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Fjaellegaard K, Koefod Petersen J, Alstrup G, Skaarup S, Frost Clementsen P, Laursen CB, Bhatnagar R, Bodtger U. Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion. Eur Clin Respir J 2024; 11:2337446. [PMID: 38711600 PMCID: PMC11073413 DOI: 10.1080/20018525.2024.2337446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Background In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage. Methods In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1. Results In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42-10.50), p = 0.01 and 2.86 (1.03-7.93), p = 0.04, respectively). Conclusions In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.
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Affiliation(s)
- Katrine Fjaellegaard
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Jesper Koefod Petersen
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Gitte Alstrup
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Søren Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Uffe Bodtger
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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Cold KM, Xie S, Nielsen AO, Clementsen PF, Konge L. Artificial Intelligence Improves Novices' Bronchoscopy Performance: A Randomized Controlled Trial in a Simulated Setting. Chest 2024; 165:405-413. [PMID: 37619664 DOI: 10.1016/j.chest.2023.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Navigating through the bronchial tree and visualizing all bronchial segments is the initial step toward learning flexible bronchoscopy. A novel bronchial segment identification system based on artificial intelligence (AI) has been developed to help guide trainees toward more effective training. RESEARCH QUESTION Does feedback from an AI-based automatic bronchial segment identification system improve novice bronchoscopists' end-of-training performance? STUDY DESIGN AND METHODS The study was conducted as a randomized controlled trial in a standardized simulated setting. Novices without former bronchoscopy experience practiced on a mannequin. The feedback group (n = 10) received feedback from the AI, and the control group (n = 10) trained according to written instructions. Each participant decided when to end training and proceed to performing a full bronchoscopy without any aids. RESULTS The feedback group performed significantly better on all three outcome measures (median difference, P value): diagnostic completeness (3.5 segments, P < .001), structured progress (13.5 correct progressions, P < .001), and procedure time (-214 seconds, P = .002). INTERPRETATION Training guided by this novel AI makes novices perform more complete, more systematic, and faster bronchoscopies. Future studies should examine its use in a clinical setting and its effects on more advanced learners.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark.
| | - Sujun Xie
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark; Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China
| | - Anne Orholm Nielsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark; Herlev University Hospital, Department of Pulmonary Diseases, Herlev, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark
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Petersen JK, Fjaellegaard K, Rasmussen DB, Alstrup G, Høegholm A, Sidhu JS, Sivapalan P, Gerke O, Bhatnagar R, Clementsen PF, Laursen CB, Bodtger U. Ultrasound in the Diagnosis of Non-Expandable Lung: A Prospective Observational Study of M-Mode, B-Mode, and 2D-Shear Wave Elastography. Diagnostics (Basel) 2024; 14:204. [PMID: 38248080 PMCID: PMC10813923 DOI: 10.3390/diagnostics14020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Non-expandable lung (NEL) has severe implications for patient symptoms and impaired lung function, as well as crucial implications for the management of malignant pleural effusion (MPE). Indwelling pleural catheters have shown good symptom relief for patients with NEL; hence, identifying patients early in their disease is vital. With the inability of the lung to achieve pleural apposition following thoracentesis and the formation of a hydropneumothorax, traditionally, chest X-ray and clinical symptoms have been used to make the diagnosis following thoracentesis. It is our aim to investigate whether ultrasound measurement of lung movement during respiration can predict NEL before thoracentesis, thereby aiding clinicians in their planning for the optimal treatment of affected patients. METHODS A total of 49 patients were consecutively included in a single-centre trial performed at a pleural clinic. Patients underwent protocolled ultrasound assessment pre-thoracentesis with measurements of lung and diaphragm movement and shear wave elastography measurements of the pleura and pleural effusion at the planned site of thoracentesis. RESULTS M-mode measurements of lung movement provided the best diagnostic ROC-curve results, with an AUC of 0.81. Internal validity showed good results utilising the calibration belt test and Brier test. CONCLUSION M-mode measurement of lung movement shows promise in diagnosing NEL before thoracentesis in patients with known or suspected MPE. A validation cohort is needed to confirm the results.
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Affiliation(s)
- Jesper Koefod Petersen
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Katrine Fjaellegaard
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Daniel B. Rasmussen
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Gitte Alstrup
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
| | - Asbjørn Høegholm
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
| | - Jatinder Singh Sidhu
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark;
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol BS8 1TU, UK;
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, 2100 Copenhagen, Denmark;
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark;
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit, Department of Internal and Respiratory Medicine, Zealand University Hospital, 4000 Roskilde, Denmark; (J.K.P.); (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
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Bodtger U, Porcel JM, Bhatnagar R, Maskell N, Munavvar M, Jensen C, Clementsen PF, Rasmussen DB. Erratum: Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion. J Vis Exp 2024. [PMID: 38691626 DOI: 10.3791/6587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
An erratum was issued for: Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion. The Authors section was updated from: Uffe Bodtger1,2 José M. Porcel3 Rahul Bhatnagar4,5 Mohammed Munavvar6,7 Casper Jensen1 Paul Frost Clementsen1,8 Daniel Bech Rasmussen1,2 1Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital 2Institute of Regional Health Research, University of Southern Denmark 3Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida 4Respiratory Department, Southmead Hospital, North Bristol NHS Trust 5Academic Respiratory Unit, University of Bristol 6Lancashire Teaching Hospitals 7University of Central Lancashire 8Centre for HR and Education, Copenhagen Academy for Medical Education and Simulation to: Uffe Bodtger1,2 José M. Porcel3 Rahul Bhatnagar4,5 Nick Maskell4,5 Mohammed Munavvar6,7 Casper Jensen1 Paul Frost Clementsen1,8 Daniel Bech Rasmussen1,2 1Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital 2Institute of Regional Health Research, University of Southern Denmark 3Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida 4Respiratory Department, Southmead Hospital, North Bristol NHS Trust 5Academic Respiratory Unit, University of Bristol 6Lancashire Teaching Hospitals 7University of Central Lancashire 8Centre for HR and Education, Copenhagen Academy for Medical Education and Simulation.
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Affiliation(s)
- Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital; Institute of Regional Health Research, University of Southern Denmark;
| | - José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida
| | - Rahul Bhatnagar
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust; Academic Respiratory Unit, University of Bristol
| | - Nick Maskell
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust; Academic Respiratory Unit, University of Bristol
| | | | - Casper Jensen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital
| | - Paul Frost Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital; Centre for HR and Education, Copenhagen Academy for Medical Education and Simulation
| | - Daniel Bech Rasmussen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital; Institute of Regional Health Research, University of Southern Denmark
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5
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Bodtger U, Porcel JM, Bhatnagar R, Munavvar M, Jensen C, Clementsen PF, Rasmussen DB. Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion. J Vis Exp 2023. [PMID: 38009737 DOI: 10.3791/65734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Local anesthetic thoracoscopy (LAT) is a minimally invasive diagnostic procedure gaining recognition among chest physicians for managing undiagnosed pleural effusions. This single-port procedure is conducted with the patient under mild sedation and involves a contralateral decubitus position. It is performed in a sterile setting, typically a bronchoscopy suite or surgical theater, by a single operator with support from a procedure-focused nurse and a patient-focused nurse. The procedure begins with a thoracic ultrasound to determine the optimal entry point, usually in the IV-V intercostal space along the midaxillary line. Lidocaine/mepivacaine, with or without adrenaline, is used to anesthetize the skin, thoracic wall layers, and parietal pleura. A designated trocar and cannula are inserted through a 10 mm incision, reaching the pleural cavity with gentle rotation. The thoracoscope is introduced through the cannula for systematic inspection of the pleural cavity from the apex to the diaphragm. Biopsies (typically six to ten) of suspicious parietal pleura lesions are obtained for histopathological evaluation and, when necessary, microbiological analysis. Biopsies of the visceral pleura are generally avoided due to the risk of bleeding or air leaks. Talc poudrage may be performed before inserting a chest tube or indwelling pleural catheter through the cannula. The skin incision is sutured, and intrapleural air is removed using a three-compartment or digital chest drainage system. The chest tube is removed once there is no airflow, and the lung has satisfactorily re-expanded. Patients are usually discharged after 2-4 h of observation and followed up on an outpatient basis. Successful LAT relies on careful patient selection, preparation, and management, as well as operator education, to ensure safety and a high diagnostic yield.
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Affiliation(s)
- Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital; Institute of Regional Health Research, University of Southern Denmark;
| | - José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida
| | - Rahul Bhatnagar
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust; Academic Respiratory Unit, University of Bristol
| | | | - Casper Jensen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital
| | - Paul Frost Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital; Centre for HR and Education, Copenhagen Academy for Medical Education and Simulation
| | - Daniel Bech Rasmussen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital; Institute of Regional Health Research, University of Southern Denmark
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Nielsen AO, Cold KM, Vamadevan A, Konge L, Clementsen PF. Systematic Endobronchial Ultrasound - The Six Landmarks Approach. J Vis Exp 2023. [PMID: 37590526 DOI: 10.3791/65551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Lung cancer is the leading cause of cancer mortality globally. To ensure the correct diagnosis and staging in relation to treatment options, it is crucial to obtain valid biopsies from suspected tumors and mediastinal lymph nodes and accurate identification of the mediastinal lymph nodes regarding the Tumor-Node-Metastasis (TNM)-classification. Flexible bronchoscopy combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is essential in the workup and diagnosis of patients suspected of lung cancer. EBUS-TBNA from mediastinal lymph nodes is a technically difficult procedure and has been identified as one of the most important procedures that should be integrated into a simulation-based training program for invasive pulmonologists. More specific guidelines that govern training in EBUS-TBNA are needed to meet this demand. We hereby propose a systematic, stepwise approach with specific attention to six landmarks that support the endoscopist when navigating through the bronchial maze. The stepwise approach relying on the six landmarks is used in the EBUS-certified training program offered by the European Respiratory Society (ERS).
