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Devi L, Verma Y, Kumar A, Khan F, Verma S, Kumar A. Understanding the Landscape of Bronchoscopy in Lung Cancer: Insights From Lesion Location, Gender, and Diagnostic Efficacy. Cureus 2024; 16:e53918. [PMID: 38465029 PMCID: PMC10924703 DOI: 10.7759/cureus.53918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Lung cancer constitutes a critical global health concern. According to the International Agency for Research on Cancer's (IARC) GLOBOCAN 2020 estimates, lung cancer is the leading cause of death in cancer patients. In areas where tuberculosis is prevalent, misdiagnosis and mistreatment frequently result from overlap, creating significant difficulties that delay diagnosis and treatment. Amid this complication, bronchoscopic techniques emerge as critical diagnostic tools, though their efficacy varies between studies. METHOD Our retrospective study, conducted from July 2021 to December 2022 at the Department of Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, examined 156 participants with malignancies. Our focus encompassed diverse lesions within the bronchial landscape, revealing intriguing findings. RESULTS Bronchoscopic examinations unravelled prevalent abnormalities: 52 (33.3%) manifested as intraluminal growth, 48 (31.6%) as mucosal irregularities, and a less frequent (16, 10.3%) as an intraluminal bulge. Transbronchial needle aspiration stood out with a 10/11 (91%) positivity rate, biopsy came in second at 38/46 (83%), and bronchoalveolar lavage showed a 44/152 (29%) positivity rate. It was interesting to see how the lesions were spread out among the different types of histology. For example, squamous cell carcinoma showed 17/37 (46%) intraluminal growth, while adenocarcinoma showed 22/60 (36.7%) intraluminal growth and 4/60 (6.7%) intraluminal bulge. Moreover, a significant absence of abnormalities was observed in various lesions, underlining the intricacies of characterising bronchial lesions. CONCLUSION Our study shows that direct tissue sampling is better and that new bronchoscopic technologies are important for diagnosing lesions that were hard to get to in the past. However, limitations in patient selection biases and the single-centre focus caution against generalised interpretations. Our research illuminates the pivotal role of bronchoscopic methods in diagnosing lung lesions, emphasising the necessity for continued advancements to enhance diagnostic accuracy and treatment efficacy in lung cancer subtypes.
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Affiliation(s)
- Laxmi Devi
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Yogendra Verma
- Pathology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Anand Kumar
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Farhan Khan
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Sanjay Verma
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Ankit Kumar
- Respiratory Medicine, King George's Medical University, Lucknow, IND
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Ho E, Hedstrom G, Murgu S. Robotic bronchoscopy in diagnosing lung cancer-the evidence, tips and tricks: a clinical practice review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:359. [PMID: 37675302 PMCID: PMC10477625 DOI: 10.21037/atm-22-3078] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/09/2022] [Indexed: 09/08/2023]
Abstract
The development of robotic-assisted bronchoscopy has empowered bronchoscopists to access the periphery of the lung with more confidence and promising accuracy. This is due in large to the superior maneuverability, further reach, and stability of these technologies. Despite the advantages of robotic bronchoscopy, there are some drawbacks to using these technologies, such as the loss of tactile feedback, the need to overcome computed tomography (CT)-to-body divergence, and the potential for overreliance on the navigation software. There are currently two robotic bronchoscopy platforms on the US market, the MonarchTM Platform by Auris Health© (Redwood City, CA, USA) and the IonTM endoluminal robotic bronchoscopy platform by Intuitive Surgical© (Sunnyvale, CA, USA). In this clinical practice review, we highlight the evidence and strategies for successful clinical use of both robotic bronchoscopy platforms for pulmonary lesion sampling. Specifically, we will review pre-procedural considerations, such as procedural mapping, room set-up and anesthesia considerations. We will also review the technical aspects of using the robotic bronchoscopy platforms, such as how to compensate for the loss of tactile feedback, optimize visualization, use of ancillary technology to accommodate for CT-to-body divergence, employ best practices for sampling techniques, and utilize information from rapid on-site evaluation (ROSE) to aid in improving diagnostic yield.
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Affiliation(s)
- Elliot Ho
- Division of Pulmonary & Critical Care Medicine, Interventional Pulmonology, Department of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Grady Hedstrom
- Division of Pulmonary & Critical Care Medicine, Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Septimiu Murgu
- Division of Pulmonary & Critical Care Medicine, Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
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Wu J, Ma Y, Chen Y. Extracellular vesicles and COPD: foe or friend? J Nanobiotechnology 2023; 21:147. [PMID: 37147634 PMCID: PMC10161449 DOI: 10.1186/s12951-023-01911-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease characterized by progressive airflow limitation. The complex biological processes of COPD include protein hydrolysis tissue remodeling, innate immune inflammation, disturbed host-pathogen response, abnormal cellular phenotype conversion, and cellular senescence. Extracellular vesicles (EVs) (including apoptotic vesicles, microvesicles and exosomes), are released by almost all cell types and can be found in a variety of body fluids including blood, sputum and urine. EVs are key mediators in cell-cell communication and can be used by using their bioactive substances (DNA, RNA, miRNA, proteins and other metabolites) to enable cells in adjacent and distant tissues to perform a wide variety of functions, which in turn affect the physiological and pathological functions of the body. Thus, EVs is expected to play an important role in the pathogenesis of COPD, which in turn affects its acute exacerbations and may serve as a diagnostic marker for it. Furthermore, recent therapeutic approaches and advances have introduced EVs into the treatment of COPD, such as the modification of EVs into novel drug delivery vehicles. Here, we discuss the role of EVs from cells of different origins in the pathogenesis of COPD and explore their possible use as biomarkers in diagnosis, and finally describe their role in therapy and future prospects for their application. Graphical Abstract.
