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Zhang J, Chen E, Xu S, Xu L, Hu H, Dong L, Ying K. Virtual bronchoscopic navigation with intraoperative cone-beam CT for the diagnosis of peripheral pulmonary nodules. BMC Pulm Med 2024; 24:146. [PMID: 38509516 PMCID: PMC10956201 DOI: 10.1186/s12890-024-02930-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Transbronchial biopsy is a safe manner with fewer complications than percutaneous transthoracic needle biopsy; however, the current diagnostic yield is still necessitating further improvement. We aimed to evaluate the diagnostic yield of using virtual bronchoscopic navigation (VBN) and cone-beam CT (CBCT) for transbronchial biopsy and to investigate the factors that affected the diagnostic sensitivity. METHODS We retrospectively investigated 255 patients who underwent VBN-CBCT-guided transbronchial biopsy at our two centers from May 2021 to April 2022. A total of 228 patients with final diagnoses were studied. Patient characteristics including lesion size, lesion location, presence of bronchus sign, lesion type and imaging tool used were collected and analyzed. Diagnostic yield was reported overall and in groups using different imaging tools. RESULTS The median size of lesion was 21 mm (range of 15.5-29 mm) with 46.1% less than 2 cm in diameter. Bronchus sign was present in 87.7% of the patients. The overall diagnostic yield was 82.1%, and sensitivity for malignancy was 66.3%. Patients with lesion > 2 cm or with bronchus sign were shown to have a significantly higher diagnostic yield. Four patients had bleeding and no pneumothorax occurred. CONCLUSION Guided bronchoscopy with VBN and CBCT was an effective diagnostic method and was associated with a high diagnostic yield in a safe manner. In addition, the multivariant analysis suggested that lesion size and presence of bronchus sign could be a predictive factor for successful bronchoscopic diagnosis.
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Affiliation(s)
- Jisong Zhang
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China
| | - Enguo Chen
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China
| | - Shan Xu
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China
| | - Li Xu
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China
| | - Huihui Hu
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China
| | - Liangliang Dong
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China
| | - Kejing Ying
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw hospital of Zhejiang University, 310016, Hangzhou, China.
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Saad F, Frysch R, Saalfeld S, Kellnberger S, Schulz J, Fahrig R, Bhadra K, Nürnberger A, Rose G. Deformable 3D/3D CT-to-digital-tomosynthesis image registration in image-guided bronchoscopy interventions. Comput Biol Med 2024; 171:108199. [PMID: 38394801 DOI: 10.1016/j.compbiomed.2024.108199] [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: 08/11/2023] [Revised: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
Traditional navigational bronchoscopy procedures rely on preprocedural computed tomography (CT) and intraoperative chest radiography and cone-beam CT (CBCT) to biopsy peripheral lung lesions. This navigational approach is challenging due to the projective nature of radiography, and the high radiation dose, long imaging time, and large footprints of CBCT. Digital tomosynthesis (DTS) is considered an attractive alternative combining the advantages of radiography and CBCT. Only the depth resolution cannot match a full CBCT image due to the limited angle acquisition. To address this issue, preoperative CT is a good auxiliary in guiding bronchoscopy interventions. Nevertheless, CT-to-body divergence caused by anatomic changes and respiratory motion, hinders the effective use of CT imaging. To mitigate CT-to-body divergence, we propose a novel deformable 3D/3D CT-to-DTS registration algorithm employing a multistage, multiresolution approach and using affine and elastic B-spline transformation models with bone and lung mask images. A multiresolution strategy with a Gaussian image pyramid and a multigrid strategy within the B-spline model are applied. The normalized correlation coefficient is included in the cost function for the affine model and a multimetric weighted cost function is used for the B-spline model, with weights determined heuristically. Tested on simulated and real patient bronchoscopy data, the algorithm yields promising results. Assessed qualitatively by visual inspection and quantitatively by computing the Dice coefficient (DC) and the average symmetric surface distance (ASSD), the algorithm achieves mean DC of 0.82±0.05 and 0.74±0.05, and mean ASSD of 0.65±0.29mm and 0.93±0.43mm for simulated and real data, respectively. This algorithm lays the groundwork for CT-aided intraoperative DTS imaging in image-guided bronchoscopy interventions with future studies focusing on automated metric weight setting.
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Affiliation(s)
- Fatima Saad
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany.
| | - Robert Frysch
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Jessica Schulz
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Siemens Healthcare GmbH, Forchheim, Germany
| | | | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, USA
| | - Andreas Nürnberger
- Data and Knowledge Engineering Group, Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany
| | - Georg Rose
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
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3
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Sugihara T, Teramoto N, Shigematsu H, Nakashima S, Ryuko T, Ueno T, Suehisa H, Abe C, Takahata H, Kato Y, Ninomiya T, Harada D, Kozuki T, Yamashita M. Benign Mesothelial Cells in transbronchial biopsy specimens: A potential diagnostic pitfall for lung cancer. Pathol Res Pract 2024; 253:154967. [PMID: 38064868 DOI: 10.1016/j.prp.2023.154967] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024]
Abstract
Bronchoscopy is a common diagnostic procedure used to identify lung cancer. Specimens acquired through transbronchial biopsy are pivotal in the diagnosis and molecular characterization of this disease. The occurrence of benign mesothelial cells during a transbronchial biopsy (TBB) is relatively rare. Furthermore, these lesions can sometimes be erroneously identified as malignant, potentially resulting in unwarranted or inappropriate treatment for patients with and without lung cancer. In this retrospective analysis, we examined 619 TBB cases at our institute from 2019 to 2021. Benign mesothelial cells were identified via immunohistochemical studies in eight (1.3%) of 619 cases. These cells were classified into three patterns based on their cellular morphology: monolayer, lace, and cobblestone. Recognizing this phenomenon during the procedure is crucial to accurately distinguish benign mesothelial cells from their cancerous counterparts.
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Affiliation(s)
- Takahito Sugihara
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan.
| | - Norihiro Teramoto
- Department of Pathology, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Hisayuki Shigematsu
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Shohei Nakashima
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Tsuyoshi Ryuko
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Hiroshi Suehisa
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Chie Abe
- Department of Pathology, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Hiroyuki Takahata
- Department of Pathology, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Yuka Kato
- Department of Thoracic Oncology and Medicine, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Takashi Ninomiya
- Department of Thoracic Oncology and Medicine, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Daijiro Harada
- Department of Thoracic Oncology and Medicine, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Motohiro Yamashita
- Department of Thoracic Surgery, NHO Shikoku Cancer Center, 160 Kou, Minami Umemoto-machi, Matsuyama, Ehime 791-0280, Japan
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4
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Wahidi MM, Lee S, Cramer GR, Cangelosi MJ. Sampling of Thoracic Lymph Nodes and Lung Lesions: Trends in Procedural Utilization. Respiration 2023; 102:495-502. [PMID: 37290401 DOI: 10.1159/000530741] [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: 01/27/2023] [Accepted: 04/05/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Advances in bronchoscopy have impacted the practice patterns in the sampling of thoracic lymph nodes and lung lesions. OBJECTIVES The aim of the study was to study the trends in utilization of mediastinoscopy, transthoracic needle aspiration (TTNA), and bronchoscopic transbronchial sampling. METHODS We conducted an analysis of patient claims for sampling of thoracic lymph nodes and lung lesions in the Medicare population and a sample of the commercial population between 2016 and 2020. We used Current Procedural Terminology codes to identify mediastinoscopy, TTNA, and bronchoscopic transbronchial sampling. Post-procedural pneumothorax rates were assessed by procedure type including subset analyses for patients with chronic obstructive pulmonary disease (COPD). RESULTS Between 2016 and 2020, utilization of mediastinoscopy has decreased in both the Medicare and commercial populations (-47.3% and -65.4%, respectively), while linear endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has increased only in the Medicare population (+28.2%). Percutaneous lung biopsy claims dropped by -17.0% in the Medicare and -41.22% in the commercial population. The use of bronchoscopic TBNA and forceps biopsy declined in both populations, but the reliance on a combination of guided technology (radial EBUS-guided and navigation) grew in the Medicare and commercial populations (+76.3% and +25%). Rates of post-procedural pneumothorax were significantly higher following percutaneous biopsy compared to bronchoscopic transbronchial biopsy. CONCLUSIONS Linear EBUS-guided sampling has surpassed mediastinoscopy as the technique for sampling thoracic lymph nodes. Transbronchial lung sampling is increasingly being performed with guidance technology. This trend is aligned with favorable rates of post-procedure pneumothorax for transbronchial biopsy.