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Affiliation(s)
- Anne Orholm Nielsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen;
| | - Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen
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Christiansen IS, Bodtger U, Nessar R, Salih GN, Kolekar S, Sidhu JS, Høegholm A, Laursen CB, Arshad A, Clementsen PF. Safety and feasibility of oesophageal ultrasound for the work-up of thoracic malignancy in patients with respiratory impairment. J Thorac Dis 2023; 15:3965-3973. [PMID: 37559642 PMCID: PMC10407489 DOI: 10.21037/jtd-22-1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/02/2023] [Indexed: 08/11/2023]
Abstract
Biopsying lung tumours with endobronchial access in patients with respiratory impairment is challenging. However, fine needle aspiration with the endobronchial ultrasound-endoscope via the oesophagus (EUS-B-FNA) makes it possible to obtain tissue samples without entering the airways. Safety of EUS-B-FNA in these patients has not earlier been investigated prospectively. Therefore, this study aimed at assessing feasibility and safety of EUS-B-FNA from centrally located tumours suspected of thoracic malignancy in patients with respiratory insufficiency. The study is a prospective observational study. Patients with indication of EUS-B-FNA of centrally located tumours and respiratory impairment defined as modified Medical Research Council (mMRC) dyspnoea scale score of ≥3, saturation ≤90% or need of continuous oxygen supply were included prospectively in three centres. Any adverse events (AEs) were recorded during procedure and 1-hour recovery. AEs were defined as hypoxemia (saturation <90% or need for increased oxygen supply) or any kind of events needing intervention. Late procedure-related events were recorded during 30-day follow-up. Between April 1, 2020 and January 30, 2021, 16 patients were included. No severe AEs (SAEs) occurred, but AEs were seen in 50% (n=8) and 13% (n=2) of the patients during procedure and recovery respectively. AEs included hypoxemia corrected with increased oxygen supply and in two cases reversal of sedation. Late procedure-related events were seen in 13% (n=2) and included prolonged need of oxygen and one infection treated with oral antibiotics. In this cohort, EUS-B-FNA of centrally located tumours was safe and feasible in patients with respiratory impairment, when examined in the bronchoscopy suite. A variety of mostly mild and manageable complications may occur, a few even up to 30 days post-procedure.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 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
| | - Shailesh Kolekar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Jatinder Sing Sidhu
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Asbjørn Høegholm
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
| | - Christian B. Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Arman Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Paul Frost Clementsen
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
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8
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Cold KM, Vamadevan A, Nielsen AO, Konge L, Clementsen PF. Systematic Bronchoscopy: the Four Landmarks Approach. J Vis Exp 2023. [PMID: 37427954 DOI: 10.3791/65358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a simulation-based training program for pulmonologists. However, more specific guidelines that govern bronchoscopy training are needed to meet this demand. To ensure patients a competent examination, we propose a systematic, stepwise approach, splitting the procedure into four "landmarks" to support novice endoscopists navigating the bronchial maze. The procedure can be evaluated based on three established outcome measures to ensure a thorough and effective inspection of the bronchial tree: diagnostic completeness, structured progress, and procedure time. The stepwise approach relying on the four landmarks is used at all simulation centers in Denmark and is being implemented in the Netherlands. To provide instant feedback to novice bronchoscopists when training and to relieve time constraints from consultants, we suggest that future studies should implement artificial intelligence as a feedback and certification tool when training new bronchoscopists.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark;
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark
| | - Anne Orholm Nielsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark; Department of Pulmonary Medicine, Bispebjerg Hospital
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen and the Capital Region of Denmark
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Fjaellegaard K, Petersen JK, Clementsen PF, Laursen CB, Bhatnagar R, Bodtger U. Additional Up-Front Thoracic Ultrasound in the Workup of Patients with Unilateral Pleural Effusion: A Prospective Observational Pilot Study. Respiration 2023:1-9. [PMID: 37062275 DOI: 10.1159/000529871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND In patients with pleural effusion, specific ultrasound characteristics are associated with pleural malignancy. OBJECTIVES This study aimed to evaluate the added value of an additional, up-front, systematic thoracic ultrasound (TUS) to standard imaging in patients with unilateral pleural effusion of unknown cause in a clinical setting. METHODS In a prospective observational pilot study, patients referred for workup and thoracentesis of a unilateral pleural effusion received up-front TUS following a set protocol in addition to available imaging and US guiding the thoracentesis or diagnostic puncture. The primary outcome was the proportion of cases where systematic TUS changed the planned diagnostic workup. Follow-up took place 26 weeks after inclusion. RESULTS From February to December 2020, 55 patients were included. Thirty-six (65%) patients had other chest imaging available before TUS. Twenty-one (38%) were diagnosed with malignant pleural effusion. Three patients (5%) had clinically relevant changes in the diagnostic workup after additional systematic TUS. CONCLUSIONS Additional up-front, systematic TUS had limited clinically relevant effect on the planned diagnostic workup in patients with unilateral pleural effusion in a setting where chest CT scans often are available at referral.
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Affiliation(s)
- Katrine Fjaellegaard
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde/Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde/Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde/Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Fjaellegaard K, Petersen JK, Rasmussen DB, Clementsen PF, Laursen CB, Bhatnagar R, Bodtger U. Prediction of Time to Next Therapeutic Thoracentesis and Identification of Risk Factors of Rapid Pleural Fluid Recurrence: A Prospective Observational Study. Respiration 2023:1-8. [PMID: 36843012 DOI: 10.1159/000528558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/24/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The value of pre-booked repeated thoracentesis in patients with recurrent pleural effusion is reliant on the estimation of time to next drainage. Identifying factors associated with rapid pleural fluid recurrence could be supportive. OBJECTIVE We aimed to evaluate the ability of the patient and physician to predict the time to next therapeutic thoracentesis and to identify characteristics associated with rapid pleural fluid recurrence. METHOD In a prospective, observational study, patients with recurrent unilateral pleural effusion and the physician were to predict the time to next symptom-guided therapeutic thoracentesis. Primary outcome was difference between days to actual thoracentesis and days predicted by the patient and the physician. Factors associated with pleural fluid recurrence within 60-day follow-up were assessed using Cox regression analysis. RESULTS A total of 98 patients were included, 71% with malignant pleural effusion. Patients' and physicians' predictions numerically deviated by 6 days from the actual number of days to re-thoracentesis (IQR 2-12 and 2-13, respectively). On multivariate analyses, factors associated with increased hazard of pleural fluid recurrence included daily fluid production (HR 1.35 [1.16-1.59], p > 0.001) and large effusion size (HR 2.76 [1.23-6.19], p = 0.01). Septations were associated with decreased hazard (HR 0.48 [0.24-0.96], p = 0.04). CONCLUSION Patients and physicians were equally unable to predict the time to next therapeutic thoracentesis. Daily fluid production and large effusion size were associated with increased risk of rapid pleural fluid recurrence, while septations were associated with a decreased risk. This may guide patients and physicians in when to expect a need for therapeutic thoracentesis.
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Affiliation(s)
- Katrine Fjaellegaard
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Daniel Beck Rasmussen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Paul Frost Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Academic Respiratory Unit, University of Bristol, Bristol, UK.,Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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11
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Andersen AG, Rahmoui L, Dalsgaard TS, Svendsen MBS, Clementsen PF, Konge L, Bjerrum F. Preparing for Reality: A Randomized Trial on Immersive Virtual Reality for Bronchoscopy Training. Respiration 2023; 102:316-323. [PMID: 36796339 DOI: 10.1159/000528319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Bronchoscopy is an essential procedure in the diagnosis and treatment of pulmonary diseases. However, the literature suggests that distractions affect the quality of bronchoscopy and affect inexperienced doctors more than experienced. OBJECTIVES The objective of the study was as follows: does simulation-based bronchoscopy training with immersive virtual reality (iVR) improve the doctors' ability to handle distractions and thereby increase the quality, measured in procedure time, structured progression score, diagnostic completeness (%), and hand motor movements of a diagnostic bronchoscopy in a simulated scenario. Exploratory outcomes were heart rate variability and a cognitive load questionnaire (Surg-TLX). METHODS Participants were randomized. The intervention group practiced in an iVR environment with a head-mounted display (HMD) while using the bronchoscopy simulator, while the control group trained without the HMD. Both groups were tested in the iVR environment using a scenario with distractions. RESULTS 34 participants completed the trial. The intervention group scored significantly higher in diagnostic completeness (100 i.q.r. 100-100 vs. 94 i.q.r. 89-100, p value = 0.03) and structured progress (16 i.q.r. 15-18 vs. 12 i.q.r. 11-15, p value 0.03) but not in procedure time (367 s standard deviation [SD] 149 vs. 445 s SD 219, p value = 0.06) or hand motor movements (-1.02 i.q.r. -1.03-[-1.02] versus -0.98 i.q.r. -1.02-[-0.98], p value = 0.27). The control group had a tendency toward a lower heart rate variability (5.76 i.q.r. 3.77-9.06 vs. 4.12 i.q.r. 2.68-6.27, p = 0.25). There was no significant difference in total Surg-TLX points between the two groups. CONCLUSION iVR simulation training increases the quality of diagnostic bronchoscopy in a simulated scenario with distractions compared with conventional simulation-based training.
