.
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Affiliation(s)
- Peng Li
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Zheng
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Li Zhao
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
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