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Affiliation(s)
- Jiankang Wu
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
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Patel K, Chauhan B, Shah N. Lung cancer diagnosis by bronchoscopy at tertiary care center: A retrospective analysis. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_92_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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Liu Z, Yan J, Tong L, Liu S, Zhang Y. The role of exosomes from BALF in lung disease. J Cell Physiol 2021; 237:161-168. [PMID: 34388259 PMCID: PMC9292261 DOI: 10.1002/jcp.30553] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/06/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023]
Abstract
Exosomes are released from a variety of immune cells and nonimmune cells, the phospholipid vesicle bilayer membrane structure actively secreted into tissues. Recently, exosomes were demonstrated to be effectively delivered proteins, cholesterol, lipids, and amounts of DNA, mRNA, and noncoding RNAs to a target cell or tissue from a host cell. These can be detected in blood, urine, exhaled breath condensates, bronchoalveolar lavage fluid (BALF), ascites, and cerebrospinal fluid. BALF is a clinical examination method for obtaining alveolar cells and biochemical components, reflecting changes in the lungs, so it is also called liquid biopsy. Exosomes from BALF become a new method for intercellular communication and well‐documented in various pulmonary diseases. In chronic obstructive pulmonary disease (COPD), BALF exosomes can predict the degree of COPD damage and serve as an effective monitoring indicator for airflow limitation and airway remodeling. It also mediates antigen presentation in the airways to the adaptive immune system as well as costimulatory effects. Furthermore, BALF exosomes from acute lung injury and infective diseases are closely related to various infections and lack of oxygen status. BALF exosomes play an important role in the diagnosis and prognosis of lung cancer. The effect of immunomodulatory role for BALF exosomes in adaptive and innate immune responses has been studied in sarcoidosis. The intercellular communication in the microenvironment of BALF exosomes in pulmonary fibrosis and lung remodeling have been studied. In this review, we summarize the novel findings of exosomes in BALF, executed function by protein, miRNA, DNA cytokine, and so on in several pulmonary diseases.
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Affiliation(s)
- Ziyu Liu
- Department of Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, Jilin, China.,School of Life Science, Jilin University, Changchun, Jilin, China
| | - Jiaqing Yan
- Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Lingling Tong
- Department of Pathology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Shouyue Liu
- Department of Neurosurgery, Second Hospital, Jilin University, Changchun, China
| | - Ying Zhang
- Department of Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, Jilin, China
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Zhang L, Wang G. Subpleural ground glass opacities diagnosed by bronchoscopic brush cytology with manual mapping navigation: A case report. Medicine (Baltimore) 2021; 100:e25515. [PMID: 33879688 PMCID: PMC8078355 DOI: 10.1097/md.0000000000025515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/25/2021] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Ground-glass opacity nodules (GGNs) are a computed tomography (CT) finding suggestive of lung cancer. Conventional bronchoscopy with brush cytology is a simple diagnostic modality but has a low diagnostic yield for peripheral lesions, especially peripheral GGNs. Therefore, maximizing the detection rate of bronchoscopic brushings should be a key objective. We report a case of a subpleural ground glass opacity (GGO) with a cytological diagnosis of adenocarcinoma by bronchoscopic brushing guided by manual mapping navigation. PATIENT CONCERNS A 46-year-old man was hospitalized for GGO in the right lung. Follow-up CT revealed a subpleural nodule sized 1.2 cm × 0.9 cm in the superior segment of the right lower lobe. DIAGNOSES CT findings of the patient's nodule were suggestive of malignancy. INTERVENTIONS The patient underwent conventional bronchoscopy combined with brushing guided by manual mapping navigation, with subsequent cytological diagnosis of adenocarcinoma. The patient then underwent right lower lobectomy with mediastinal lymph node dissection. OUTCOMES There were no postoperative complications. Postoperative pathological examination showed lung adenocarcinoma with lepidic and acinar growth without visceral pleural invasion (pT1aN0M0, IA1). LESSONS Exfoliated cells present in peripheral GGNs are rarely detected on brush sampling. However, use of a manual mapping navigation system may help increase the sensitivity of conventional bronchoscopic brushing for the diagnosis of peripheral pulmonary lesions.
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Hantera ME, Ganna SA, Elsaka AM, El-Lawaty WM. Role of imprint cytology in thoracic endoscopy suite. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fiberoptic bronchoscopy and medical thoracoscopy are basic interventional modalities for the diagnosis of a wide variety of pleuropulmonary diseases. In some cases, we need fast and accurate results for decision-making. We aimed to evaluate the diagnostic accuracy of imprint cytology and its added value to the pulmonologist.