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Affiliation(s)
- Annarita Ghosh Andersen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Surgery, National Hospital of the Faroe Islands, Tórshavn, Faeroe Islands
| | - Laila Rahmoui
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Tor-Salve Dalsgaard
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Computer Science DIKU, University of Copenhagen, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Respiratory Research Unit PLUZ, Zealand University Hospital Roskilde/Naestved, Roskilde, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Computer Science DIKU, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Ahmadzai S, Koefod Petersen J, Fjaellegaard K, Frost Clementsen P, Bodtger U. Suspected Lung Cancer with Suspicious Liver Lesions: Diagnostic Yield and Safety of Same-Day Bronchoscopy and Liver Biopsy in the Hands of a Pulmonologist. Adv Respir Med 2023; 91:11-17. [PMID: 36825937 PMCID: PMC9951995 DOI: 10.3390/arm91010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Bronchoscopy and endobronchial ultrasound (EBUS) are standard procedures for the diagnosis and staging of patients suspected of lung cancer. If the patient simultaneously presents with suspicious liver lesions, it is tradition to refer the patient to a radiologist for ultrasound-guided percutaneous liver biopsy. OBJECTIVE The aim of this study was to investigate the results and complications when the pulmonologist performs all three procedures in the same setting. METHODS We retrospectively identified patients who during 2018-2020 underwent invasive workup of suspected lung cancer and liver metastases with percutaneous liver lesion biopsy with or without same-day endoscopy (bronchoscopy and EBUS). We compared diagnostic yield and safety of liver lesion biopsy stratified by same-day endoscopy or not. RESULTS In total, 89 patients were included, of whom 28 patients (31%) underwent same-day endoscopy. All liver lesion biopsies were fine-needle aspiration biopsies performed by experienced pulmonologists. No complications were reported, and overall diagnostic yield was 88%. The diagnostic yield was significantly lower in the same-day endoscopy group (71% vs. 95%), and undergoing endoscopy was significantly associated with having fewer liver lesions, higher prevalence of lung cancer, and lower overall prevalence of a malignant diagnosis. CONCLUSION Liver biopsy in the same session as endoscopy during lung cancer workup was feasible and safe. Confounding by indication was present in our study.
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Affiliation(s)
- Sina Ahmadzai
- Institute of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Correspondence:
| | - Jesper Koefod Petersen
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Katrine Fjaellegaard
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Paul Frost Clementsen
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), 2100 Copenhagen, Denmark
| | - Uffe Bodtger
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
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13
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Issa MA, Sidhu JS, Tehrani SG, Clementsen PF, Bodtger U. Endoscopic ultrasound-guided pancreas biopsy in the hands of a chest physician. Respir Med Case Rep 2023; 43:101833. [PMID: 36942163 PMCID: PMC10024129 DOI: 10.1016/j.rmcr.2023.101833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
This is the first paper to report sampling of pancreatic lesions by EUS-B-FNA. A 76 year old patient suspected of primary lung cancer presented with a 36 × 24 mm lesion in the pancreas. Thoracentesis showed malignant cells suggestive of mucinous adenocarcinoma, but immunohistochemistry was inconclusive. Due to rapid deterioration of performance status of this frail patient, the program was shortened to EUS-B-FNA of the pancreatic lesion, which showed mucinous adenocarcinoma suggestive of primary pancreatic cancer. We conclude that EUS-B-FNA from a pancreatic lesion in the hands of a chest physician is feasible and diagnostic of a tumor in pancreas.
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Affiliation(s)
- Mohammad Ahmad Issa
- Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital in Roskilde & Næstved, Denmark
- Corresponding author. Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital Næstved, 61 Ringstedgade, DK-4700, Næstved, Denmark.
| | - Jatinder Singh Sidhu
- Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital in Roskilde & Næstved, Denmark
| | | | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Uffe Bodtger
- Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital in Roskilde & Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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14
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Toennesen LL, Vindum HH, Risom E, Pulga A, Nessar RM, Arshad A, Christophersen A, Park YS, Cold KM, Konge L, Clementsen PF. When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield? Diagnostics (Basel) 2022; 12:diagnostics12123127. [PMID: 36553134 PMCID: PMC9777088 DOI: 10.3390/diagnostics12123127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Predicting factors of diagnostic yield in electromagnetic navigation bronchoscopy (ENB) have been explored in a number of previous studies based on data from experienced operators. However, little is known about predicting factors when the procedure is carried out by operators in the beginning of their learning curve. We here aim to identify the role of operators' experience as well as lesion- and procedure characteristics on diagnostic yield of ENB procedures in the hands of novice ENB operators. Four operators from three centers without prior ENB experience were enrolled. The outcome of consecutive ENB procedures was assessed and classified as either diagnostic or non-diagnostic and predicting factors of diagnostic yield were assessed. A total of 215 procedures were assessed. A total of 122 (57%) of the ENB procedures resulted in diagnostic biopsies. Diagnostic ENB procedures were associated with a minor yet significant difference in tumor size compared to non-diagnostic/inconclusive ENB procedures (28 mm vs. 24 mm; p = 0.03). Diagnostic ENB procedures were associated with visible lesions at either fluoroscopy (p = 0.003) or radial endobronchial ultrasound (rEBUS), (p = 0.001). In the logistic regression model, lesion visibility on fluoroscopy, but none of operator experience, the presence of a bronchus sign, lesion size, or location nor visibility on rEBUS significantly impacted the diagnostic yield. In novice ENB operators, lesion visibility on fluoroscopy was the only factor found to increase the chance of obtaining a diagnostic sample.
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Affiliation(s)
- Louise L. Toennesen
- Department of Pulmonary Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Helene H. Vindum
- Department of Onchology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Ellen Risom
- Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Alexis Pulga
- Department of Pulmonary Medicine, Bispebjerg University Hospital, 2400 Copenhagen, Denmark
| | - Rafi M. Nessar
- Department of Pulmonary Medicine, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Arman Arshad
- Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Alice Christophersen
- Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Yoon Soo Park
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Kristoffer Mazanti Cold
- Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, 1165 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-38623862
| | - Lars Konge
- Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, 1165 Copenhagen, Denmark
| | - Paul Frost Clementsen
- Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, 1165 Copenhagen, Denmark
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15
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Bugalho A, Guedes F, Freitas F, Rodrigues LV, Clementsen PF, Eberhardt R, Cepeda Ribeiro J. LINEAR ENDOSONOGRAPHY IN LUNG CANCER: A COMPREHENSIVE REVIEW. Port J Card Thorac Vasc Surg 2022; 29:35-43. [PMID: 35471220 DOI: 10.48729/pjctvs.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
The role of endobronchial ultrasound (EBUS) and trans-esophageal endobronchial ultrasound (EUS-B) in lung cancer is well established and scientifically validated. There is increasing data that endosonography is a crucial tool for the diagnosis of central lung lesions, and mediastinal staging and restaging of non-small cell lung cancer patients. The present article reviews the technical aspects of EBUS and EUS-B and focus on the last published research regarding its value in lung cancer.
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Affiliation(s)
- Antonio Bugalho
- Pulmonology Unit, CUF Tejo Hospital, Lisbon, Portugal; Pulmonology Unit, CUF Descobertas Hospital, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Lisbon, Portugal
| | - Fernando Guedes
- Pulmonology Department, Centre Hospitalier de Luxembourg, Luxembourg
| | - Francisco Freitas
- Pulmonology Unit, CUF Tejo Hospital, Lisbon, Portugal; Pulmonology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Luis Vaz Rodrigues
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | | | - Ralf Eberhardt
- Pulmonology and Intensive Care Medicine Department, Asklepios KlinikBarmbek, Hamburg, Germany
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16
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Kolekar S, Gudmundsdottir K, Olsen KE, Sivapalan P, Clementsen PF, Bodtger U. Adult pulmonary blastoma in an adult with urothelial cancer: A case report. Respir Med Case Rep 2021; 34:101556. [PMID: 34820260 PMCID: PMC8600148 DOI: 10.1016/j.rmcr.2021.101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Pulmonary blastoma is an aggressive lung cancer with incidence ranging from 0.25–0.5 of all the reported lung cancers. Although, pulmonary blastoma is seen commonly in childhood its very rare in adults. Surgical treatment is often the treatment of choice, but benefits of neoadjuvant chemotherapy are unclear. People with DICER1 syndrome commonly develop Pulmonary blastoma and do have concomitant or previous history of benign or malignant tumours in extra pulmonary site like kidney, thyroid, ovary cervix testicle and eye. As per our knowledge, this is the first case of adult pulmonary blastoma previously diagnosed with urothelial cancer and a strong familial predilection of malignancy, with negative genetic test for DICER1 mutations.