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Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sonia Lee
- Boston Scientific, Marlborough, Massachusetts, USA
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Mondoni M, Rinaldo RF, Solidoro P, Di Marco F, Patrucco F, Pavesi S, Baccelli A, Carlucci P, Radovanovic D, Santus P, Raimondi F, Vedovati S, Morlacchi LC, Blasi F, Sotgiu G, Centanni S. Interventional pulmonology techniques in lung transplantation. Respir Med 2023; 211:107212. [PMID: 36931574 DOI: 10.1016/j.rmed.2023.107212] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/04/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Lung transplantation is a key therapeutic option for several end-stage lung diseases. Interventional pulmonology techniques, mostly bronchoscopy, play a key role throughout the whole path of lung transplantation, from donor evaluation to diagnosis and management of post-transplant complications. We carried out a non-systematic, narrative literature review aimed at describing the main indications, contraindications, performance characteristics and safety profile of interventional pulmonology techniques in the context of lung transplantation. We highlighted the role of bronchoscopy during donor evaluation and described the debated role of surveillance bronchoscopy (with bronchoalveolar lavage and transbronchial biopsy) to detect early rejection, infections and airways complications. The conventional (transbronchial forceps biopsy) and the new techniques (i.e. cryobiopsy, biopsy molecular assessment, probe-based confocal laser endomicroscopy) can detect and grade rejection. Several endoscopic techniques (e.g. balloon dilations, stent placement, ablative techniques) are employed in the management of airways complications (ischemia and necrosis, dehiscence, stenosis and malacia). First line pleural interventions (i.e. thoracentesis, chest tube insertion, indwelling pleural catheters) may be useful in the context of early and late pleural complications occurring after lung transplantation. High quality studies are advocated to define endoscopic standard protocols and thus help improving long-term prognostic outcomes of lung transplant recipients.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Rocco Francesco Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Solidoro
- S.C. Pneumologia, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy
| | - Stefano Pavesi
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Andrea Baccelli
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | | | - Sergio Vedovati
- Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Francesco Blasi
- Respiratory Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department Pathophysiology and Trasplantation, Università degli studi di Milano, Milano, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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6
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Abe Y, Miyake K, Shiroyama T, Hirata H, Nagatomo I, Takeda Y, Kumanogoh A. Virtual fluoroscopic preprocedural planning using Ziostation2 for transbronchial biopsy: A prospective self-controlled study. Respir Investig 2023; 61:157-163. [PMID: 36682085 DOI: 10.1016/j.resinv.2022.12.005] [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: 06/19/2022] [Revised: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Bronchoscopes cannot reach the periphery of the lung because the bronchi are tapered. Therefore, selectively advancing a device-e.g., an endobronchial ultrasonography (EBUS) probe-to the targets can be challenging. Virtual fluoroscopic preprocedural planning (VFPP) is a method in which the route to the target is superimposed on an X-ray fluoroscopy-like image reconstructed from CT images, facilitating the advancement of the EBUS probe to the target. The VFPP method was integrated into the Ziostation2 bronchoscopic navigation system (Ziosoft, Inc., Tokyo, Japan) in 2018. Here, we prospectively examined the feasibility of the VFPP method using Ziostation2 (Zio-VFPP). METHODS Thirty-six patients who had pulmonary lesions with long axes ≤30 mm and who underwent thin-slice CT with ≤0.625-mm thickness were enrolled. We initiated bronchoscopy using EBUS with a guide sheath (EBUS-GS) while referring to Ziostation2 bronchoscopic navigation. When the probe was not "within" a lesion, we attempted to correct its position based on Zio-VFPP. EBUS findings before and after Zio-VFPP were compared. RESULTS Zio-VFPP was performed in 24 patients, and EBUS findings improved in nine patients. Before Zio-VFPP, 18 patients were "outside," but after Zio-VFPP, the number decreased to ten. Statistically, this difference was significant (p = 0.0392). There were no cases in which EBUS findings worsened with Zio-VFPP. CONCLUSION Zio-VPFPP improves EBUS findings and significantly reduces "outside" cases. However, further investigation is necessary to verify its effectiveness.
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Affiliation(s)
- Yuko Abe
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Department of Immunopathology, World Premier Institute Immunology Frontier Research Center (WPI-IFReC), Osaka University, Osaka 565-0871, Japan
| | - Kotaro Miyake
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - Takayuki Shiroyama
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Izumi Nagatomo
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Yoshito Takeda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Department of Immunopathology, World Premier Institute Immunology Frontier Research Center (WPI-IFReC), Osaka University, Osaka 565-0871, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka 565-0871, Japan
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7
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Ishak M, Chakraborty D, Kassirian S, Dhaliwal I, Mitchell MA. Risk of iatrogenic pneumothorax based on location of transbronchial biopsy: a retrospective cohort study. BMC Res Notes 2023; 16:14. [PMID: 36782263 PMCID: PMC9926766 DOI: 10.1186/s13104-023-06275-5] [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: 06/20/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Transbronchial lung biopsy (TBB) is a commonly performed procedure to obtain parenchymal lung tissue during bronchoscopy. Pneumothorax is among the most common serious complications of TBB. The objective of this study was to assess whether location of TBB correlated with development of post-procedural pneumothorax. We also sought to identify additional risk factors associated with pneumothorax development. This was a single-centre, retrospective cohort study. All TBB performed between 2010 and 2020 underwent subsequent chart review. The primary outcome was radiologist reported pneumothorax on post-procedure chest x-ray. Multivariable logistic regression model was created with included variables chosen a priori based on clinical significance. RESULTS There were a total of 222 TBB performed that met inclusion criteria. Radiographic evidence of pneumothorax was reported in 38 patients (15.4%). Ten patients (4.1%) required a chest tube. In the multivariable analysis, risk of pneumothorax was significantly higher for biopsies obtained from the left upper lobe (OR 3.3; 95% CI 1.3-9.1). There was an increased risk of pneumothorax following TBB when obtained from the left upper lobe. Clinicians should be aware of the increased risk and should consider alternative locations in patients with diffuse lung disease.
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Affiliation(s)
- Mina Ishak
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Debarati Chakraborty
- grid.39381.300000 0004 1936 8884Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Shayan Kassirian
- grid.39381.300000 0004 1936 8884Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Inderdeep Dhaliwal
- grid.39381.300000 0004 1936 8884Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Michael A. Mitchell
- grid.39381.300000 0004 1936 8884Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
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8
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Fernandez-Trujillo L, Morales EI, Arias D, Zúñiga-Restrepo V, Sua LF. Organizing pneumonia as presenting feature of primary Sjögren's syndrome: A case report. Respir Med Case Rep 2023; 42:101830. [PMID: 36941995 PMCID: PMC10024043 DOI: 10.1016/j.rmcr.2023.101830] [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: 11/27/2022] [Revised: 01/28/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Sjögren's Syndrome (SS) is an autoimmune inflammatory disease, characterized by lymphocytic infiltration of exocrine glands. Approximately 10% of patients with SS have pulmonary involvement as the first manifestation of their disease, the most common being non-specific interstitial pneumonia. We present the case of a 51-year-old man with organizing pneumonia as the presenting feature of primary SS. Pulmonary involvement as the presenting feature of SS is uncommon, especially when the pattern on CT-scan is that of organized pneumonia. Initial management includes steroids and other immunosuppressants agents, with a better response in organized pneumonia secondary SS cases.
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Affiliation(s)
- Liliana Fernandez-Trujillo
- Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Corresponding author. Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Avenida Simón Bolívar, Cra 98 No. 18-49, Fundación Valle del Lili, Tower 6, 4th Floor, Cali, Colombia.
| | - Eliana I. Morales
- Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Daniela Arias
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | | | - Luz F. Sua
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Cali, Colombia
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9
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Thiboutot J, Illei PB, Maldonado F, Kapp CM, DeMaio A, Lee HJ, Feller-Kopman D, Lentz RJ, Sathyanarayan P, Rahman NM, Silvestri GA, Yarmus L. Safety and Feasibility of a Sheath Cryoprobe for Bronchoscopic Transbronchial Biopsy: The FROSTBITE Trial. Respiration 2022; 101:1131-1138. [PMID: 36265451 DOI: 10.1159/000526876] [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: 03/15/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung biopsy is typically performed using transbronchial forceps. However, this method is limited by small sample size and presence of crush artifact. Cryobiopsy offers the potential to overcome these limitations with larger artifact-free samples but has not been widely adopted due to concerns over increased rates of bleeding and pneumothorax. A new, smaller 1.1-mm cryoprobe has been developed that operates in a similar fashion to forceps, though the safety profile of this cryoprobe has not yet been prospectively studied. OBJECTIVE The aim of this study was to investigate the safety of transbronchial biopsy using a novel 1.1-mm cryoprobe. METHODS This prospective, single-arm study enrolled patients referred for transbronchial biopsy. All procedures were performed using the 1.1-mm cryoprobe with oversheath. The primary outcome was the composite of significant complications related to the cryobiopsy procedure (bleeding Grade ≥3, pneumothorax Grade ≥2, and respiratory failure). Bleeding and pneumothorax were graded according to previously published scales. RESULTS Fifty participants from two academic medical centers underwent transbronchial cryobiopsy. Indications for biopsy included evaluation of lung transplant allograft (50%), diffuse lung disease (44%), and pulmonary parenchymal lesion (6%). There were two pneumothoraces (4%), neither of which required aspiration or chest tube placement. There were no Grade 3 or 4 bleeding events. Mild bleeding (Grade ≤2) was observed in 25 cases (50%). No complications occurred that met the a priori primary outcome of bleeding Grade ≥3, pneumothorax Grade ≥2, and respiratory failure. CONCLUSIONS Transbronchial cryobiopsy using a 1.1-mm cryoprobe is feasible with an acceptable safety profile.