Results
Multiple biopsies were taken from 54 patients included 31 patients with lung masses subjected to fiberoptic bronchoscopy and 23 patients with undiagnosed exudative pleural effusion subjected to medical thoracoscopy. Imprint cytology was done to all biopsies which are later examined histopathologically. Regarding fiberoptic bronchoscopy biopsies, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of imprint cytology were 93.33, 100, 100, 33.33, and 93.55%, respectively. While in medical thoracoscopy biopsies, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of imprint cytology were 94.74, 100, 100, 80, and 95.65%, respectively.
Conclusion
Imprint cytology is an easy, rapid, and reliable method that has a high sensitivity and specificity in the diagnosis of lung and pleural malignancies compared with histopathology.
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Pachori G, Toor SS, Sharma R, Bayla T. Utility of Image Guided Fine Needle Aspiration Cytology in Intra-Thoracic Lesions with Emphasis on Lung Cancer Detection. J Cytol 2020; 37:136-140. [PMID: 33088032 PMCID: PMC7542043 DOI: 10.4103/joc.joc_109_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 01/09/2023] Open
Abstract
Background and Aims Fine Needle aspiration cytology has emerged as an essential pre-biopsy investigation to rule out or confirm malignancy in superficial as well as deep seated lesions. Radiological assistance has proved to be a blessing for obtaining adequate samples. With unwavering leading position of lung cancer in terms of incidence and mortality, it has become necessary to study the trends of our population and assess the usefulness of techniques aiding in early diagnosis. The objective is to obtain prevalence of lung cancer and utility of various methods in obtaining cytological material for assessment in intrathoracic lesions. Material and Methods We conducted an observational analytic study at a tertiary care teaching hospital over a period of 3.5 years including a total of 307 patients with suspected lung malignancy. Samples were collected using image guided techniques including Fibre-optic bronchoscopy (FOB), Ultra-sonography (USG) and Computed tomography (CT). The smears were processed as per standard institutional protocol and were evaluated by a senior pathologist. Results Squamous cell carcinoma was the most frequent type of Primary lung malignancy, followed by adenocarcinoma. The malignancies were more common in males and in age group of 61 to 70 years. Conclusion Respiratory cytology remains the initial mode of investigation in intra-thoracic malignancies. The high sensitivity, low-cost and rapidity of the results works its advantages for both the patient and the clinician. High cellular yield obtained with the use of trans-bronchial needle aspiration and bronchial brushing rationalizes their use as a screening test to establish both malignant as well as non-malignant diagnoses. Further improvement in utilization of the available modalities and addition of ancillary testing can reduce the need of invasive procedures.
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Affiliation(s)
| | | | | | - Tushar Bayla
- Government, Medical College, Bhilwara, Rajasthan, India
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Wang P, Zhao H, Shi R, Liu X, Liu J, Ren F, Zhao Q, Zhang H, Li Y, Liu H, Chen J. [The Role of Plasma CDO1 Methylation in the Early Diagnosis of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:314-320. [PMID: 32317090 PMCID: PMC7260387 DOI: 10.3779/j.issn.1009-3419.2020.102.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
背景与目的 肺癌的发生率和死亡率常居所有恶性肿瘤的首位, DNA甲基化作为表观遗传学之一参与肿瘤的发生发展过程, CDO1作为抑癌基因常在肿瘤发生早期便会发生甲基化改变, 因此本研究旨在探讨CDO1甲基化在肺癌早期诊断中的价值。 方法 收集肿瘤患者和健康人群的外周血液样本, 游离DNA通过亚硫酸盐修饰并结合实时荧光定量PCR检测CDO1在外周血中的甲基化水平。 结果 肺癌患者的外周血的基因甲基化水平明显高于肺部良性疾病患者及健康人群。肺癌患者CDO1的甲基化水平在性别、淋巴结转移和肿瘤原发灶-淋巴结-转移(tumor-node-metastasis, TNM)分期的分层比较中存在显著性差异(P < 0.05)。CDO1对肺癌诊断的灵敏度和特异性分别为52.2%和78.6%。其诊断的整体准确度明显高于应用于临床的肿瘤标志物而且对I期、II期患者的诊断灵敏度表现最好(40.8%, 47.1%)。此外, CDO1可有效增加多项联检中诊断的灵敏性。 结论 检测CDO1的甲基化水平对肺癌的早期诊断具有潜在的巨大优势。
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Affiliation(s)
- Pan Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ruifeng Shi
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xingyu Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qingchun Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yongwen Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment,Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment,Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment,Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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Gao W, Li C, Wang H, Han P, Nie Y. Multivariate Analysis Of The Diagnostic Yield Of Conventional Bronchoscopy In Peripheral Lung Adenocarcinoma. Cancer Manag Res 2019; 11:9883-9889. [PMID: 31819625 PMCID: PMC6875494 DOI: 10.2147/cmar.s229073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/24/2019] [Indexed: 12/27/2022] Open
Abstract