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Affiliation(s)
- Shailesh Kolekar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | - Karen Ege Olsen
- Department of Pathology, Odense University Hospital, Denmark
| | - Pradeesh Sivapalan
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Corresponding author. Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
- University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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17
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Fjaellegaard K, Koefod Petersen J, Andersen G, Biagini M, Bhatnagar R, Laursen CB, Clementsen PF, Bodtger U. The prevalence of tumour markers in malignant pleural effusions associated with primary pulmonary adenocarcinoma: a retrospective study. Eur Clin Respir J 2021; 8:1984375. [PMID: 34745460 PMCID: PMC8567952 DOI: 10.1080/20018525.2021.1984375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Oncological treatment of primary pulmonary adenocarcinoma (AC) includes drugs targeting the pathways involving programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK). The aim of the study was to report the prevalence of these tumour markers in pleural fluid with cytology positive for pulmonary AC and the potential influence of volume pleural fluid tested. Methods We retrospectively reviewed all thoracenteses performed in a two-year period at our interventional unit at Department of Respiratory Medicine at Zealand University Hospital Naestved, Denmark. ALK and PD-L1 testing was done using immunohistochemistry and EGFR testing using next-generation sequencing. We included pleural fluid specimens containing malignant cells originating from primary pulmonary AC and with at least one tumour marker requested by the clinicians. Results When screening 927 pleural fluid specimens, we identified 57 in accordance with the inclusion criteria. PD-L1, ALK and EGFR were obtained in 35/55 (64%), 38/57 (67%) and 26/47 (55%), respectively. The prevalence did not increase when analysing volumes > 50 mL (p = 0.21–0.58) Conclusion Tumour markers in pleural fluid specimens containing cells from pulmonary AC can be demonstrated in more than half of the cases. Therefore, supplementary invasive procedures than thoracentesis could potentially await these analyses.
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Affiliation(s)
- Katrine Fjaellegaard
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Gitte Andersen
- Department of Pathology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Matteo Biagini
- Department of Pathology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Rahul Bhatnagar
- Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, 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 Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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18
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Nayahangan LJ, Svendsen MBS, Bodtger U, Rahman N, Maskell N, Sidhu JS, Lawaetz J, Clementsen PF, Konge L. Assessment of competence in local anaesthetic thoracoscopy: development and validity investigation of a new assessment tool. J Thorac Dis 2021; 13:3998-4007. [PMID: 34422330 PMCID: PMC8339737 DOI: 10.21037/jtd-20-3560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 12/03/2022]
Abstract
Background The aims of the study were to develop an assessment tool in local anaesthetic thoracoscopy (LAT), investigate validity evidence, and establish a pass/fail standard. Methods Validity evidence for the assessment tool was gathered using the unified Messick framework. The tool was developed by five experts in respiratory medicine and medical education. Doctors with varying experience performed two consecutive procedures in a standardized, simulation-based setting using a newly developed thorax/lung silicone model. Performances were video-recorded and assessed by four expert raters using the new tool. Contrasting groups’ method was used to set a pass/fail standard. Results Nine novices and 8 experienced participants were included, generating 34 recorded performances and 136 expert assessments. The tool had a high internal consistency (Cronbach’s alpha =0.94) and high inter-rater reliability (Cronbach’s alpha =0.91). The total item score significantly correlated with the global score (rs=0.86, P<0.001). Participants’ first performance correlated to second performance (test-retest reliability) with a Pearson’s r of 0.93, P<0.001. Generalisability (G) study showed a G-coefficient of 0.92 and decision (D) study estimated that one performance assessed by two raters or four performances assessed by one rater are needed to reach an acceptable reliability, i.e., G-coefficient >0.80. The tool was able to discriminate between the two groups in both performances: experienced mean score =30.8±4.2; novice mean score =15.8±2.3, P<0.001. Pass/fail standard was set at 22 points. Conclusions The newly developed assessment tool showed solid evidence of validity and can be used to ensure competence in LAT.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal and Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Najib Rahman
- Nuffield Department of Medicine, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Jonathan Lawaetz
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal and Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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19
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Clementsen PF, Bodtger U, Konge L, Christiansen IS, Nessar R, Salih GN, Kolekar S, Meyer CN, Colella S, Jenssen C, Herth F, Hocke M, Dietrich CF. Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide. Endosc Ultrasound 2021; 10:325-334. [PMID: 33666182 PMCID: PMC8544013 DOI: 10.4103/eus-d-20-00139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, medical or multimodal treatment. EUS and endobronchial ultrasound (EBUS) have gained ground in the diagnosis and staging of lung cancer in addition to radiological imaging (e.g., computed tomography, fluoroscopy, and magnetic resonance imaging), nuclear medicine techniques (e.g. positron emission tomography, PET), combined techniques (e.g., fluorodesoxyglucosepositron emission tomography scanning), and sonographic imaging including conventional transcutaneous mediastinal and lung ultrasound. By using one single echoendoscope in both the trachea and the esophagus, surgical staging procedures (e.g. mediastinoscopy and video assisted thoracoscopy) can be avoided in a considerable proportion of patients with NSCLC.
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Affiliation(s)
- Paul Frost Clementsen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Respiratory Medicine, Næstved Hospital, Næstved; Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ida Skovgaard Christiansen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rafi Nessar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Shailesh Kolekar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Christian Niels Meyer
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sara Colella
- Pulmonology Unit, "C.G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg; Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg Heidelberg, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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20
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Cold KM, Svendsen MBS, Bodtger U, Nayahangan LJ, Clementsen PF, Konge L. Automatic and Objective Assessment of Motor Skills Performance in Flexible Bronchoscopy. Respiration 2021; 100:347-355. [PMID: 33550311 DOI: 10.1159/000513433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Motor skills have been identified as a useful measure to evaluate competency in bronchoscopy. However, no automatic assessment system of motor skills with a clear pass/fail criterion in flexible bronchoscopy exists. OBJECTIVES The objective of the study was to develop an objective and automatic measure of motor skills in bronchoscopy and set a pass/fail criterion. METHODS Participants conducted 3 bronchoscopies each in a simulated setting. They were equipped with a Myo Armband that measured lower arm movements through an inertial measurement unit, and hand and finger motions through electromyography sensors. These measures were composed into an objective and automatic composite score of motor skills, the motor bronchoscopy skills score (MoBSS). RESULTS Twelve novices, eleven intermediates, and ten expert bronchoscopy operators participated, resulting in 99 procedures available for assessment. MoBSS was correlated with a higher diagnostic completeness (Pearson's correlation, r = 0.43, p < 0.001) and a lower procedure time (Pearson's correlation, r = -0.90, p < 0.001). MoBSS was able to differentiate operator performance based on the experience level (one-way ANOVA, p < 0.001). Using the contrasting groups' method, a passing score of -0.08 MoBSS was defined that failed 30/36 (83%) novice, 5/33 (15%) intermediate, and 1/30 (3%) expert procedures. CONCLUSIONS MoBSS can be used as an automatic and unbiased assessment tool for motor skills performance in flexible bronchoscopy. MoBSS has the potential to generate automatic feedback to help guide trainees toward expert performance.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark,
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Kolekar S, Fjaellegaard K, Petersen JK, Olsen KE, Clementsen PF, Bodtger U. Asymptomatic pleural thickening with effusion as the only manifestation of
IgG4
‐related disease. Respirol Case Rep 2021; 9:e00663. [PMID: 36225989 PMCID: PMC9531709 DOI: 10.1002/rcr2.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022] Open
Abstract
Immunoglobulin G4 (IgG4)‐related disease is a systemic fibroinflammatory disorder that can affect almost any tissue. Isolated IgG4 pleural disease is a rare manifestation and, when present, is usually described in patients presenting with dyspnoea. We present a case of asymptomatic isolated IgG4 pleural effusion and highlight that IgG4‐related disease should be remembered as a differential diagnosis in patients with pleural effusion and pleural thickening, even if asymptomatic and without any other organ involvement.