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Affiliation(s)
- Jeffrey Thiboutot
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter B Illei
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher M Kapp
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew DeMaio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hans J Lee
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Feller-Kopman
- Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Robert J Lentz
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Priya Sathyanarayan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Najib M Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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10
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Tanaka M, Matsumoto Y, Imabayashi T, Kawahara T, Tsuchida T. Diagnostic value of a new cryoprobe for peripheral pulmonary lesions: a prospective study. BMC Pulm Med 2022; 22:226. [PMID: 35689261 PMCID: PMC9188163 DOI: 10.1186/s12890-022-02003-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/07/2021] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
Background Cryobiopsy is an established technique that yields larger and higher-quality samples than does a forceps biopsy. However, it remains underutilised in the diagnosis of peripheral pulmonary lesions (PPLs), mainly because of difficulties in handling conventional cryoprobes. A recently introduced single-use cryoprobe with a smaller diameter and more flexibility than conventional ones may improve its diagnostic ability for PPLs. We conducted this prospective study to evaluate the feasibility of transbronchial cryobiopsy in the diagnoses of PPLs, using a new 1.7-mm cryoprobe.
Methods The study included patients with PPLs less than 30 mm in diameter scheduled to undergo bronchoscopy. All the procedures were performed using a combination of virtual bronchoscopic navigation, radial endobronchial ultrasound (R-EBUS) and X-ray fluoroscopy, and all the samples were collected using the cryoprobe alone. Thereafter, we assessed the diagnostic outcomes and safety profiles. Results A total of 50 patients were enrolled and underwent cryobiopsy. The median lesion size was 20.8 mm (range, 8.2–29.6 mm), and the negative bronchus sign was seen in 34% of lesions. The diagnostic yield was 94% (95% confidence interval, 83.5–98.8%). A positive bronchus sign had a significantly higher diagnostic yield than did a negative bronchus sign (100% vs. 82.4%; P = 0.035). The yield was achieved regardless of other variables, including lesion size, location, and R-EBUS findings. The major complications were mild and moderate bleeding in 28% and 62% of patients, respectively. Pneumothorax was identified in one patient.
Conclusion Transbronchial cryobiopsy using the new 1.7-mm cryoprobe is a feasible procedure that has the potential to increase the diagnostic accuracy for PPLs. Trial registration Japan Registry of Clinical Trials, jRCT1032200065. Registered July 8 2020, https://jrct.niph.go.jp/en-latest-detail/jRCT1032200065
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Affiliation(s)
- Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. .,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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11
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Palumbo R, Sarwar Z, Stewart KE, Garwe T, Reinersman JM. Predictors of Success When Implementing an Electromagnetic Navigational Bronchoscopy Program. J Surg Res 2022; 274:248-253. [PMID: 35216801 DOI: 10.1016/j.jss.2022.01.025] [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: 03/01/2021] [Revised: 11/10/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION With the advent of lung cancer screening, lung nodules are being discovered at an increasing rate. With improvements in transbronchial biopsy technology, it is important for thoracic surgeons to be involved with diagnostic procedures. The aim of this project is to relate the thoracic surgeon experience in implementing an electromagnetic navigational bronchoscopy (ENB) program at our institution and describe the factors that led to successful navigation (the ability to position a biopsy instrument in range for biopsy) and diagnostic biopsy of nodules. METHODS The thoracic surgery ENB program was initiated in 2014. A retrospective analysis of patients referred to thoracic surgery from 2014 to 2019 for lung nodule evaluation was performed. Patients who underwent ENB and biopsy were included. Recursive partitioning (CART) and multivariable regression analyses were used to identify predictors of successful navigation and biopsy. RESULTS There were 73 patients who underwent ENB evaluation of 91 nodules from 2014 to 2019. There was successful navigation in 75.8% of nodules, and on multivariable analysis, bronchus sign, lesion size, and pleural distance were significant predictors of successful navigation. Of the lesions that had successful navigation, 65.2% had a diagnostic biopsy. Based on CART analysis, positive bronchus sign and lesion size ≥ 1.3 cm were most predictive of obtaining a diagnostic biopsy with a probability of 0.75. CONCLUSIONS Nodule size, distance to the pleura, and bronchus size are independent variables of successful navigation when using ENB. However, of the lesions that were successfully reached, combined lesion size >1.3 cm and a positive bronchus sign were most predictive of obtaining a diagnostic biopsy. These factors should be considered when implementing an ENB program in a thoracic surgery practice.
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Affiliation(s)
- Rachael Palumbo
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Zoona Sarwar
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kenneth E Stewart
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Tabitha Garwe
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - J Matthew Reinersman
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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12
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Ueno H, Tsubouchi H, Nakanishi K, Sugiyama T, Kadomatsu Y, Goto M, Ozeki N, Nakamura S, Fukui T, Chen-Yoshikawa TF. Removal of hematoma due to massive hemoptysis after transbronchial biopsy: a case report. Surg Case Rep 2021; 7:237. [PMID: 34731346 PMCID: PMC8566610 DOI: 10.1186/s40792-021-01323-3] [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: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Massive hemoptysis is a life-threatening complication after transbronchial biopsy (TBB). Reports on massive hemoptysis occurring several days after TBB are scarce. Case presentation A 62-year-old man presented with massive hemoptysis and was admitted to hospital as an emergency on the eighth day after TBB. On the 12th day after TBB, computed tomography showed complete atelectasis of the right middle and lower lobes. The patient underwent emergent right upper lobectomy. The right upper lobe bronchus was separated with a scalpel, the hematoma was pulled out with forceps, and the bronchus subsequently sutured shut. The patient was discharged from the hospital uneventfully. Conclusions We experienced a case of massive hemoptysis on the eighth day after TBB, which required emergency surgery due to persistent bleeding into the airway and airway obstruction during follow-up. Postoperative pneumonia and atelectasis could be prevented by manual removal of the residual hematoma.
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Affiliation(s)
- Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hideki Tsubouchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keita Nakanishi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toyofumi Fengshi Chen-Yoshikawa
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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13
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Nishimatsu K, Minami S, Ihara S, Yasuoka H. Transformation From Adenocarcinoma to Pleomorphic Carcinoma as an Acquired Resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors. J Med Cases 2021; 12:310-314. [PMID: 34434479 PMCID: PMC8383589 DOI: 10.14740/jmc3710] [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: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022] Open
Abstract
Pulmonary pleomorphic carcinoma is a very rare histological type of primary lung cancer, and usually provides aggressive clinical courses. A 65-year-old Japanese woman was diagnosed by transbronchial biopsy of the primary tumor as c-stage IV (cT4N3M1b) of adenocarcinoma harboring L858R point mutation in the exon 21 of epidermal growth factor receptor (EGFR). She received EGFR tyrosine kinase inhibitors (TKIs) (gefitinib and erlotinib) and subsequently cytotoxic chemotherapies. Gefitinib achieved partial response, but was switched to erlotinib due to elevated serum aspartate transaminase. After resistance to EGFR-TKIs, the second transbronchial re-biopsy revealed pulmonary pleomorphic carcinoma. Both carcinomatous and sarcomatous components retained the L858R mutation, but did not acquire T790M mutation. This case suggested that the histological transformation to pulmonary pleomorphic carcinoma may be one of mechanisms of drug resistance to EGFR-TKIs.
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Affiliation(s)
- Kanako Nishimatsu
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Shoichi Ihara
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Hironao Yasuoka
- Department of Pathology, Osaka Police Hospital, Osaka, Japan
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14
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Abstract
The indications and utility of flexible bronchoscopy have expanded over the past few decades with major innovations in design and development of new tools for endobronchial interventions and image-guided tissue sampling techniques. This review highlights the application of advanced diagnostic bronchoscopy (including endobronchial ultrasound and CT navigational techniques), cryotherapy and the use of one-way endobronchial valves for persistent air leak in the pediatric setting.
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15
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Gotoh Y, Yamaguchi T, Yatsuya H, Ikeda A, Okamura T, Sakakibara Y, Ina T, Maeda Y, Hirochi M, Kako H, Goto Y, Isogai S, Yamamoto N, Kondo M, Imaizumi K. Predictive risk factors for pneumothorax after transbronchial biopsy using endobronchial ultrasonography with a guide sheath. BMC Pulm Med 2021; 21:181. [PMID: 34051763 PMCID: PMC8164257 DOI: 10.1186/s12890-021-01551-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pneumothorax is one complication of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS-TBB). We sought to clarify the risk factors for pneumothorax after EBUS-GS-TBB under fluoroscopic guidance. Methods We retrospectively reviewed data from 916 patients who underwent EBUS-GS-TBB at Fujita Health University Hospital. We evaluated the following risk factors for pneumothorax after EBUS-GS-TBB: patient characteristics (sex, age, and pulmonary comorbidities); lesion data (location, size, existence of ground-glass opacities [GGOs], pleural involvement, computed tomography [CT] bronchus sign, visibility on fluoroscopy, and EBUS findings); final diagnosis; years of bronchoscopist experience; and guide sheath size. Univariate and multivariate logistic regression analyses were performed. Results Among the 916 patients, 30 (3.28%) presented with pneumothorax. With a univariate analysis, factors that independently predisposed to pneumothorax included lesions containing GGOs, lesions in sagittal lung segments on fluoroscopy, lesions that were not visible on fluoroscopy, and infectious lesions. A univariate analysis also showed that lesions in the right upper lobe or left upper division, as well as malignant lesions, were less likely to lead to pneumothorax. Age, underlying pulmonary disease, CT bronchus sign, EBUS findings, bronchoscopist experience, and guide sheath size did not influence the incidence of pneumothorax. A multivariate analysis revealed that only lesions containing GGOs (odds ratio [OR] 6.47; 95% confidence interval [CI] 2.13–19.6, P = 0.001) and lesions in lung segments with a sagittal orientation on fluoroscopy (OR 2.47; 95% CI 1.09–5.58, P = 0.029) were significant risk factors for EBUS-GS-TBB-related pneumothorax. Conclusions EBUS-GS-TBB of lesions containing GGOs or lesions located in sagittal lung segments on fluoroscopy correlate with a higher pneumothorax risk.