Background The new subtypes of lung adenocarcinoma reflect local invasive growth, pulmonary alveoli, and intraluminal spreading, while the effective improvement of the diagnostic yield of bronchoscopy still remains unclear. This study aims to explore whether the subtypes of lung adenocarcinoma and other factors affect the diagnostic yield of bronchoscopy. Methods All patients were performed 64-row CT examination and bronchoscopy. Results The bronchus cutoff sign in 48 cases and the endoscopic diagnostic yield was 60.4%. The lumen of the lobes and segments was invaded in 59 cases, and the endoscopic diagnostic yield was 54.2%.The lymph node metastasis was detected in 46 cases, and the endoscopic diagnostic yield was 60.9%. In addition, 42 cases showed acinar type-predominant, and the endoscopic diagnostic yield was 28.6%. Eighteen cases showed solid type-predominant, and the endoscopic diagnostic yield was 33.3%. The micropapillary type-predominant was noted in 17 cases, with the endoscopic diagnostic yield as 94.1%. The papillary type-predominant was in 14 cases, and the endoscopic diagnostic yield was 42.9%. The lepidic type-predominant was seen in 13 cases, and the endoscopic diagnostic yield was 7.7%. The mean diameter of tumors with a positive endoscopic diagnostic yield was 4.34±2.65cm, and the mean diameter of tumors with a negative diagnostic yield was 2.83±1.47cm. Multivariate analysis showed that micropapillary lung adenocarcinoma affected the endoscopic diagnostic yield (OR=37.594, 95% CI: 4.074-346.94) .Tumor diameter affects endoscopic diagnostic yield (OR=1.39, 95% CI: 1.073-1.802), bronchus cutoff sign is easy to obtain endoscopic diagnostic yield (OR=4.86, 95% CI: 1.606-14.704), and lymph node metastasis affects the endoscopic diagnostic yield (OR=3.696, 95% CI: 1.255-10.883). Conclusion The micropapillary subtype lung adenocarcinoma has a certain influence on the diagnostic yield of bronchoscopy. When the lung adenocarcinoma has a large tumor diameter, bronchus cutoff sign and lymph node metastasis, it is easy to obtain a diagnostic yield of bronchoscopy.
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Affiliation(s)
- Wei Gao
- Department of Blood Screening Test, Linyi People's Hospital, Linyi 276000, People's Republic of China
| | - Cuiyun Li
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, People's Republic of China
| | - Hui Wang
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, People's Republic of China
| | - Ping Han
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, People's Republic of China
| | - Yunqiang Nie
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, People's Republic of China
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Metovic J, Righi L, Delsedime L, Volante M, Papotti M. Role of Immunocytochemistry in the Cytological Diagnosis of Pulmonary Tumors. Acta Cytol 2019; 64:16-29. [PMID: 30878997 DOI: 10.1159/000496030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022]
Abstract
Pulmonary cytology is a challenging diagnostic tool, and it is usually evaluated considering medical history and radiological findings in order to reach an accurate diagnosis. Since the majority of lung cancer patients have an advanced stage at diagnosis, a cytological specimen is frequently the only material available for diagnosis and further prognostic/predictive marker determination. Several types of specimens can be obtained from the respiratory system (including sputum, bronchoalveolar lavage, bronchial brushing, fine needle aspiration, and pleural fluid) with different technical preclinical management protocols and different diagnostic yields. Immunocytochemistry (ICC) has a pivotal role in the determination of diagnostic, prognostic, and predictive markers. Therefore, limited cytology samples are to be used with a cell-sparing approach, to allow both diagnostic ICC evaluation as well as predictive marker assessment by ICC or specific molecular assays. In this review, we describe the most common ICC markers used for the diagnosis and prognostic/predictive characterization of thoracic tumors in different cytological specimens.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luisella Righi
- Department of Oncology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Luisa Delsedime
- Department of Oncology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco Volante
- Department of Oncology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, Città della Salute e della Scienza, University of Turin, Turin, Italy,
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12
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Kang HS, Ha JH, Kang HH, Yeo CD, Rhee CK, Kim SK, Moon HS, Lee SH. Factors Related to the Diagnostic Yield of Flexible Bronchoscopy without Guidance in Bronchoscopically Invisible Peripheral Lung Lesions. Tuberc Respir Dis (Seoul) 2017; 80:284-290. [PMID: 28747962 PMCID: PMC5526956 DOI: 10.4046/trd.2017.80.3.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/14/2016] [Accepted: 02/21/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We aimed to analyze the factors predicting the diagnostic performance of flexible bronchoscopy without guidance in peripheral lung lesions that are endoscopically invisible. METHODS This was a retrospective study conducted in St. Paul's Hospital, The Catholic University of Korea, between January 2007 and March 2013. We included all patients who received bronchoscopy during this period. The analyzed variables were age, sex, the etiology of the lesion, lesion size, distance from the pleura, and presence of the bronchus sign. We used multiple logistic regression analysis to identify the significant independent factors associated with diagnostic yield. RESULTS We included 151 patients in this study. The overall diagnostic yield was 58.3%. The sensitivity was 43.2% for malignant disease and 78.1% for benign disease. The benign lung lesions (p<0.001), lesion size (p=0.015), presence of the exposed type of bronchus sign (p<0.001), and presence of cavitary lung lesions (p=0.005) were factors influencing the yield of flexible bronchoscopy by univariate analysis. In a multivariate logistic regression analysis, the exposed type of bronchus sign and benign lung lesions were independent predicting factors (odds ratio [OR]: 27.95; 95% confidence interval [CI], 7.56-103.32; p<0.001 and OR, 4.91; 95% CI, 1.76-13.72; p=0.002). CONCLUSION The presence of the exposed type of bronchus sign and benign lung lesions are determining factors of the diagnostic yield in flexible bronchoscopy in evaluating peripheral lesions that are not endoscopically visible.