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Affiliation(s)
- Shailesh Kolekar
- Department of Internal Medicine Zealand University Hospital Roskilde Denmark
| | - Katrine Fjaellegaard
- Department of Internal Medicine Zealand University Hospital Roskilde Denmark
- Department of Respiratory Medicine Naestved Hospital Naestved Denmark
- Institute of Regional Health Research University of Southern Denmark Odense Denmark
| | - Jesper Koefod Petersen
- Department of Internal Medicine Zealand University Hospital Roskilde Denmark
- Department of Respiratory Medicine Naestved Hospital Naestved Denmark
- Institute of Regional Health Research University of Southern Denmark Odense Denmark
| | - Karen Ege Olsen
- Department of Pathology Odense University Hospital Odense 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 Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Uffe Bodtger
- Department of Internal Medicine Zealand University Hospital Roskilde Denmark
- Department of Respiratory Medicine Naestved Hospital Naestved Denmark
- Institute of Regional Health Research University of Southern Denmark Odense Denmark
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23
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Abstract
Background Flexible bronchoscopy is a core invasive procedure in pulmonary medicine and training in the procedure is mandatory. Diagnostic completeness and procedure time have been identified as useful measures of competence. No outcome measures have been developed regarding navigational path in bronchoscopy to assess whether the bronchial segments have been identified in an arbitrary or structured order. We investigated whether a new outcome measure for structured progression could be used to assess competency in flexible bronchoscopy. Methods The study was designed as a prospective comparative study. Twelve novices, eleven intermediates, and ten expert bronchoscopy operators completed three full bronchoscopies in a simulated setting on a phantom. The following outcome measures were collected through a checklist evaluation by a trained rater: Diagnostic Completeness as amount of visualized bronchial segments, Structured Progress between the bronchial segments in ascending order, and average intersegmental time (AIT). Results The ability to follow a structured ascending path through the bronchial tree correlated with a higher amount of identified bronchial segments (Pearson’s correlation, r=0.62, P<0.001) and a lower AIT (Pearson’s correlation, r=−0.52, P<0.001). Conclusions Operators should advance through the bronchial tree in a structured ascending order to ensure systematic progress with the highest level of diagnostic yield and the lowest procedure time. Structured progression is a useful measure to evaluate competency in flexible bronchoscopy.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark.,Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
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24
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Bødtger U, Christiansen IS, Salih GN, Nessar R, Kolekar S, Meyer C, Høegholm A, Laursen CB, Clementsen PF. [The use of one single echoendoscope in both the trachea and the oesophagus in diagnosing and staging of lung cancer]. Ugeskr Laeger 2020; 182:V06200445. [PMID: 33118498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The use of one single ultrasound echoendoscope in both the trachea (EBUS) and the oesophagus (EUS-B) gives a fast, safe and precise diagnosis and stage of the patient with suspected lung cancer. There is solid evidence for simulator-based training in EBUS concerning safety and diagnostic outcome, but this is currently not an option in EUS-B and needs development. In this review, we recommend evidence-based simulator training and certification in EBUS and when available also in EUS-B before practicing on patients.
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25
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Fjaellegaard K, Petersen JK, Stamp IM, Hoegholm A, Clementsen PF, Bodtger U. Pleural epithelioid hemangioendothelioma mimicking pleural empyema: A case report. Respir Med Case Rep 2020; 31:101194. [PMID: 32837903 PMCID: PMC7434324 DOI: 10.1016/j.rmcr.2020.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Malignant pleural effusion is an important and difficult differential diagnosis to pleural empyema. Epithelioid hemangioendothelioma is an uncommon vascular tumor, which typically occurs in liver, lung or bone. We present an extremely rare case of primary pleural epithelioid hemangioendothelioma mimicking pleural empyema. We conclude, that pleural epithelioid hemangioendothelioma should be kept in mind as a differential diagnosis in patients suspected of empyema.
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Affiliation(s)
- Katrine Fjaellegaard
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inger Merete Stamp
- Department of Pathology, Zealand University Hospital Naestved, Naestved, Denmark
| | - Asbjorn Hoegholm
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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26
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Christiansen IS, Clementsen PF, Petersen JK, Fjaellegaard K, Høegholm A, Bodtger U. Aspiration of Pericardial Effusion Performed with EUS-B-FNA in Suspected Lung Cancer. Respiration 2020; 99:686-689. [PMID: 32726794 DOI: 10.1159/000508844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/20/2020] [Indexed: 01/28/2023] Open
Abstract
Ultrasound-guided needle aspiration via the esophagus using the endobronchial endoscope (EUS-B-FNA) is increasingly being performed by the pulmonologist for the diagnosis of lung cancer, but we have little experience and data available in the literature especially with respect to staging of the disease. We present 2 cases of EUS-B-guided aspiration of malignant pericardial effusion performed in the same setting as bronchoscopy and endobronchial ultrasound. No complications were observed. We conclude that EUS-B-FNA may be safe and efficacious in the evaluation of pericardial effusion during lung cancer workup. Thus, EUS-B-FNA may save time in the diagnostic workup, improve cancer staging, and prevent transthoracic pericardiocentesis.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Naestved, 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 Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Asbjørn Høegholm
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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27
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Naur TMH, Bodtger U, Nessar R, Salih GN, Clementsen PF. Asymptomatic silicone induced granulomatous disease diagnosed by endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA). Respir Med Case Rep 2020; 30:101102. [PMID: 32551219 PMCID: PMC7289761 DOI: 10.1016/j.rmcr.2020.101102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/11/2020] [Accepted: 05/20/2020] [Indexed: 10/25/2022] Open
Abstract
Silicone from ruptured breast implants can cause lung symptoms mimicking cancer. The diagnosis may be established by transbronchial lung biopsy or surgery. We report a case of asymptomatic silicone induced granulomatous reaction in the lungs and mediastinal lymph nodes diagnosed with EBUS-TBNA. We conclude that this differential diagnosis should be kept in mind even in an asymptomatic patients and that EBUS-TBNA should be considered.
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Affiliation(s)
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Naestved, 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
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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28
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Skaarup SH, Clementsen PF, Laursen CB, Folkersen B, Katballe N, Bødtger U. [Medical thoracoscopy in the elucidationof recurrent pleural effusion]. Ugeskr Laeger 2020; 182:V08190443. [PMID: 32285783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Medical thoracoscopy allows the respiratory physician access to inspection and biopsy of the pleura. The method has several names, such as pleuroscopy, non-intubated thoracoscopy and exploratory thoracoscopy, all of which cover the same procedure. The main indication for medical thoracoscopy is the diagnosis of recurrent pleural effusion, where pleural biopsy is needed. Medical thoracoscopy differs from thoracic surgical surgery as patients are sedated rather than in general anaesthesia. This is a review of the state of the art of pulmonological investigations of recurrent pleural effusion and the important role of medical thoracoscopy.
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29
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Christiansen IS, Ahmad K, Bodtger U, Naur TMH, Sidhu JS, Nessar R, Salih GN, Høegholm A, Annema JT, Clementsen PF. EUS-B for suspected left adrenal metastasis in lung cancer. J Thorac Dis 2020; 12:258-263. [PMID: 32274092 PMCID: PMC7139040 DOI: 10.21037/jtd.2020.01.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Several studies have reported the efficacy of esophageal ultrasound-guided fine needle aspiration (EUS-FNA) for the detection of metastases in the left adrenal gland (LAG) in patients with lung cancer. Currently we have only limited evidence based on small studies on the usefulness of EUS-B [endobronchial ultrasound (EBUS) scope into the esophagus] to provide tissue proof of suspected LAG metastases. The objectives of this study are to investigate feasibility, safety and diagnostic yield of EUS-B-FNA in LAG analysis in patients with proven or suspected lung cancer. Methods In two Danish hospitals, a systematic search in the electronic database for patients who underwent EUS-B-FNA of the LAG for suspected or proven lung cancer was performed retrospectively between January 1st, 2015 and December 31st, 2017. Computed tomography (CT), positron emission tomography-CT, endoscopy, pathology and follow-up data were acquired. Results One hundred and thirty-five patients were included; the prevalence of biopsy proven LAG malignancy was 30% (40/135). A total of 87% (117/135) of EUS-B-FNA samples were adequate (i.e., containing adrenal or malignant cells). No complications were observed. Conclusions We present the largest cohort of patients ever reported showing that EUS-B-FNA of the LAG is a safe and feasible procedure and should therefore be used for staging purposes in patients with lung cancer and a suspicious LAG.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Khaliq Ahmad
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Therese Maria Henriette Naur
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Rafi Nessar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Jouke Tabe Annema
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Paul Frost Clementsen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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30
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Sidhu JS, Salte G, Christiansen IS, Naur TMH, Høegholm A, Clementsen PF, Bodtger U. Fluoroscopy guided percutaneous biopsy in combination with bronchoscopy and endobronchial ultrasound in the diagnosis of suspicious lung lesions - the triple approach. Eur Clin Respir J 2020; 7:1723303. [PMID: 32128079 PMCID: PMC7034437 DOI: 10.1080/20018525.2020.1723303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/21/2020] [Indexed: 11/04/2022] Open
Abstract
Flexible bronchoscopy and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) are the pulmonologists´ basic procedures for the biopsy of suspicious lung lesions. If inconclusive, other guiding-modalities for tissue sampling are needed, computed tomography performed by a radiologist, or – if available – radial EBUS or electromagnetic navigation biopsy. We wanted to investigate if same-day X-ray fluoroscopy-guided transthoracic fine-needle aspiration biopsy (F-TTNAB) performed by the pulmonologist immediately after bronchoscopy and EBUS is a feasible alternative. We retrospectively identified consecutive patients in whom F-TTNAB followed a bronchoscopy and EBUS in the same séance. Patients in whom the suspicion of malignancy was invalidated after complete work up were followed for six months to identify false-negative cases. In total 125 patients underwent triple approach (bronchoscopy, EBUS and F-TTNAB) during the same séance. Malignancy was diagnosed in 86 (69%), and 77 of these (90%) were primary lung cancers. The diagnostic yield of F-TTNAB for malignancy was 77%, and sensitivity was 90%. Pneumothorax occurred in 35 (28%) patients, and was administered with pleural drainage in 22 (18% of all patients). No cases of prolonged haemoptysis were observed. The risk of pneumothorax differed insignificantly with lesion size ≤2.0 cm (27%) versus >2.0 cm (29%). We conclude that it is feasible for pulmonologist to perform F-TTNAB immediately after endoscopy as a combined triple approach in a fast-track workup of suspected lung cancer.