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Affiliation(s)
- Yusuke Gotoh
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Teppei Yamaguchi
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Nagoya, Japan
| | - Aki Ikeda
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yosuke Sakakibara
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuma Ina
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuri Maeda
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Mariko Hirochi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Sumito Isogai
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naoki Yamamoto
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
| | - Masashi Kondo
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
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16
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Yu KL, Yang SM, Ko HJ, Tsai HY, Ko JC, Lin CK, Ho CC, Shih JY. Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions. Respiration 2021; 100:538-546. [PMID: 33845482 DOI: 10.1159/000515181] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated. OBJECTIVES The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. METHODS We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety. RESULTS While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; p = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; p = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; p = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm2, respectively. CONCLUSIONS TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.
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Affiliation(s)
- Kai-Lun Yu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Huan-Jang Ko
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hui-Yu Tsai
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ching-Kai Lin
- Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Yuan Shih
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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17
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Klein F, Soriano JC, Anfuso MB, Ruiz V, Perazzo M, Paladini H, Vigliano A, Ossés J, Lowenstein P, Vigliano C, Cáneva J. Transbronchial biopsies' histopathological findings leading to successful late steroid therapy in Covid-19 acute respiratory failure. Virchows Arch 2021; 479:827-833. [PMID: 33411031 PMCID: PMC7789084 DOI: 10.1007/s00428-020-02975-6] [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] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 12/15/2022]
Abstract
We present results from clinical, radiologic, gas exchange, lung mechanics, and fibre-optic bronchoscopy-guided transbronchial biopsies in a case of acute respiratory failure due to SARS-CoV-2 (Covid-19). This report highlights the pulmonary, immunological, and inflammatory changes found during acute diffuse alveolar damage and the later organizing phase. An early diffuse alveolar damage pattern with predominant epithelial involvement with active recruitment of T cells and monocytes was observed followed by a late organizing pattern with pneumocyte hyperplasia, inflammatory infiltration, prominent endotheliitis, and secondary germinal centers. The patient’s deterioration paralleling the late immuno-pathological findings based the decision to administer intravenous corticosteroids, resulting in clinical, gasometric, and radiologic improvement. We believe that real-time clinicopathological correlation, along with the description of the immunological processes at play, will contribute to the full clinical picture of Covid-19 and might lead to a more rational approach in the precise timing of anti-inflammatory, anti-cytokine, or steroid therapies.
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Affiliation(s)
- Francisco Klein
- Department of Critical Care, Favaloro Foundation University Hospital, Favaloro University, Solís 453, C1078AAI, Buenos Aires, Argentina.
| | - Juan Calderón Soriano
- Department of Lung Diseases, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Melany Berdiñas Anfuso
- Department of Critical Care, Favaloro Foundation University Hospital, Favaloro University, Solís 453, C1078AAI, Buenos Aires, Argentina
| | - Victoria Ruiz
- Department of Critical Care, Favaloro Foundation University Hospital, Favaloro University, Solís 453, C1078AAI, Buenos Aires, Argentina
| | - María Perazzo
- Department of Critical Care, Favaloro Foundation University Hospital, Favaloro University, Solís 453, C1078AAI, Buenos Aires, Argentina
| | - Hugo Paladini
- Department of Radiology, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Alejandra Vigliano
- Department of Radiology, Favaloro Foundation University Hospital, Buenos Aires, Argentina.,Department of Basic Sciences of Pathology, Favaloro Foundation University, Buenos Aires, Argentina
| | - Juan Ossés
- Department of Lung Diseases, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Pedro Lowenstein
- Department of Basic Sciences of Pathology, Favaloro Foundation University, Buenos Aires, Argentina.,Department of Neurosurgery, The University of Michigan School of Medicine, Ann Arbor, MI, 48104, USA
| | - Carlos Vigliano
- Department of Basic Sciences of Pathology, Favaloro Foundation University, Buenos Aires, Argentina.,Department of Pathology, Favaloro Foundation University Hospital, Buenos Aires, Argentina.,Institute of Translational Medicine, Transplantation and Bioengineering (IMeTTyB), Favaloro University-CONICET, Buenos Aires, Argentina
| | - Jorge Cáneva
- Department of Lung Diseases, Favaloro Foundation University Hospital, Buenos Aires, Argentina
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18
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Tateishi A, Matsumoto Y, Tanaka M, Nakai T, Sasada S, Aoshima M, Tsuchida T. The utility of transbronchial rebiopsy for peripheral pulmonary lesions in patients with advanced non-squamous non-small cell lung cancer. BMC Pulm Med 2020; 20:238. [PMID: 32907572 DOI: 10.1186/s12890-020-01277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 01/06/2023] Open
Abstract
Background Patients treated for non-squamous (non-Sq) non-small cell lung cancer (NSCLC) often require repeat biopsies to determine the optimal subsequent treatment. However, the differences between rebiopsy and initial biopsy in terms of their diagnostic yields and their ability to test the molecular profiles using bronchoscopy with radial endobronchial ultrasound guidance in patients with advanced NSCLC remain unclear. Hence, we aimed to compare the diagnostic yields and ability for molecular analyses of rebiopsies with those of initial biopsies. Methods We investigated 301 patients with advanced non-Sq NSCLC who underwent radial endobronchial ultrasound-guided transbronchial biopsy (TBB) for peripheral pulmonary lesions (PPLs) between August 2014 and July 2017. Patients were divided into the rebiopsy and initial biopsy groups: the latter referred to the biopsy that determined the definitive diagnosis. The diagnostic yields and ability for molecular analyses were compared between the two groups, and the factors affecting the TBB diagnostic yield were identified using univariate and multivariate analyses. Results The diagnostic yields of the rebiopsy and initial biopsy groups were comparable (86.8 and 90.8%, respectively; p = 0.287). Furthermore, 93.0 and 94.0% of the patients in the rebiopsy and initial biopsy groups, respectively, had adequate specimens for gene profiling and mutational analysis (p = 0.765). The factors that increased the diagnostic yield were a positive bronchus sign (p < 0.001) and tumour location within the internal two-thirds of the lungs (p = 0.026). Conclusions The PPL diagnostic yield of the rebiopsy group was as high as that of the initial biopsy group. Hence, TBB for PPLs is feasible for patients requiring rebiopsy as well as for those with initial diagnoses. Adequate, high-quality biopsy specimens can be obtained by transbronchial rebiopsy for molecular testing.
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19
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Boonsarngsuk V, Petnak T, So-Ngern A, Saksitthichok B, Kanoksil W. Comparison of different transbronchial biopsy sampling techniques for the diagnosis of peripheral pulmonary lesions with radial endobronchial ultrasound-guided bronchoscopy: A prospective study. Respir Investig 2020; 58:381-386. [PMID: 32284223 DOI: 10.1016/j.resinv.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/07/2020] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Data regarding the transbronchial biopsy (TBB) techniques in radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy are limited. The purpose of this study was to compare three R-EBUS-guided TBB techniques for the diagnosis of peripheral pulmonary lesions (PPLs). METHODS A prospective pilot study was conducted including 90 patients with positive bronchus sign PPLs, who underwent R-EBUS-guided TBB. TBB techniques were performed in all patients using small biopsy forceps with a guide sheath (GS). These samples were submitted for both cell block histology (CB) and conventional histology (SB). Standard biopsy forceps were used to collect further samples that were submitted for conventional histology (LB). The diagnostic yields of the three techniques were compared. RESULTS The mean diameter of the PPLs was 25.5 ± 8.2 mm and the final diagnoses included 70 malignant and 20 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 82.2%. Although the difference was not statistically significant, CB provided the highest yield of the three TBB techniques: 68.9%, 65.6%, and 62.2% for CB, SB, and LB, respectively (P = 0.20). When the GS was removed and standard biopsy forceps were introduced, misplacement (detected by fluoroscopy) was observed in 24 cases, and LB provided a diagnosis in 11 cases. PPLs ≤20 mm were associated with misplacement (P = 0.003). After the exclusion of misplaced cases, the diagnostic yields were 69.7%, 71.2%, and 68.2% for CB, SB, and LB, respectively (P = 0.65). CONCLUSIONS Neither the size of biopsy forceps nor the histology process affected the diagnostic yield of R-EBUS-guided bronchoscopy.