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Affiliation(s)
- Hye Seon Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jick Hwan Ha
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Kyoung Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwa Sik Moon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Zhan P, Zhu QQ, Miu YY, Liu YF, Wang XX, Zhou ZJ, Jin JJ, Li Q, Sasada S, Izumo T, Tu CY, Cheng WC, Evison M, Lv TF, Song Y. Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2017; 6:23-34. [PMID: 28331821 DOI: 10.21037/tlcr.2017.01.01] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND With the release of the National Lung Screening Trial results, the detection of peripheral pulmonary lesions (PPLs) is likely to increase. Computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and radial probe endobronchial ultrasound (r-EBUS)-guided transbronchial lung biopsy (TBLB) are recommended for tissue diagnosis of PPLs. METHODS A systematic review of published literature evaluating the accuracy of r-EBUS-TBLB and CT-PTNB for the diagnosis of PPLs was performed to determine point sensitivity and specificity, and to construct a summary receiver-operating characteristic curve. RESULTS This review included 31 publications dealing with EBUS-TBLB and 14 publications dealing with CT-PTNB for the diagnosis of PPLs. EBUS-TBLB had point sensitivity of 0.69 (95% CI: 0.67-0.71) for the diagnosis of peripheral lung cancer (PLC), which was lower than the sensitivity of CT-PTNB (0.94, 95% CI: 0.94-0.95). However, the complication rates observed with EBUS-TBLB were lower than those reported for CT-PTNB. CONCLUSIONS This meta-analysis showed that EBUS-TBLB is a safe and relatively accurate tool in the investigation of PLC. Although the yield remains lower than that of CT-PTNB, the procedural risks are lower.
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Affiliation(s)
- Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qing-Qing Zhu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ying-Ying Miu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ya-Fang Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Xiao-Xia Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ze-Jun Zhou
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jia-Jia Jin
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Shinji Sasada
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo 108-0073, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo 150-8935, Japan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, China
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, China
| | - Matthew Evison
- North West Lung Centre, University Hospital of South Manchester, Wythenshawe M23 9LT, UK
| | - Tang-Feng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
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Methylation analysis of SHOX2 and RASSF1A in bronchoalveolar lavage fluid for early lung cancer diagnosis. Ann Diagn Pathol 2017; 27:57-61. [PMID: 28325362 DOI: 10.1016/j.anndiagpath.2017.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 12/20/2022]
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15
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Mondoni M, Sotgiu G, Bonifazi M, Dore S, Parazzini EM, Carlucci P, Gasparini S, Centanni S. Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis. Eur Respir J 2016; 48:196-204. [PMID: 27174878 DOI: 10.1183/13993003.00051-2016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/07/2016] [Indexed: 11/05/2022]
Abstract
Fluoroscopy-guided transbronchial needle aspiration (TBNA) has long been used in the diagnosis of peripheral pulmonary lesions (PPLs), although its diagnostic performance varies considerably.We conducted a systematic review and meta-analysis evaluating the accuracy of TBNA in the diagnosis of PPLs, comparing its diagnostic yield with transbronchial biopsy (TBB) and assessing the main predictors of a successful aspirate.In 18 studies, the overall TBNA yield was 0.53 (95% CI 0.44-0.61). TBNA showed a higher accuracy when directly compared to TBB (0.60 (95% CI 0.49-0.71) versus 0.45 (95% CI 0.37-0.54)). The subgroup analyses documented a higher TBNA yield when the computed tomography (CT) bronchus sign was present (0.70 (95% CI 0.63-0.77) versus 0.51 (95% CI 0.38-0.64)), when rapid on-site evaluation (ROSE) was performed (0.62 (95% CI 0.43-0.79) versus 0.51 (95% CI 0.42-0.60)), in the case of malignant lesions (0.55 (95% CI 0.44-0.66) versus 0.17 (95% CI 0.11-0.24)) and for lesions >3 cm (0.81 (95% CI 0.73-0.87) versus 0.55 (95% CI 0.47-0.63)).Conventional TBNA is a useful sampling technique for the diagnosis of PPL, with a higher diagnostic yield than TBB. The presence of CT bronchus sign, an underlying malignant process, lesion size >3 cm and ROSE employment are predictors of a higher yield.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Martina Bonifazi
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Simone Dore
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Elena Maria Parazzini
- Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Paolo Carlucci
- Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Gasparini
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Stefano Centanni
- Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Song L, Yu H, Li Y. Diagnosis of Lung Cancer by SHOX2 Gene Methylation Assay. Mol Diagn Ther 2016; 19:159-67. [PMID: 26014676 DOI: 10.1007/s40291-015-0144-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lung cancer is the most prevalent cancer in the world. Few effective and cheap methods are available so far for early detection and screening of lung cancer. Although histological and cytological examinations are gold standards in lung cancer diagnosis, patients are always at late stages when diagnosis is confirmed. Therefore, new diagnostic methods are needed urgently to increase the early diagnostic rate, enhance the confirmed diagnostic rate, and reduce mortality. The SHOX2 gene methylation assay has become a promising option for the above purposes. It has been shown to enhance the confirmed diagnostic rate of lung cancer in several clinical trials when combined with histological or cytological assays, and has the potential to become an early diagnostic tool. This article reviews the outcome of clinical trials using the SHOX2 gene methylation assay alone or in combination with other examinations, and suggests its future applications and research directions.