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Affiliation(s)
| | - Geir Salte
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Ida Skovgaard Christiansen
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Therese Marie Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Naestved Hospital, Naestved, 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 Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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31
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Nessar R, Toennesen LL, Bodtger U, Christiansen IS, Clementsen PF. Endoscopic ultrasound-guided ascites aspiration in the hands of the chest physician using the EBUS endoscope in the oesophagus. Respir Med Case Rep 2020; 29:100998. [PMID: 31956479 PMCID: PMC6957818 DOI: 10.1016/j.rmcr.2020.100998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background The use of the endobronchial ultrasound (EBUS) scope in the oesophagus, the so-called EUS-B procedure, for the diagnosis and staging of lung cancer is quickly gaining ground. Case presentation We here present a case demonstrating that EUS-B guided aspiration of intraperitoneal fluid (ascites) is possible. This has never been described before. The procedure was performed with the use of a 22 G needle in a 71 years old woman suspected of lung cancer. No complications were seen. Conclusion We hereby demonstrate that EUS-B fine needle aspiration from ascites fluid is feasible and appears to be safe.
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Affiliation(s)
- Rafi Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark
| | - Louise L Toennesen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark.,Department of Pulmonary Medicine, Bispebjerg University Hospital, 2400, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, 4700, Naestved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
| | | | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, 2100, Copenhagen, University of Copenhagen and the Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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Sidhu JS, Salte G, Christiansen IS, Naur T, Hoeegholm A, Clementsen PF, Bodtger U. Fluoroscopy guided percutaneous biopsy in combination with bronchoscopy and endobronchial ultrasound in the diagnosis of suspicious lung lesions – the triple approach. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Christiansen IS, Bodtger U, Naur TMH, Ahmad K, Singh Sidhu J, Nessar R, Salih GN, Høegholm A, Annema JT, Clementsen PF. EUS-B-FNA for Diagnosing Liver and Celiac Metastases in Lung Cancer Patients. Respiration 2019; 98:428-433. [PMID: 31563907 DOI: 10.1159/000501834] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In patients with suspected or proven lung cancer, assessment of regional nodal and distant metastases is key before treatment planning. By introducing the endobronchial ultrasound (EBUS)-guided scope into the esophagus and stomach (EUS-B), liver lesions and celiac nodes can be visualized. To date, the utility of EUS-B in diagnosing liver lesions and retroperitoneal lymph nodes is unknown. OBJECTIVES To assess the feasibility, safety, and diagnostic yield of sampling of liver lesions and retroperitoneal nodes by EUS-B fine-needle aspiration (FNA) in a lung cancer staging setting. METHOD Consecutive patients suspected of lung cancer in 2 Danish centers between 1 January 2015 and 31 December 2017 were included retrospectively when a lesion in the liver or a retroperitoneal lymph node was visualized and biopsied with EUS-B-FNA. RESULTS 23 left liver lobe lesions and 19 retroperitoneal lymph nodes were sampled by EUS-B-FNA. Sensitivity and diagnostic yield of sampled liver lesions were 86 and 83%, respectively. In 19/23 patients, there was a cytopathological diagnosis of malignancy. Sensitivity and diagnostic yield from retroperitoneal lymph node samples were 83 and 63%, respectively. In 10/19 patients, the diagnosis was malignancy. No complications were observed. CONCLUSION EUS-B-FNA enables safe sampling of left liver lobe lesions and retroperitoneal lymph nodes. EUS-B should be considered as a minimally invasive technique to provide tissue proof of distant metastases lung cancer patients.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Unit of Respiratory Medicine, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Uffe Bodtger
- Unit of Respiratory Medicine, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Therese Maria Henriette Naur
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark
| | - Khaliq Ahmad
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | | | - Rafi Nessar
- Unit of Respiratory Medicine, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Unit of Respiratory Medicine, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Jouke Tabe Annema
- Department of Respiratory Medicine, AMC, Amsterdam University Medical Centers, Amsterdam, The Netherlands,
| | - Paul Frost Clementsen
- Unit of Respiratory Medicine, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Reuter S, Lindgaard D, Laursen C, Fischer BM, Clementsen PF, Bodtger U. Computed tomography of the chest in unilateral pleural effusions: outcome of the British Thoracic Society guideline. J Thorac Dis 2019; 11:1336-1346. [PMID: 31179075 DOI: 10.21037/jtd.2019.03.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The guidelines from the British Thoracic Society (BTS) regarding the investigation of unilateral pleural effusions recommend computed tomography (CT) in exudates. We decided to investigate if clinicians follow BTS guidelines' recommendations with respect to CT in patients with unilateral pleural effusions. Secondly, to investigate the diagnostic consequences of following and not following this recommendation. Methods The study was a retrospective, non-randomized study including consecutive patients referred to our tertiary centers in 2013-2016 because of unilateral pleural effusion. Patients undergoing chest CT for unilateral pleural effusion of unknown cause after thoracentesis and chest X-ray were included. Patients were categorized as having pleural exudates or transudates, according to Light's criteria, if applicable. We registered use of CT, and calculated diagnostic values. Results In total, 323 of the 465 included patients underwent CT (69%). CT was performed in the majority of patients not having an exudate (transudates: n=40; 54%; Light's criteria not assessed: n=111; 67%). 18F-FDG positron emission tomography (PET)/CT without prior CT was performed in 32 patients with an exudate (58%). The sensitivity of a non-guideline supported CT (70%) was significantly higher compared to a guideline supported CT (47%), P value <0.045. The post-test probability of a positive guideline-supported CT [likelihood ratio (LR) positive 3.26] for a later diagnosis of thoracic malignancy increased the probability from 25% to 52%. A negative CT (LR negative 0.62) decreased the probability to 17%. For a non-guideline-supported CT the numbers were (LR positive 3.42) 53% and (LR negative 0.38) 11%, respectively. Conclusions Clinicians appear not to follow BTS guidelines when deciding to perform chest CT. The relevance of this deviation is supported by the superior sensitivity of CT non-guideline supported CT. Overall, CT is associated with suboptimal sensitivity and negative predictive values for the diagnosis of thoracic malignancy.
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Affiliation(s)
- Simon Reuter
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dennis Lindgaard
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
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Christiansen IS, Clementsen PF, Bodtger U, Naur TMH, Pietersen PI, Laursen CB. Transthoracic ultrasound-guided biopsy in the hands of chest physicians - a stepwise approach. Eur Clin Respir J 2019; 6:1579632. [PMID: 30815241 PMCID: PMC6383606 DOI: 10.1080/20018525.2019.1579632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background: The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB).Objective: The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. Method/results: Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. Conclusion: US-TTNB performed by pulmonologists is a safe and feasible procedure.
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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
| | - 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 Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, 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
| | - Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
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Reuter S, Naur TMH, Clementsen PF, Bodtger U. The value of computed tomography in discriminating malignant from non-malignant causes of unresolved unilateral pleural effusions: a systematic review. Eur Clin Respir J 2019; 6:1565803. [PMID: 33868602 PMCID: PMC8026111 DOI: 10.1080/20018525.2019.1565803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
The scientific background in expert-opinion papers for recommending Computed Tomography (CT) in unilateral pleural exudates is based on studies including patients with other findings than unilateral pleural effusions or selected patients undergoing thoracoscopy. Therefore, we performed a systematic review investigating the sensitivity of CT for predicting malignancy in patients with unilateral, non-transudative, pleural effusions. A search strategy was developed with the assistance of a medical information specialist at our university library. We searched PubMed/MEDLINE, EMBASE and Cochrane Library, ClinicalTrials.gov and articles citing the included studies. No date restrictions were applied (the first included paper was published in 2001 (1)), and only literature in English was included. We used the Quality Assessment of Diagnostic Accuracy Studies 2 for bias assessment. We registered the protocol at PROSPERO (CRD42018094830). Five studies were included, two prospective and three retrospective, all performed in Western Europe. No study reported diagnostic values for patients with unilateral, non-transudative pleural effusions only; one study did for unilateral pleural effusions. In the remaining studies, most patients had unilateral effusions and non-transudative effusions. Patients were primarily males and >70 years. All but one study found a high incidence of malignancy, dominated by malignant pleural mesothelioma. All studies were limited by risk of bias and applicability, predominantly regarding study population, pretests and index test. The current evidence supporting the sensitivity of CT for predicting malignancy in unilateral pleural effusions (both non-transudative and all types of effusion) is very low and did not allow meta-analysis. Standardization of patient population and CT protocol may facilitate conclusions of futures studies.