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Affiliation(s)
- Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Apichart So-Ngern
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Bancha Saksitthichok
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Wasana Kanoksil
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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20
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Hetzel J, Linzenbold W, Boesmueller H, Enderle M, Poletti V. Evaluation of Efficacy of a New Cryoprobe for Transbronchial Cryobiopsy: A Randomized, Controlled in vivo Animal Study. Respiration 2020; 99:248-256. [PMID: 32101862 DOI: 10.1159/000506017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/03/2019] [Accepted: 01/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Forceps biopsy (FB) is still the most popular procedure for the bronchoscopic sampling of lung tissue. However, it has limitations like inadequate sample size and crush artifacts. Cryobiopsy (CB) has been introduced to obtain bronchoscopic biopsies with improved diagnostic yield compared to FB. Limitations of CB are the need to retract the cryoprobe en bloc with bronchoscope because samples are larger than the working channel and the variations of the freezing power of the reusable CB (rCB). Therefore, 3 new disposable cryoprobes (dCB) have been developed with different outer diameters: 1.1 mm (CB11-S) that can be retracted through the working channel of the bronchoscope, 1.7 mm (CB17) and 2.4 mm (CB24n), respectively. OBJECTIVES The aim was to evaluate the new cryoprobes with regard to feasibility, specimen area, specimen quality and complications. METHODS We compared biopsy samples of the new probes with those obtained by FB and by rCB in an in vivo (porcine) model. A flexible bronchoscope was used to perform biopsy at 4 different locations at the upper and lower lobes of the right and left lung, respectively. The biopsies were taken under fluoroscopic control. The biopsy tool and activation times were allocated randomly. Altogether 204 biopsy procedures were performed. RESULTS The sample quality of the dCB was superior to that of FB (all p < 0.05) and not significantly different to the rCB sample quality. Mean specimen sample area of all CB was significantly larger compared to FB (p < 0.05). The sample area of the small cryoprobe (CB11-S) was significantly smaller compared to the other CB probes (p < 0.05). No severe bleedings occurred. Pneumothoraces were detected in 3 of the 7 pigs. CONCLUSION We conclude that CB with the new single-use instruments are feasible and represent a viable option to improve the diagnostic accuracy of histopathological evaluation compared to FB.
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Affiliation(s)
- Jürgen Hetzel
- Department of Medical Oncology and Pneumology, University of Tübingen, Tübingen, Germany,
| | | | - Hans Boesmueller
- Institute of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | | | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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21
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Suzuki S, Ichikawa K, Kouno Y, Takeda N, Suzuki Y, Suzuki A. Transbronchial biopsy of peripheral lung lesions using fluoroscopic guidance combined with an enhanced ray-summation display. Radiol Phys Technol 2019; 13:52-61. [PMID: 31745721 DOI: 10.1007/s12194-019-00546-2] [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: 12/11/2018] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the effectiveness of guidance assistance during transbronchial biopsy (TBB) to achieve an appropriate pathway to small and peripheral pulmonary lesions (PPLs) using a combination of fluoroscopy and specialized ray-summation (Ray-sumTBB) images, which were processed from preprocedural lung computed tomography (CT) images. To improve the visibility of the correct pathway to the PPLs, three-dimensional spatial resolution enhancement and CT number conversion processes were applied to the original CT images. The Ray-sumTBB images reconstructed from the processed CT images were used as additional guides. We compared the rates of successful tumor localization and biopsy (arrival rate) between the trial (with Ray-sumTBB) and control (without Ray-sumTBB) groups. The fluoroscopy and examination times were also compared. The arrival rate of the trial group (73.1%) was significantly better than that of the control group (42.3%) (p = 0.048). The fluoroscopy and examination times did not differ significantly between the trial and control groups. No complications were identified in the trial group. Our results suggest that Ray-sumTBB improves the diagnostic accuracy of TBB.
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Affiliation(s)
- Shogo Suzuki
- Department of Radiological Technology, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, 448-8505, Aichi, Japan. .,Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Ishikawa, Japan.
| | - Katsuhiro Ichikawa
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Ishikawa, Japan
| | - Yasuhisa Kouno
- Department of Radiological Technology, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, 448-8505, Aichi, Japan
| | - Naoya Takeda
- Department of Respiratory and Allergy Medicine, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, 448-8505, Aichi, Japan
| | - Yoshihiro Suzuki
- Department of Respiratory and Allergy Medicine, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, 448-8505, Aichi, Japan
| | - Ayumi Suzuki
- Department of Thoracic Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, 448-8505, Aichi, Japan
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22
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Ndilanha DA, Shayo GA, Hassan R, Byomuganyizi M, Lema LEK. Diagnoses from lung specimen collected through flexible bronchoscopy from patients in a tertiary hospital in Dar es Salaam Tanzania: a retrospective cross-sectional study. BMC Pulm Med 2019; 19:214. [PMID: 31727025 PMCID: PMC6854817 DOI: 10.1186/s12890-019-0972-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/21/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Flexible bronchoscopy enables visualization of the respiratory airway mucosa from the oropharynx to third generation branching of the tracheobronchial tree. Bronchoscopic diagnoses vary from one locality to the other in accordance to the locality specific risk factors for lung diseases. This study aimed at describing diagnoses of all specimen of patients who underwent flexible bronchoscopy at Muhimbili National Hospital from January 2013 to November 2017. METHODS A retrospective hospital-based cross sectional study was conducted among 451 patients. Data was collected from archives and included both demographic and clinical variables. Descriptive statistics were used to summarize the study findings. RESULTS There was a 3 fold increase in the number of patients who underwent flexible bronchoscopy from 57 cases in 2013 to 180 cases in 2017. About 39% (174/451) of patients underwent lung biopsies while 64.5% (291/451) underwent bronchioalveolar lavage, bronchial washings or brush cytology, alone or in combination with biopsy. Generally, 64.4% (112/174) of all lung biopsies were malignant. Adenocarcinoma was the most common diagnosis seen in 33.9% (59/174). Of 76 cytological samples which were sent for bacterial culture and sensitivity, 11/76 (11.8%) were culture positive. A total of 6 (10.7%) out of 56 samples which were sent for GeneXpert MTB/RIF tested positive for M.tuberculosis. CONCLUSION Adenocarcinoma was the most common diagnosis. Bacterial and mycobacterial infections were among the most reported findings in cytological samples. Suspicious tuberculosis lesions during bronchoscopy made it possible to diagnose tuberculosis which was hard to diagnose before patients were sent for bronchoscopy.
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Affiliation(s)
- Deus A. Ndilanha
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Grace A. Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Ramadhan Hassan
- Department of Surgery, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Moses Byomuganyizi
- Department of Surgery, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Leonard E. K. Lema
- Department of Surgery, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
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Mondoni M, Sotgiu G. Bronchoscopic management of peripheral pulmonary lesions: robotic approach paves the way to the future. BMC Pulm Med 2019; 19:166. [PMID: 31470842 PMCID: PMC6717328 DOI: 10.1186/s12890-019-0927-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy.
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Futami S, Takimoto T, Nakagami F, Satoh S, Hamaguchi M, Kuroyama M, Miyake K, Koyama S, Iwahori K, Hirata H, Nagatomo I, Takeda Y, Kida H, Kumanogoh A. A lung abscess caused by secondary syphilis - the utility of polymerase chain reaction techniques in transbronchial biopsy: a case report. BMC Infect Dis 2019; 19:598. [PMID: 31288744 DOI: 10.1186/s12879-019-4236-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background In Japan and other countries, the number of patients with syphilis is increasing year by year. Recently, the cases of the pulmonary involvement in patients with secondary syphilis have been reported. However, it is still undetermined how to obtain a desirable specimen for a diagnosis of the pulmonary involvement, and how to treat it if not cured. Case presentation A 34-year-old man presented with cough and swelling of the right inguinal nodes. A physical examination revealed erythematous papular rash over the palms, soles and abdomen. A 4 cm mass in the right lower lobe of the lung was detected on computed tomography. He was diagnosed as having secondary syphilis, because he was tested positive for the rapid plasma reagin and Treponema pallidum hemagglutination assay. Amoxycillin and probenecid were orally administered for 2 weeks. Subsequently, rash and serological markers were improved, however, the lung mass remained unchanged in size. Transbronchial biopsy (TBB) confirmed the pulmonary involvement of syphilis using polymerase chain reaction techniques (tpp47- and polA-PCR). Furthermore, following surgical resection revealed the lung mass to be an abscess. Conclusions To our knowledge, this is the first surgically treated case of a lung abscess caused by syphilis, which was diagnosed by PCR techniques in TBB. This report could propose a useful diagnostic method for the pulmonary involvement of syphilis.
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25
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Herout V, Heroutova M, Merta Z, Cundrle I, Brat K. Transbronchial biopsy from the upper pulmonary lobes is associated with increased risk of pneumothorax - a retrospective study. BMC Pulm Med 2019; 19:56. [PMID: 30823915 PMCID: PMC6397442 DOI: 10.1186/s12890-019-0820-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 12/19/2018] [Accepted: 02/21/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes. METHODS All bronchoscopic records from the period January 1st, 2015 - December 31st, 2017 (from the Department of Respiratory Diseases, University Hospital Brno, Czech Republic) were retrospectively analyzed. Of the 3542 bronchoscopic records, 796 patients underwent TBB and were further analyzed. Basic demographic data, TBB procedure-related factors, smoking history and radiological features were analyzed. Furthermore, in patients who developed PTX, PTX onset, PTX symptoms, distribution of the abnormal radiological findings and duration of hospitalization were also analyzed. RESULTS Patients who developed PTX had significantly lower body mass index (BMI) and more than 4 samples taken during procedure (all p < 0.05). TBB performed from the left upper pulmonary lobe was associated with a significant risk of PTX development (OR 2.27; 95% CI 1.18-4.35; p = 0.02). On the contrary, TBB performed from the right lower lobe was associated with a significant reduction of risk of developing PTX (OR 0.47; 95% CI 0.22-0.98; p = 0.04). Logistic regression analysis showed BMI (OR 1.08; 95% CI 1.02-1.16; p = 0.01), left upper lobe as sampling site (OR 2.15; 95% CI 1.13-4.11; p = 0.02) and more than 4 samples taken (OR 1.91; 95% CI 1.04-3.49; p = 0.04) to be significantly associated with PTX development. CONCLUSIONS We conclude that TBB from the left upper pulmonary lobe is associated with significantly increased risk of post-procedural PTX. The right lower pulmonary lobe seems to be the safest sampling site to perform TBB. In patients with diffuse-type pulmonary disease, TBB should be performed preferably from the right lower lobe in order to decrease the risk of post-procedural PTX.