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Affiliation(s)
- Lele Song
- The Chinese PLA 309 Hospital, No. 17, Heishanhu Road, HaiDian District, Beijing, 100091, People's Republic of China,
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17
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Bonney A, Beaty A, See K, Irving L, Steinfort D. Diagnostic Utility of Bronchial Brush-Tip Washings for the Immunohistochemical Assessment of Peripheral Lung Lesions. Acta Cytol 2016; 60:74-8. [PMID: 26918654 DOI: 10.1159/000444044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/08/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Immunohistochemistry (IHC) is an important component of lung cancer diagnosis and management, although performance can be limited due to tissue availability. We describe a novel technique for processing brush-tip washings (BTW) and evaluate the feasibility of IHC testing on these samples. STUDY DESIGN All patients who had cell blocks (CB) created from BTW following bronchoscopic investigation of peripheral lung lesions were included. CB were assessed for adequate material before undergoing IHC staining. RESULTS 75 patients were included in the study, with bronchoscopic diagnosis of malignancy achieved in 77%. Sixty-seven samples (89%) had sufficient cells for diagnosis on CB and 56 of these (84%) proved amenable to IHC. CB created from BTW were the sole specimens available for IHC subtyping in 7 patients (9%). CONCLUSIONS CB are easily created from BTW and are a simple method for increasing the diagnostic utility of bronchoscopic specimens without increasing the risk or duration of bronchoscopy. IHC can be easily performed in a high proportion of cases, increasing the likelihood of accurate sub-typing of tumours following diagnostic bronchoscopy.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory Medicine, The Royal Melbourne Hospital, University of Melbourne Health, Parkville, Vic., Australia
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Slavova-Azmanova NS, Lizama C, Johnson CE, Ludewick HP, Lester L, Karunarathne S, Phillips M. Impact of the introduction of EBUS on time to management decision, complications, and invasive modalities used to diagnose and stage lung cancer: a pragmatic pre-post study. BMC Cancer 2016; 16:44. [PMID: 26822160 PMCID: PMC4730595 DOI: 10.1186/s12885-016-2081-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/21/2016] [Indexed: 12/25/2022] Open
Abstract
Background Utilisation of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and guide sheath (EBUS-GS) for diagnosis and staging of lung cancer is gaining popularity, however, its impact on clinical practice is unclear. This study aimed to determine the impact of the introduction of endobronchial ultrasound-guided procedures (EBUS) on time to management decision for lung cancer patients, and on the utilisation of other invasive diagnostic modalities, including CT-guided trans-thoracic needle aspiration (CT-TTNA), bronchoscopy, and mediastinoscopy. Methods Hospital records of new primary lung cancer patients presenting in 2007 and 2008 (Pre-EBUS cohort) and in 2010 and 2011 (Post-EBUS cohort) were reviewed retrospectively. Results The Pre-EBUS cohort included 234 patients. Of the 326 patients in the Post-EBUS cohort, 90 had an EBUS procedure (EBUS-TBNA for 19.0 % and EBUS-GS for 10.4 % of cases). The number of CT-TTNAs and bronchoscopies decreased following the introduction of EBUS (p = 0.015 and p < 0.001 respectively). Of 162 CT-TTNAs, 59 (36 %) resulted in complications compared to 1 complication each for bronchoscopy and EBUS-GS, and no complications from EBUS-TBNA. Fewer complications occurred overall in the Post-EBUS cohort compared to the Pre-EBUS cohort (p = 0.0264). The median time to management decision was 17 days (IQR 24) for the Pre-EBUS and 13 days (IQR 21) for the Post-EBUS cohort (p = 0.07). Within the Post-EBUS cohort, median time to management decision was longer for the EBUS group (n = 90) than the Non-EBUS group (17 days (IQR 29) vs. 10 days (IQR 10), p < 0.001). For half of EBUS-TBNA patients (n = 28, 50.0 %) and EBUS-GS patients (n = 14, 50.0 %), EBUS alone provided sufficient diagnostic and/or staging information; these patients had median time to management decision of 10 days. Regression analysis revealed that the number of imaging events, inpatient, and outpatient visits were significant predictors of time to management decision of >28 days; EBUS was not a predictor of time to management decision. Conclusions The introduction of EBUS led to fewer CT-TTNAs and bronchoscopies and did not impact on the time to management decision. EBUS-TBNA or EBUS-GS alone provided sufficient information for diagnosis and/or regional staging in half of the lung cancer patients referred for this investigation.