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Affiliation(s)
- Simon Reuter
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
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Abstract
Background The long-term outcome after non-diagnostic thoracoscopy (idiopathic pleuritis) has not been investigated in nationwide studies, and the survival has never been estimated. Therefore, we decided to investigate the three-year incidence of malignancy and survival of patients with idiopathic pleuritis. Methods Retrospective, register-based, nationwide study of patients undergoing diagnostic video-assisted thoracoscopic surgery (VATS) thoracoscopy ≤30 days after thoracentesis, using The National Patient Registry and The Danish Cancer Registry. Idiopathic pleuritis was defined as; no diagnosis of malignancy within 31 days after VATS. Patients were followed for 36 months after VATS. Results In total, idiopathic pleuritis were identified in 547 out of 658 patients undergoing VATS (83%), and 29 (5%) were diagnosed with malignancy during the 3 years follow-up period after VATS. Of these, 93% were diagnosed with malignancy within the first year. Numbers-needed-to-follow-up for detecting one case of malignancy was 18 during the first year after VATS and 250 in the two subsequent years. Survival was independent on type of malignancy (MPM vs. other malignancies; P=0.13) and of time from VATS to diagnosis (≤31 days vs. 1-36 months; P=0.15). Median survival in the non-malignant group was 1,095 days. Conclusions Our study confirms a low incidence of malignancy in idiopathic pleuritis after VATS. Nearly all incident cases of malignancy were diagnosed within 12 months from VATS. No survival disadvantage was observed in patients with incident malignancy. Our data suggest that follow-up of idiopathic pleuritis could safely be limited to 1 year. The optimal follow-up strategy remains to be investigated.
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Affiliation(s)
- Simon Bertram Reuter
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Roskilde, Denmark
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Rasmussen KMB, Hertz P, Laursen CB, Arshad A, Saghir Z, Clementsen PF, Konge L. Ensuring Basic Competence in Thoracentesis. Respiration 2019; 97:463-471. [PMID: 30625480 DOI: 10.1159/000495686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trocar pigtail catheter thoracentesis (TPCT) is a common procedure often performed by junior physicians. Simulation-based training may effectively train physicians in the procedure prior to performing it on patients. An assessment tool with solid validity evidence is necessary to ensure sufficient procedural competence. OBJECTIVES Our study objectives were (1) to collect evidence of validity for a newly developed pigtail catheter assessment tool (Thoracentesis Assessment Tool [ThorAT]) developed for the evaluation of TPCT performance and (2) to establish a pass/fail score for summative assessment. METHODS We assessed the validity evidence for the ThorAT using the recommended framework for validity by Messick. Thirty-four participants completed two consecutive procedures and their performance was assessed by two blinded, independent raters using the ThorAT. We compared performance scores to test whether the assessment tool was able to discern between the two groups, and a pass/fail score was established. RESULTS The assessment tool was able to discriminate between the two groups in terms of competence level. Experienced physicians received significantly higher test scores than novices in both the first and second procedure. A pass/fail score of 25.2 points was established, resulting in 4 (17%) passing novices and 1 (9%) failing experienced participant in the first procedure. In the second procedure 9 (39%) novices passed and 2 (18%) experienced participants failed. CONCLUSIONS This study provides a tool for summative assessment of competence in TPCT. Strong validity evidence was gathered from five sources of evidence. A simulation-based training program using the ThorAT could ensure competence before performing thoracentesis on patients.
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Affiliation(s)
| | - Peter Hertz
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Christian B Laursen
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Arman Arshad
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Zaigham Saghir
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
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Colella S, Scarlata S, Bonifazi M, Ravaglia C, Naur TMH, Pela R, Clementsen PF, Gasparini S, Poletti V. Biopsy needles for mediastinal lymph node sampling by endosonography: current knowledge and future perspectives. J Thorac Dis 2018; 10:6960-6968. [PMID: 30746242 DOI: 10.21037/jtd.2018.11.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Due to the increasing role of endosonography [endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound-guided fine needle aspiration (EUS-FNA)] in the diagnosis of several lung diseases, the knowledge of technical aspects is mandatory to optimize the success of the procedure. Among those technicalities related to the procedure, the choice of a needle over another one-either in terms of dimension and type-may have a role in the diagnostic process, especially in some diseases such as lymphoproliferative disorders. In this review, we analyze the current knowledge about the biopsy needle for endosonography, providing also some hints for the future.
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Affiliation(s)
- Sara Colella
- Pulmonary Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Simone Scarlata
- Geriatrics, Department of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy
| | - Martina Bonifazi
- Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic Diseases, G B Morgagni L Pierantoni Hospital, Forli, Italy
| | | | - Riccardo Pela
- Pulmonary Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - 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 Region of Denmark, Copenhagen, Denmark
| | - Stefano Gasparini
- Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases, G B Morgagni L Pierantoni Hospital, Forli, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
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Cold KM, Konge L, Clementsen PF, Nayahangan LJ. Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion. Respiration 2018; 97:160-167. [PMID: 30391958 DOI: 10.1159/000493431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have shown the beneficial effects of mastery learning of a simulation-based course, but not all trainees complete it. OBJECTIVES The purpose of this study was to find deciding factors for the completion of a simulation-based mastery learning course with distributive practice in flexible bronchoscopy. METHODS Seventy-seven trainees who signed up for the course were invited to a survey for deciding factors of completing the course. Sixty-two (81%) trainees answered the survey. RESULTS Male trainees were more likely to complete the course. The most important factor for completion was clinical relevance, and the most important factor for not completing the course was being "too busy." CONCLUSION Several deciding factors for completing the course were identified. Successful simulation-based mastery learning courses should be clinically relevant, and the trainees should be provided protected time to complete the training. The instructional design should also be adapted systematically for male and female trainees to achieve the necessary competencies.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark, .,University of Copenhagen, Copenhagen, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
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Skovgaard Christiansen I, Kuijvenhoven JC, Bodtger U, Naur TMH, Ahmad K, Singh Sidhu J, Nessar R, Salih GN, Høegholm A, Annema JT, Clementsen PF. Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions. Respiration 2018; 97:277-283. [PMID: 30253411 DOI: 10.1159/000492578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/25/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diagnosing centrally located lung tumors without endobronchial abnormalities and not located near the major airways is a diagnostic challenge. Tumors near or adjacent to the esophagus can be aspirated and detected with esophageal ultrasound (EUS) using gastrointestinal endoscopes. OBJECTIVE To assess the feasibility and diagnostic yield of endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) in paraesophageally located lung tumors and its added value to bronchoscopy and endobronchial ultrasound (EBUS). METHODS Retrospective, multicenter international study (from January 1, 2015 until January 1, 2018) of patients with suspected lung cancer, undergoing bronchoscopy, EBUS, and endoscopic ultrasound bronchoscopy (EUS-B) in one session by a single operator (pulmonologist), in whom the primary lung tumor was detected and aspirated by EUS-B. In the absence of malignancy following endoscopy, transthoracic ultrasound needle aspiration, clinical and radiological follow-up of at least 6 months was performed. The yield and sensitivity of EUS-B-FNA and its added value to bronchoscopy and EBUS was assessed. RESULTS 58 patients were identified with the following diagnosis: non-small-cell lung cancer (n = 43), small-cell lung cancer (n = 6), mesothelioma (n = 2), metastasis (n = 1), nonmalignant (n = 6). The yield and sensitivity of EUS-B-FNA for detecting lung cancer was 90%. In 26 patients (45%), the intrapulmonary tumor was exclusively detected by EUS-B. Adding EUS-B to conventional bronchoscopy and EBUS increased the diagnostic yield for diagnosing lung cancer in para-esophageally located lung tumors from 51 to 91%. No EUS-B-related complications were observed. CONCLUSION EUS-B-FNA is a feasible and safe technique for diagnosing centrally located intrapulmonary tumors that are located near or adjacent to the esophagus. EUS-B should be considered in the same endoscopy session following nondiagnostic bronchoscopy and EBUS.
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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
| | - Jolanda Corina Kuijvenhoven
- Academic Medical Center, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - 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
| | - Therese Maria Henriette Naur
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Khaliq Ahmad
- Department of Respiratory Medicine, Næstved Hospital, Næstved, 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
| | - Jouke Tabe Annema
- Academic Medical Center, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands,
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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de Blanck SR, Rydhög JS, Larsen KR, Clementsen PF, Josipovic M, Aznar MC, Af Rosenschöld PM, Jølck RI, Specht L, Andresen TL, Persson GF. Long term safety and visibility of a novel liquid fiducial marker for use in image guided radiotherapy of non-small cell lung cancer. Clin Transl Radiat Oncol 2018; 13:24-28. [PMID: 30258990 PMCID: PMC6154396 DOI: 10.1016/j.ctro.2018.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022] Open
Abstract
Safety and clinical feasibility of injecting a novel liquid fiducial marker for use in image guided radiotherapy in 15 patients with non-small cell lung cancer are reported. No major safety or toxicity issues were encountered. Markers present at start of radiotherapy remained visible in cone beam computed tomography and fluoroscopy images throughout the treatment course and on computed tomography images during follow-up (0-38 months). Marker volume reduction was seen until 9 months after treatment, after which no further marker breakdown was found. No post-treatment migration or marker related complications were found.