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Affiliation(s)
- Vladimir Herout
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska 20, 62500, Brno, Czech Republic
| | - Michaela Heroutova
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska 20, 62500, Brno, Czech Republic
| | - Zdenek Merta
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska 20, 62500, Brno, Czech Republic
| | - Ivan Cundrle
- Department of Anesthesiology and Intensive Care, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska 20, 62500, Brno, Czech Republic.
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Almadani A, Ping MNY, Deenadayalu A, Saunders J, O'Brien A. The Effect of Using Different Types of Forceps in the Efficacy of Transbronchial Lung Biopsy. Lung 2018; 197:61-66. [PMID: 30443800 DOI: 10.1007/s00408-018-0179-6] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transbronchial lung biopsy (TBBX) is a common respiratory diagnostic procedure performed to investigate several lung diseases. There are different types of forceps used to perform this procedure. The alligator and cupped (oval) forceps are most commonly used ones. To date, there are few studies that have compared the efficacy of these two types of forceps. This study compares the two types of forceps relating to the rate of complications and diagnostic value. METHODS In this retrospective observational study, 40 patients who underwent TBBX using the alligator forceps were compared to a previous group of 40 patients who underwent the same procedure using the cupped forceps. The two groups were compared with respect to the rate of complications (bleeding and pneumothorax), diagnostic value and size of biopsies. RESULTS The rate of complications was higher in patients who underwent TBBX using alligator forceps, in which seven patients (17.5%) had significant bleeding in the group that used alligator forceps versus three patients (7.5%) in cupped forceps group. Pneumothorax developed in three patients, all of whom were in the alligator forceps group. While there was no significant difference in the adequacy and size of the samples, the diagnostic yield was higher in the cupped forceps group. CONCLUSIONS The results of the study showed that using cupped forceps in performing TBBX had fewer complications (pneumothorax and bleeding) and a higher diagnostic yield in comparison with alligator forceps, but the difference did not reach a statistical significant value.
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Affiliation(s)
- Abdulrahman Almadani
- University Hospital Limerick, Limerick, Ireland. .,Bahrain Defence Force Hospital-Royal Medical Services (BDF-RMS), Riffa, Bahrain.
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Sueyasu T, Tobino K, Okahisa M, Murakami K, Goto Y, Munechika M, Yoshimine K, Nishizawa S, Ko Y, Yoshimatsu Y, Asaji M, Tsuruno K, Ide H, Miyajima H. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) presenting as an endobronchial lesion: Case report and literature review. Respir Med Case Rep 2018; 23:176-181. [PMID: 29719812 PMCID: PMC5926509 DOI: 10.1016/j.rmcr.2018.03.003] [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: 12/01/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022] Open
Abstract
Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) is a rare entity of lymphoma. We herein report an even rarer case of a 68-year-old male with PTCL-NOS presenting as an endobronchial lesion, and review previously published cases in the literature. Initially, he was referred to our hospital for further investigation of the right upper lobe consolidation on chest radiograph. Computed tomography and 18F-fludeoxyglucose positron emission tomography revealed a right hilar mass with obstruction of the main bronchus and submandibular, right axillary and mediastinal lymphadenopathy. Pathological examination of the biopsy specimens from of the endobronchial lesion and subcutaneous nodule revealed PTCL-NOS. Chemotherapy was started but he finally died due to septic shock after the second-line chemotherapy.
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Affiliation(s)
- Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Masanobu Okahisa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Kojin Murakami
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Goto
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Miyuki Munechika
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Mina Asaji
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
| | - Hiroyuki Miyajima
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi; Iizuka, Fukuoka, 820-8505, Japan
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Akten HS, Kilic H, Celik B, Erbas G, Isikdogan Z, Turktas H, Kokturk N. Diagnostic Yield of Transbronchial Biopsy in Comparison to High Resolution Computerized Tomography in Sarcoidosis Cases. Asian Pac J Cancer Prev 2018; 19:1029-1033. [PMID: 29693979 PMCID: PMC6031780 DOI: 10.22034/apjcp.2018.19.4.1029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aimed to evaluate the diagnostic yield of fiberoptic bronchoscopic (FOB) transbronchial biopsy and
its relation with quantitative findings of high resolution computerized tomography (HRCT). A total of 83 patients,
19 males and 64 females with a mean age of 45.1 years diagnosed with sarcoidosis with complete records of high
resolution computerized tomography were retrospectively recruited during the time period from Feb 2005 to Jan 2015.
High resolution computerized tomography scans were retrospectively assessed in random order by an experienced
observer without knowledge of the bronchoscopic results or lung function tests. According to the radiological staging
with HRCT, 2.4% of the patients (n=2) were stage 0, 19.3% (n=16) were stage 1, 72.3% (n=60) were stage 2 and 6.0%
(n=5) were stage 3. This study showed that transbronchial lung biopsy showed positive results in 39.7% of the stage I
or II sarcoidosis patients who were diagnosed by bronchoscopy. Different high resolution computerized tomography
patterns and different scores of involvement did make a difference in the diagnostic accuracy of transbronchial biopsy
(p=0.007).
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Affiliation(s)
- H Serpil Akten
- Department of Pulmonary Medicine , Medical Faculty, Gazi University, Ankara, Turkey. nkokturk©gmail.com
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Asano F, Ishida T, Shinagawa N, Sukoh N, Anzai M, Kanazawa K, Tsuzuku A, Morita S. Virtual bronchoscopic navigation without X-ray fluoroscopy to diagnose peripheral pulmonary lesions: a randomized trial. BMC Pulm Med 2017; 17:184. [PMID: 29228929 PMCID: PMC5725971 DOI: 10.1186/s12890-017-0531-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 07/06/2017] [Accepted: 11/24/2017] [Indexed: 02/08/2023] Open
Abstract
Background Transbronchial biopsy for peripheral pulmonary lesions is generally performed under X-ray fluoroscopy. Virtual bronchoscopic navigation (VBN) is a method in which virtual images of the bronchial route to the lesion are produced based on CT images obtained before VBN, and the bronchoscope is guided using these virtual images, improving the diagnostic yield of peripheral pulmonary lesions. VBN has the possibility of eliminating the need for X-ray fluoroscopy in the bronchoscopic diagnosis of peripheral lesions. To determine whether VBN can be a substitute for X-ray fluoroscopy, a randomized multicenter trial (non-inferiority trial) was performed in VBN and X-ray fluoroscopy (XRF) -assisted groups. Methods The non-inferiority margin in the VBN-assisted group compared with the XRF-assisted group was set at 15%. The subjects consisted of 140 patients with peripheral pulmonary lesions with a mean diameter > 3 cm. In the VBN-assisted group, the bronchoscope was guided to the lesion using a VBN system without X-ray fluoroscopy. In the XRF-assisted group, the same bronchoscope was guided to the lesion under X-ray fluoroscopy. Subsequently, in both groups, the lesion was visualized using endobronchial ultrasonography with a guide sheath (EBUS/GS), and biopsy was performed. In this serial procedure, X-ray fluoroscopy was not used in the VBNA group. Results The subjects of analysis consisted of 129 patients. The diagnostic yield was 76.9% (50/65) in the VBN-assisted group and 85.9% (55/64) in the XRF-assisted group. The difference in the diagnostic yield between the two groups was -9.0% (95% confidence interval: -22.3% ~ 4.3%). The non-inferiority of the VBN-assisted group could not be confirmed. The rate of visualizing lesions by EBUS was 95.4% (62/65) in the VBN-assisted group and 96.9% (62/64) in the XRF-assisted group, being high in both groups. Conclusions On EBUS/GS, a bronchoscope and biopsy instruments may be guided to the lesions using VBN without X-ray fluoroscopy, but X-ray fluoroscopy is necessary to improve the accuracy of sample collection from lesions. During transbronchial biopsy for peripheral pulmonary lesions, VBN cannot be a substitute for X-ray fluoroscopy. Trial registration UMIN-CTR (UMIN000001710); registered 16 February 2009.