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Affiliation(s)
- Neli S Slavova-Azmanova
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Surgery, The University of Western Australia, Perth, 6009, WA, Australia.
| | - Catalina Lizama
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Surgery, The University of Western Australia, Perth, 6009, WA, Australia
| | - Claire E Johnson
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Surgery, The University of Western Australia, Perth, 6009, WA, Australia
| | - Herbert P Ludewick
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Surgery, The University of Western Australia, Perth, 6009, WA, Australia
| | - Leanne Lester
- Health Promotion Evaluation Unit, School of Sport Science, Exercise and Health, The University of Western Australia, Perth, 6009, WA, Australia
| | - Shanka Karunarathne
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, 6009, WA, Australia
| | - Martin Phillips
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, 6009, WA, Australia
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Zhao QT, Guo T, Wang HE, Zhang XP, Zhang H, Wang ZK, Yuan Z, Duan GC. Diagnostic value of SHOX2 DNA methylation in lung cancer: a meta-analysis. Onco Targets Ther 2015; 8:3433-9. [PMID: 26640383 PMCID: PMC4657794 DOI: 10.2147/ott.s94300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The diagnostic value of SHOX2 DNA methylation in patients with lung cancer remains controversial. Thus, we performed a systematic review and meta-analysis to assess diagnostic accuracy of SHOX2 DNA methylation in the lymph node, bronchial aspirates, pleural effusion, plasma, and tumor tissue for lung cancer. We conducted a comprehensive literature search in PubMed, Ovid, the Cochrane library, and Web of Science databases in May 2015. The diagnostic sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were pooled using STATA 12.0 software. A total of 2,296 subjects included 1,129 lung cancer patients in eight studies were recruited in this meta-analysis. The summary estimates for SHOX2 DNA methylation in the diagnosis of lung cancer in these studies were pooled SEN =0.70 (95% confidence interval [CI]: 0.46–0.87), SPE =0.96 (95% CI: 0.91–0.99), PLR 20.01 (95% CI: 6.96–57.52), NLR 0.31 (95% CI: 0.15–0.64), and DOR 65.11 (95% CI: 13.10–323.61), and the area under the curve (AUC) was 0.96 (95% CI: 0.94–0.97). SHOX2 DNA methylation has greater diagnostic value in detecting lung cancer. In addition, considering the potential publication bias and high heterogeneity, further research studies with more well-designed and large sample sizes are needed in the future.
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Affiliation(s)
- Qing-Tao Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Tao Guo
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Hui-En Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Xiao-Peng Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Hua Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Zhi-Kang Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Zheng Yuan
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Guo-Chen Duan
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
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Chen CH, Liao WC, Wu BR, Chen CY, Chen WC, Hsia TC, Cheng WC, Tu CY, Hsu WH. Endobronchial Ultrasound Changed the World of Lung Cancer Patients: A 11-Year Institutional Experience. PLoS One 2015; 10:e0142336. [PMID: 26545094 PMCID: PMC4636346 DOI: 10.1371/journal.pone.0142336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/13/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The role of advanced bronchoscopic diagnostic techniques in the detection and staging of lung cancer has increased sharply in recent years. The development of endobronchial ultrasound (EBUS) improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions (PLLs). We investigated the impact of using EBUS as a diagnostic method for tissue acquisition in lung cancer patients. METHODS In a single center observational retrospective study, 3712 subjects were diagnosed with lung cancer from 2003 to 2013 (EBUS was introduced in 2008). Thus, we divided the data into two periods: the conventional bronchoscopy period (2003 to 2007) and the EBUS period (2008 to 2013). RESULTS A total of 3712 patients were included in the analysis. Comparing the conventional bronchoscopy period with the EBUS period data, there has been a significant reduction in the use of diagnostic modalities: CT-guided biopsy (P < 0.0001) and pleural effusion cytology (P < 0.0001). The proportion of subjects diagnosed using bronchoscopy significantly increased from 39.4% in the conventional period to 47.4% in the EBUS period (P < 0.0001). In the EBUS period, there has also been a significant increase in the proportion of patients proceeding directly to diagnostic surgery (P < 0.0001). Compared to bronchoscopy, the incidence of complications was higher in those who underwent CT guide biopsy. The incidence of iatrogenic pneumothorax significantly decreased in the EBUS period. CONCLUSIONS Advanced bronchoscopic techniques are widely used in the diagnosis of lung cancer. At our institution, the increasing use of EBUS for providing lung cancer diagnosis has led to a significant reduction in other diagnostic modalities, namely CT-guided biopsy and pleural effusion cytology. These changes in practice also led to a reduction in the incidence of complications.