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Affiliation(s)
- Steen Riisgaard de Blanck
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jonas Scherman Rydhög
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Klaus Richter Larsen
- Department of Respiratory Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 København, NV, Denmark
| | - Paul Frost Clementsen
- Department of Respiratory Medicine, Gentofte University Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Marianne Camille Aznar
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Rasmus Irming Jølck
- DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Building 345E, Ørsteds Plads, 2800 Kgs. Lyngby, Denmark.,Nanovi Radiotherapy A/S, Diplomvej 373N, 2800 Kgs. Lyngby, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Lars Andresen
- DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Building 345E, Ørsteds Plads, 2800 Kgs. Lyngby, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Abstract
OBJECTIVE To provide an overview of current literature that informs how to approach simulation practice of bronchoscopy and discuss how findings from other simulation research can help inform the use of simulation in bronchoscopy training. SUMMARY We conducted a literature search on simulation training of bronchoscopy and divided relevant studies in three categories: 1) structuring simulation training in bronchoscopy, 2) assessment of competence in bronchoscopy training, and 3) development of cheap alternatives for bronchoscopy simulation. CONCLUSION Bronchoscopy simulation is effective, and the training should be structured as distributed practice with mastery learning criteria (ie, training until a certain level of competence is achieved). Dyad practice (training in pairs) is possible and may increase utility of available simulators. Trainee performance should be assessed with assessment tools with established validity. Three-dimensional printing is a promising new technology opening possibilities for developing cheap simulators with innovative features.
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Affiliation(s)
- Philip Mørkeberg Nilsson
- Copenhagen Academy for Medical Education and Simulation, Center of HR, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | | | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center of HR, Capital Region and University of Copenhagen, Copenhagen, Denmark
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Naur TMH, Konge L, Clementsen PF. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography. Respiration 2017; 94:279-284. [DOI: 10.1159/000477625] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022] Open
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Ashraf H, Krag-Andersen S, Naqibullah M, Minddal V, Nørgaard A, Naur TMH, Myschetzky PS, Clementsen PF. Computer tomography guided lung biopsy using interactive breath-hold control: a randomized study. Ann Transl Med 2017; 5:253. [PMID: 28706921 DOI: 10.21037/atm.2017.05.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study. METHODS Patients admitted for CT-guided lung biopsy were randomized to biopsy either with (N=201) or without (N=206) IBC. Biopsy accuracy, procedure time, radiation, and complications were compared in the two groups. Predictors for pneumothorax were analyzed. RESULTS Procedures performed with the use of IBC (N=130) did not show higher biopsy accuracy (P=0.979) but were associated with a higher risk of pneumothorax (P=0.022) compared to procedures without the use of IBC (N=171). Overall, 50% of the biopsies were malignant, 13% were benign, and 33% were inconclusive (4% missing). Long needle time (P=0.037) and small nodule size (P=0.001) were predictors of pneumothorax. CONCLUSIONS The use of IBC for CT-guided lung biopsy was not an advantage for unselected patients in our care, since it did not improve the biopsy accuracy and the risk of pneumothorax was increased.
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Affiliation(s)
- Haseem Ashraf
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark.,Department of Radiology, Gentofte University Hospital, Hellerup, Denmark.,Department of Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Shella Krag-Andersen
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Matiullah Naqibullah
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Valentina Minddal
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Annette Nørgaard
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | | | | | - Paul Frost Clementsen
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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Naur TMH, Konge L, Nayahangan LJ, Clementsen PF. Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2017; 9:2118-2123. [PMID: 28840013 DOI: 10.21037/jtd.2017.06.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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Naur TMH, Nilsson PM, Pietersen PI, Clementsen PF, Konge L. Simulation-Based Training in Flexible Bronchoscopy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Systematic Review. Respiration 2017; 93:355-362. [PMID: 28343219 DOI: 10.1159/000464331] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of simulators in a training programme for technically challenging procedures has the advantages of lowering the risk of patient complications while helping the trainees with the initial part of their learning curve. OBJECTIVES The aim of this study was to perform a systematic review of simulation-based training in flexible bronchoscopy and endobronchial ultrasound (EBUS). METHODS We identified 1,006 publications in the PubMed database and included publications on flexible bronchoscopy below the carina and EBUS involving hands-on simulation-based training. Publications were excluded if they were written in languages other than English, if paediatric airways were involved or if they were not journal articles. The screening process was performed by 2 individuals, and a third reviewer made the final decision in case of disagreement. RESULTS We included 30 publications. The studies included participants of varying experience and most commonly used a virtual reality simulator as a training modality. Assessment of the participants' skills was based on simulator metrics or on an assessment tool. Some studies included performance on patients for assessment of the operator after training on a simulator. CONCLUSIONS Simulation-based training was demonstrated to be more efficient than the traditional apprenticeship model. Physical models and virtual reality simulators complement each other. Simulation-based education should be based on a mastery learning approach and structured as directed self-regulated learning in a distributed training programme.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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Korevaar DA, Colella S, Spijker R, Bossuyt PM, Konge L, Clementsen PF, Annema JT. Esophageal Endosonography for the Diagnosis of Intrapulmonary Tumors: A Systematic Review and Meta-Analysis. Respiration 2016; 93:126-137. [PMID: 27926910 DOI: 10.1159/000452958] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/28/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Biopsy-based diagnosis in patients with paraesophageal intrapulmonary tumors suspected of lung cancer is crucial for adequate treatment planning. OBJECTIVE To evaluate the performance of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the diagnosis of intrapulmonary tumors located near or adjacent to the esophagus. METHODS We performed a systematic review (PROSPERO, CRD42016033737) and searched MEDLINE, Embase, BIOSIS Previews, and Web of Science on September 22, 2016, without date or language restrictions. We included studies that evaluated the yield and/or sensitivity of EUS-FNA for diagnosing intrapulmonary tumors. Yield was defined as the number of patients in whom EUS-FNA made a biopsy-proven diagnosis (malignant or nonmalignant) relative to the total number of patients on whom EUS-FNA was performed. Sensitivity was defined as the number of patients in whom EUS-FNA made a biopsy-proven diagnosis of malignancy relative to the total number of patients in whom the tumor was found to be malignant. We performed a random-effects meta-analysis. RESULTS Of 3,320 search results, 11 studies were included. Ten had a high risk of bias. The total number of patients was 313; the proportion of patients with malignancy ranged from 87 to 100% across these studies. The average yield was 0.90 (95% CI 0.82-0.95) and the average sensitivity was 0.92 (0.83-0.96). In the subgroup of prospective studies (n = 3), the average yield was 0.80 (0.56-0.93) and the average sensitivity was 0.83 (0.58-0.95). EUS-FNA-induced complications were reported for 5/256 patients (2.0%) for whom this information was available. CONCLUSIONS Although the number of high-quality studies is limited, these findings suggest that EUS-FNA is safe and has a high yield for diagnosing intrapulmonary tumors.
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Affiliation(s)
- Daniël A Korevaar
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Nayahangan LJ, Clementsen PF, Paltved C, Lindorff-Larsen KG, Nielsen BU, Konge L. Identifying Technical Procedures in Pulmonary Medicine That Should Be Integrated in a Simulation-Based Curriculum: A National General Needs Assessment. Respiration 2016; 91:517-22. [PMID: 27287472 DOI: 10.1159/000446926] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Simulation training is a revolutionary addition to health care education. However, developing simulation-based training programs is often dictated by those simulators that are commercially available. Curriculum development requires deliberate planning and a standardized approach, including a 'general needs assessment'. OBJECTIVES The aim of this study was to perform a national general needs assessment to identify technical procedures in pulmonary medicine that should be integrated in a simulation-based curriculum. METHODS A three-round Delphi process was initiated among 62 key opinion leaders. Round 1 was an open-ended question to identify technical procedures pulmonologists should learn. Round 2 was a survey using a newly developed needs assessment formula to explore the frequency of procedures, number of operators, risk or discomfort when performed by an inexperienced doctor, and feasibility of simulation-based training. In round 3, results were reviewed and ranked according to priority. RESULTS The response rates for the three rounds were 74, 63, and 60%, respectively. The Delphi process reduced the 30 procedures identified in round 1 to 11 prioritized technical procedures in round 3. These were: flexible bronchoscopy, pleurocentesis, endobronchial ultrasound, endoscopic ultrasound-guided fine-needle aspiration, noninvasive ventilation treatment, transthoracic biopsy of pleural or lung tumor, focused ultrasound scanning of the lungs, chest tube insertion, needle biopsy of visible lymph node/tumor of the skin, focused ultrasound scanning of the heart, and thoracoscopy. CONCLUSION We performed a Delphi study using a needs assessment formula, which identified 11 technical procedures that are highly suitable for simulation-based training. Medical educators can use this list as a resource in planning simulation-based training programs for trainees in pulmonary medicine.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
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Fally M, Nessar R, Behrendt N, Clementsen PF. Endoscopic Ultrasound-Guided Liver Biopsy in the Hands of a Chest Physician. Respiration 2016; 92:53-5. [PMID: 27287428 DOI: 10.1159/000446924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
Liver biopsy using transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) has never been described before and biopsies of infradiaphragmatic lesions using this technique are not considered to be standard. A patient suspected for primary lung cancer with multiple lesions in the liver was referred to our department. We conducted bronchoscopy and endobronchial ultrasound-guided (EBUS) biopsy from several enlarged mediastinal lymph nodes. Thereafter, we conducted EUS-B-FNA from a lesion in the left liver lobe. Pathology showed that the liver lesion represented a metastasis from a pulmonary adenocarcinoma. Bronchoscopy and EBUS samples were not able to establish diagnosis. We hereby demonstrated that a diagnostic EUS-B-FNA from a liver metastasis in a patient with lung cancer is possible. This underlines that chest physicians should not forget the esophagus when staging lung cancer.
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Affiliation(s)
- Markus Fally
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
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