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Affiliation(s)
- Fumihiro Asano
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, 500-8717, Japan.
| | - Takashi Ishida
- Department of Pulmonary Medicine, Fukushima Medical University, 1, Hikariga-oka, Fukushima City, 960-1295, Japan
| | - Naofumi Shinagawa
- First Department of Medicine, Hokkaido University School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Noriaki Sukoh
- Department of Pulmonary Diseases, National Hospital Organization Hokkaido Cancer Center, 4-2-3-54, Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan
| | - Masaki Anzai
- Department of Pulmonary Medicine, Fukui University School of Medicine, 23-3, Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, 1, Hikariga-oka, Fukushima City, 960-1295, Japan
| | - Akifumi Tsuzuku
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, 4-6-1, Noishiki, Gifu, 500-8717, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Choi Y, Lu J, Hu Z, Pankratz DG, Jiang H, Cao M, Marchisano C, Huiras J, Fedorowicz G, Wong MG, Anderson JR, Tom EY, Babiarz J, Imtiaz U, Barth NM, Walsh PS, Kennedy GC, Huang J. Analytical performance of Envisia: a genomic classifier for usual interstitial pneumonia. BMC Pulm Med 2017; 17:141. [PMID: 29149880 PMCID: PMC5693488 DOI: 10.1186/s12890-017-0485-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Received: 01/12/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical guidelines specify that diagnosis of interstitial pulmonary fibrosis (IPF) requires identification of usual interstitial pneumonia (UIP) pattern. While UIP can be identified by high resolution CT of the chest, the results are often inconclusive, making surgical lung biopsy necessary to reach a definitive diagnosis (Raghu et al., Am J Respir Crit Care Med 183(6):788-824, 2011). The Envisia genomic classifier differentiates UIP from non-UIP pathology in transbronchial biopsies (TBB), potentially allowing patients to avoid an invasive procedure (Brown et al., Am J Respir Crit Care Med 195:A6792, 2017). To ensure patient safety and efficacy, a laboratory developed test (LDT) must meet strict regulatory requirements for accuracy, reproducibility and robustness. The analytical characteristics of the Envisia test are assessed and reported here. METHODS The Envisia test utilizes total RNA extracted from TBB samples to perform Next Generation RNA Sequencing. The gene count data from 190 genes are then input to the Envisia genomic classifier, a machine learning algorithm, to output either a UIP or non-UIP classification result. We characterized the stability of RNA in TBBs during collection and shipment, and evaluated input RNA mass and proportions on the limit of detection of UIP. We evaluated potentially interfering substances such as blood and genomic DNA. Intra-run, inter-run, and inter-laboratory reproducibility of test results were also characterized. RESULTS RNA content within TBBs preserved in RNAprotect is stable for up to 14 days with no detectable change in RNA quality. The Envisia test is tolerant to variation in RNA input (5 to 30 ng), with no impact on classifier results. The Envisia test can tolerate dilution of non-UIP and UIP classification signals at the RNA level by up to 60% and 20%, respectively. Analytical specificity studies utilizing UIP and non-UIP samples mixed with genomic DNA (up to 30% relative input) demonstrated no impact to classifier results. The Envisia test tolerates up to 22% of blood contamination, well beyond the level observed in TBBs. The test is reproducible from RNA extraction through to Envisia test result (standard deviation of 0.20 for Envisia classification scores on > 7-unit scale). CONCLUSIONS The Envisia test demonstrates the robust analytical performance required of an LDT. Envisia can be used to inform the diagnoses of patients with suspected IPF.
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Affiliation(s)
- Yoonha Choi
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Jiayi Lu
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Zhanzhi Hu
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Daniel G Pankratz
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Huimin Jiang
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Manqiu Cao
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Cristina Marchisano
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Jennifer Huiras
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Grazyna Fedorowicz
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Mei G Wong
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Jessica R Anderson
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Edward Y Tom
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Joshua Babiarz
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Urooj Imtiaz
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Neil M Barth
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - P Sean Walsh
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Giulia C Kennedy
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA
| | - Jing Huang
- Veracyte, Inc., 6000 Shoreline Ct., Suite 300, South San Francisco, 94080, California, USA.
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Galli JA, Panetta NL, Gaeckle N, Martinez FJ, Moore B, Moore T, Courey A, Flaherty K, Criner GJ; COMET investigators. Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial. Lung 2017; 195:537-43. [PMID: 28623539 DOI: 10.1007/s00408-017-0028-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Some patients with diffuse interstitial lung disease (ILD) undergo bronchoscopy with transbronchial biopsy (TBB) as part of their diagnostic evaluation. It is unclear what the incidence and risk factors for pneumothorax (PTX) following TBB are in this patient population. METHODS Ninety-seven subjects with pulmonary fibrosis who underwent a research bronchoscopy with TBB as part of the multicenter correlating outcomes with biochemical markers to estimate time-progression in idiopathic pulmonary fibrosis (COMET) trial were retrospectively reviewed. We compared subjects who developed a PTX during research bronchoscopy with TBB versus those who did not. RESULTS Seven patients (7.2%) experienced a PTX during research bronchoscopy with TBB. Subjects who experienced PTX during TBB had significantly lower DLCO percent predicted (29 ± 8 vs. 45 ± 15, P = 0.006) and had lower resting room air saturation of peripheral oxygen (SPO2) on 6-min walk testing (91 ± 10 vs. 95 ± 3, P = 0.02). No differences between groups were found with respect to age, gender, race, BMI, HRCT characteristics, or the number of transbronchial biopsies performed. CONCLUSION The incidence of PTX following research bronchoscopy with TBB in patients with pulmonary fibrosis was found to be 7.2% in this study. Patients who developed a pneumothorax had greater impairments in gas exchange at baseline evidenced by a lower DLCO % predicted and a lower resting room air SPO2 compared with subjects without PTX as a complication.
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Abstract
BACKGROUND Bronchoscopic procedures have been increasingly used for the diagnosis of peripheral lung cancers, but the yield remains moderately low. The aim of this study is to assess the feasibility and ability of a custom-built bimodal optical spectroscopy system to enhance the on-site discrimination between malignant and benign specimens obtained from the transbronchial lung biopsies (TBLB) of peripheral lung lesions. METHODS We conducted a prospective and single-center pilot study to examine the TBLB specimens obtained from peripheral lung lesions. Diffuse reflectance spectroscopy (DRS) and diffuse fluorescence spectroscopy (DFS) parameters were used to analyze the optical characteristics of these specimens. RESULTS One hundred and sixteen biopsy specimens from 15 patients were analyzed using optical imaging. All specimens had a confirmed pathologic diagnosis. Notably, 22 of the 116 specimens were malignant, and 10 of the 94 non-malignant specimens were necrotic biopsies. Individual parameters showed significant difference between the three groups (malignant, non-malignant and necrosis). Multivariate analysis of the blood, scattering and fluorescence parameters demonstrated a sensitivity of 77.3% and specificity of 73.1% in differentiating between malignant and benign specimens and a sensitivity of 90.9% and specificity of 100% in differentiating malignant from necrotic specimens. CONCLUSIONS We conclude that optical spectroscopy is a feasible modality for on-site discrimination between malignant and benign as well as malignant and necrotic TBLB specimens of peripheral lung lesions.
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Affiliation(s)
- Kassem Harris
- Department of Medicine, Interventional Pulmonary section, Westchester Medical Center, Valhalla New York, USA
| | - Daniel J Rohrbach
- Department of Biomedical, Industrial and Human Factors Engineering, United States Wright State University, Dayton, Ohio, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Jingxin Qiu
- Department of pathology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Ulas Sunar
- Department of Biomedical, Industrial and Human Factors Engineering, United States Wright State University, Dayton, Ohio, USA
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Cirino CCI, Nogueira AP, Amate Neto A, Urbano PC, de Nadai TR. Toxoplasma gondii pseudocyst in a transbronchial biopsy: a case report. J Med Case Rep 2016; 10:261. [PMID: 27658582 PMCID: PMC5034576 DOI: 10.1186/s13256-016-1039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/05/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background We herein present a case in which a Toxoplasma cyst was found in a transbronchial biopsy specimen from an immunocompetent patient with negative serology for the parasite. Case presentation An 18-year-old Brazilian man presented with a 1-week history of dyspnea and fever and was diagnosed with right lower lobe pneumonia. He began inpatient treatment with intravenous antibiotics. During treatment, a bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed. Anatomopathological examination of the transbronchial biopsy showed a small fragment of lung parenchyma with discrete septal thickening and a rounded structure, suggestive of a pseudocyst containing Toxoplasma gondii bradyzoites. However, serological tests were negative for immunoglobulin G and immunoglobulin M. Conclusions Bronchoscopy is a minimally invasive, effective diagnostic and therapeutic method. Despite the fact that the Toxoplasma pseudocyst in the present case was not the cause of the patient’s comorbidities, bronchoscopy with transbronchial biopsy allowed for an incidental diagnosis of a Toxoplasma pseudocyst with minimal invasiveness.
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Affiliation(s)
- Caio César Inaco Cirino
- Americo Brasiliense State Hospital, 1260 Alameda Aldo Lupo, 14820-000, Américo Brasiliense, SP, Brazil
| | - André Peluso Nogueira
- Americo Brasiliense State Hospital, 1260 Alameda Aldo Lupo, 14820-000, Américo Brasiliense, SP, Brazil
| | - André Amate Neto
- Americo Brasiliense State Hospital, 1260 Alameda Aldo Lupo, 14820-000, Américo Brasiliense, SP, Brazil
| | - Patricia Cristina Urbano
- Americo Brasiliense State Hospital, 1260 Alameda Aldo Lupo, 14820-000, Américo Brasiliense, SP, Brazil
| | - Tales Rubens de Nadai
- Americo Brasiliense State Hospital, 1260 Alameda Aldo Lupo, 14820-000, Américo Brasiliense, SP, Brazil. .,Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, 3900 Avenida Bandeirantes, 14048-900, Ribeirão Preto, SP, Brazil.
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Gleason JB, Schroeder JR, Ramirez J. Meningotheliomatosis: A Rare Cause of Diffuse Miliary Pattern Pulmonary Opacities. J Clin Diagn Res 2016; 10:OJ05. [PMID: 27656496 DOI: 10.7860/jcdr/2016/22345.8354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 07/15/2016] [Indexed: 11/24/2022]
Affiliation(s)
- James Benjamin Gleason
- Chief Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida , Weston, Florida, USA
| | - Jonathan Ryan Schroeder
- Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida , Weston, Florida, USA
| | - Jose Ramirez
- Attending Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida , Weston, Florida, USA
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Hayama M, Okamoto N, Suzuki H, Tamiya M, Shiroyama T, Tanaka A, Nishida T, Nishihara T, Uehara N, Morishita N, Kawahara K, Hirashima T. Radial endobronchial ultrasound with a guide sheath for diagnosis of peripheral cavitary lung lesions: a retrospective study. BMC Pulm Med 2016; 16:76. [PMID: 27170169 PMCID: PMC4866378 DOI: 10.1186/s12890-016-0244-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Received: 02/22/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Radial endobronchial ultrasound with a guide sheath (EBUS-GS) has improved the diagnostic outcomes of peripheral lung lesions. However, to our knowledge, reports on the use of EBUS-GS for diagnosis of cavitary lesions are unavailable. Therefore, this study aimed to assess the effectiveness and safety of EBUS-GS for diagnosis of peripheral cavitary lung lesions (PCLLs). Methods This study was a single-institution retrospective review of PCLLs examined by using EBUS-GS between July 2013 and October 2015. The diagnostic results of different EBUS-GS samples, including cytologic, histopathologic, and microbiologic samples, were analysed separately. Results Of 696 radial EBUS procedures performed during the study period, 50 were performed for examination of PCLLs. The overall diagnostic yield for EBUS-GS was 80 % (40/50). Regarding 27 malignant lesions, the diagnostic yields for cytologic and histopathologic samples were 63.0 % (17/27) and 74.1 % (20/27), respectively. Regarding 23 benign lesions, the diagnostic yields for histopathologic and microbiologic samples were 69.6 % (16/23) and 47.8 % (11/23), respectively. Uni- and multivariate analyses indicated that the EBUS probe being within the lesion was the only factor significantly associated with increased diagnostic yield (odds ratio, 7.04; P = 0.03). Although pulmonary infection occurred after the procedure in 1 patient (2.0 %), no other complications, including pneumothorax or significant haemorrhage, were reported. Conclusion EBUS-GS was found to be an effective and safe procedure for diagnosis of PCLLs.
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Affiliation(s)
- Manabu Hayama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan.
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takuji Nishida
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takashi Nishihara
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Nobuko Uehara
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
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Mehta AC, Wang J, Abuqayyas S, Garcha P, Lane CR, Tsuang W, Budev M, Akindipe O. New Nodule-Newer Etiology. World J Transplant 2016; 6:215-219. [PMID: 27011920 PMCID: PMC4801798 DOI: 10.5500/wjt.v6.i1.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/08/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate frequency and temporal relationship between pulmonary nodules (PNs) and transbronchial biopsy (TBBx) among lung transplant recipients (LTR).
METHODS: We retrospectively reviewed 100 records of LTR who underwent flexible bronchoscopy (FB) with TBBx, looking for the appearance of peripheral pulmonary nodule (PPN). If these patients had chest radiographs within 50 d of FB, they were included in the study. Data was compared with 30 procedures performed among non-transplant patients. Information on patient’s demographics, antirejection medications, anticoagulation, indication and type of lung transplantation, timing of the FB and the appearance and disappearance of the nodules and its characteristics were gathered.
RESULTS: Nineteen new PN were found in 13 procedures performed on LTR and none among non-transplant patients. Nodules were detected between 4-47 d from the procedure and disappeared within 84 d after appearance without intervention.
CONCLUSION: FB in LTR is associated with development of new, transient PPN at the site of TBBx in 13% of procedures. We hypothesize that these nodules are related to local hematoma and impaired lymphatic drainage. Close observation is a reasonable management approach.
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Umeda Y, Demura Y, Anzai M, Matsuoka H, Araya T, Nishitsuji M, Nishi K, Tsuchida T, Sumida Y, Morikawa M, Ameshima S, Ishizaki T, Kasahara K, Ishizuka T. (18)F-FDG uptake predicts diagnostic yield of transbronchial biopsy in peripheral lung cancer. Lung Cancer 2014; 85:47-52. [PMID: 24775095 DOI: 10.1016/j.lungcan.2014.03.025] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/18/2014] [Accepted: 03/27/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Recent advances in endobronchial ultrasonography with a guide sheath (EBUS-GS) have enabled better visualization of distal airways, while virtual bronchoscopic navigation (VBN) has been shown useful as a guide to navigate the bronchoscope. However, indications for utilizing VBN and EBUS-GS are not always clear. To clarify indications for a bronchoscopic examination using VBN and EBUS-GS, we evaluated factors that predict the diagnostic yield of a transbronchial biopsy (TBB) procedure for peripheral lung cancer (PLC) lesions. METHODS We retrospectively reviewed the charts of 194 patients with 201 PLC lesions (≤3cm mean diameter), and analyzed the association of diagnostic yield of TBB with [(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) positron emission tomography and chest computed tomography (CT) findings. RESULTS The diagnostic yield of TBB using VBN and EBUS-GS was 66.7%. High maximum standardized uptake value (SUVmax), positive bronchus sign, and ground-glass opacity component shown on CT were all significant predictors of diagnostic yield, while multivariate analysis showed only high (18)F-FDG uptake (SUVmax ≥2.8) and positive bronchus sign as significant predictors. Diagnostic yield was higher for PLC lesions with high (18)F-FDG uptake (SUVmax ≥2.8) and positive bronchus sign (84.6%) than for those with SUVmax <2.8 and negative bronchus sign (33.3%). High (18)F-FDG uptake was also correlated with tumor invasiveness. CONCLUSIONS High (18)F-FDG uptake predicted the diagnostic yield of TBB using VBN and EBUS-GS for PLC lesions. (18)F-FDG uptake and bronchus sign may indicate for the accurate application of bronchoscopy with those modalities for diagnosing PLC.
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Affiliation(s)
- Yukihiro Umeda
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
| | - Yoshiki Demura
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan
| | - Masaki Anzai
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Hiroki Matsuoka
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan
| | - Tomoyuki Araya
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan
| | - Masaru Nishitsuji
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan
| | - Koichi Nishi
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan
| | - Tatsuro Tsuchida
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Yasuyuki Sumida
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Miwa Morikawa
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Shingo Ameshima
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Takeshi Ishizaki
- Fundamental Nursing Department, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa-shi, Ishikawa 920-8641, Japan
| | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
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Sendo S, Tsuji G, Umeda R, Ichise Y, Kumagai S, Suzuki Y. Granulomatosis with polyangiitis (Wegener's granulomatosis) diagnosed by transbronchial biopsy from stenotic portion of mainstem bronchus. Mod Rheumatol 2013; 25:649-52. [PMID: 24251995 DOI: 10.3109/14397595.2013.844305] [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] [Indexed: 11/13/2022]
Abstract
This report concerns a case of granulomatosis with polyangiitis (GPA) (Wegener's granulomatosis (WG)) with bronchus narrowing. Although nasal biopsy had been performed three times, no positive histology for GPA (WG) could be obtained. Flexible bronchoscopy revealed diffuse erythema, edema of the mucosa and stenosis of the right mainstem bronchus. Transbronchial biopsy identified granuloma with giant cells. These findings led to a diagnosis of GPA (WG). This case suggests that biopsy from the bronchus is useful for diagnosis of GPA (WG).
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Rai SP, Bhattacharyya D, Choudhary RK. Flexible Bronchoscopy in the Evaluation of Mediastinal and Hilar Lymphadenopathy. Med J Armed Forces India 2007; 63:26-8. [PMID: 27407932 DOI: 10.1016/s0377-1237(07)80101-8] [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: 05/31/2005] [Accepted: 10/06/2005] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The diagnosis in cases of mediastinal and/or hilar lymphadenopathy with no lung parenchymal involvement is often difficult. We undertook this study to assess the diagnostic value of flexible bronchoscopy (FOB) especially transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) in these patients. METHODS Forty eight patients with hilar and/or mediastinal lymphadenopathy without any parenchymal lung lesions, managed between 2000 to 2004 at a tertiary care centre who underwent FOB were evaluated retrospectively. RESULTS Out of 48 patients, FOB showed widening of carina in six, widening of secondary carina in four, bulge in airways because of extrinsic compression in seven and endobronchial nodule in two patients. It was normal in rest 29 patients. TBNA was done in all patients and TBLB in 13 patients where clinico-radiologic findings were consistent with stage 1 sarcoidosis. FOB established diagnosis in 18 patients (caseating granuloma in eight, noncaseating granuloma in nine, and AFB culture positive in one). It was inconclusive in other patients. One patient developed pneumothorax requiring intercostal tube drainage. CONCLUSION FOB especially TBNA has an important role in the diagnosis of hilar and mediastinal lymphadenopathy and should be considered before other invasive procedures.
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Affiliation(s)
- S P Rai
- Senior Advisor (Medicine & Respiratory Medicine) Military Hospital (CTC) Pune - 40
| | - D Bhattacharyya
- Classified Specialist (Medicine & Respiratory Medicine), Base Hospital, Delhi Cantt - 10
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