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Affiliation(s)
- Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan
| | - Biing-Ru Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Chun Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan
- * E-mail: (CYT); (WCC)
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
- * E-mail: (CYT); (WCC)
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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Zhang L, Tong R, Wang J, Li M, He S, Cheng S, Wang G. Improvements to bronchoscopic brushing with a manual mapping method: A three-year experience of 1143 cases. Thorac Cancer 2015; 7:72-9. [PMID: 26816541 PMCID: PMC4718127 DOI: 10.1111/1759-7714.12279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/21/2015] [Indexed: 12/17/2022] Open
Abstract
Background Conventional bronchoscopy with brushing alone for diagnosing peripheral pulmonary lesions (PPLs) is of low sensitivity. A manual mapping method was introduced and evaluated in this study, which could be routinely applied with bronchoscopic brushing to improve the sensitivity for malignant PPLs. Methods This mapping method involves the bronchoscopist drawing the route with a series of bronchial opening sketches and marking the leading bronchus at every bifurcation point based on thin‐section computed tomography. This map is then used to guide bronchoscope insertion for brushing. A cross‐sectional study on the evaluation of this method for the diagnosis of malignant PPLs was conducted on patients from July 2010 to June 2013. Results The sensitivity for malignant PPLs of conventional brushing, conventional brushing with mapping on a portion of patients, and conventional brushing with mapping method increased from 17.0% to 25.8% to 31.5% (P < 0.001), respectively. For lesion sizes over 3 cm, the rate of these three groups increased from 25.1% to 38.6% to 50.9% (P < 0.001), respectively. The sensitivity of this mapping method for malignant PPLs was statistically associated with lesion size, lesion character, relationship between the lesion and the leading bronchus, linear distance between the targeted bronchus and the opening of the lobe bronchus, and accessibility (P < 0.001, P = 0.039, P < 0.001, P = 0.031, and P = 0.020, respectively). Conclusions The manual mapping method greatly increased the bronchoscopic brushing sensitivity for malignant PPLs compared to the conventional brushing method. During routine clinical work, it is economical and convenient for guiding bronchoscope insertion.
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Affiliation(s)
- Lei Zhang
- Department of Endoscopy Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Run Tong
- Department of Endoscopy Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China; State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jianwei Wang
- Department of Diagnostic imaging Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Meng Li
- Department of Diagnostic imaging Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shun He
- Department of Endoscopy Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shujun Cheng
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Guiqi Wang
- Department of Endoscopy Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Labbé C, Beaudoin S, Martel S, Delage A, Joubert P, Drapeau C, Provencher S. Diagnostic yield of non-guided flexible bronchoscopy for peripheral pulmonary neoplasia. Thorac Cancer 2015; 6:517-23. [PMID: 26273409 PMCID: PMC4511332 DOI: 10.1111/1759-7714.12223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/07/2014] [Indexed: 12/26/2022] Open
Abstract
Background The role of conventional bronchoscopy for peripheral pulmonary neoplasia remains controversial. We aimed to assess the diagnostic yield and the added value of non-guided bronchial aspiration, bronchoalveolar lavage (BAL), and brushing for the diagnosis of pulmonary neoplasia not visible endoscopically. Methods We retrospectively assessed 207 consecutive patients with a final diagnosis of peripheral lung malignancy who underwent bronchoscopy with non-guided aspiration, brushing, and BAL as their initial evaluation. The influence of clinical and radiological factors on diagnostic yield was assessed using univariate logistic regression analyses. Results The overall sensitivity of non-guided bronchoscopy was 25.6%, whereas sensitivities for bronchial aspiration, BAL, and brushing were 14.2%, 11.6%, and 16.5%, respectively. Younger age, larger lesion, central/intermediate distance from the hilum, presence of a bronchus sign, and higher standardized uptake value (SUV) on positron emission tomography scan were predictors of a higher diagnostic yield. Conversely, forced expiratory volume in one second, fellow implication in the procedure, and tumor histology did not influence sensitivity. The overall sensitivity of bronshoscopy was >40% for tumors >4 cm, located in the central/intermediate thirds of the lung, showing a bronchus sign, with an SUV >12 or occurring in patients <50 years of age. Conversely, the sensitivity was <10% for tumors <2 cm, located peripherally or with an SUV <4. Conclusion Neoplasia characteristics may help targeting situations in which conventional bronchoscopy could be used as the initial diagnostic procedure when advanced techniques are unavailable. However, advanced diagnostic tools should probably be proposed as the initial modality for the diagnosis of peripheral malignant lesions when available.
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Affiliation(s)
- Catherine Labbé
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada
| | - Stéphane Beaudoin
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada ; Respiratory Division, Department of Medicine, McGill University Health Center Montreal, Quebec, Canada
| | - Simon Martel
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada
| | - Antoine Delage
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada
| | - Philippe Joubert
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada
| | - Christine Drapeau
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada ; Centre hospitalier affilié universitaire régional de Trois-Rivières Trois-Rivières, Quebec, Canada
| | - Steeve Provencher
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval Québec, Quebec, Canada
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Steinfort DP, Leong TL, Laska IF, Beaty A, Tsui A, Irving LB. Diagnostic utility and accuracy of rapid on-site evaluation of bronchoscopic brushings. Eur Respir J 2014; 45:1653-60. [PMID: 25537567 DOI: 10.1183/09031936.00111314] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/09/2014] [Indexed: 11/05/2022]
Abstract
The aim of the study was to determine the accuracy of rapid on-site examinations, performed on transbronchial brushings of peripheral pulmonary lesions, in determining final bronchoscopic diagnosis. In addition to determining if rapid on-site examination impacts procedural outcomes. A prospective cohort study of consecutive patients with peripheral pulmonary lesions, which had been located by radial endobronchial ultrasound, was undertaken. Bronchoscopy was terminated if rapid on-site examination demonstrated diagnostic malignant material. Non-diagnostic rapid on-site examination resulted in further bronchoscopic sampling, including transbronchial lung biopsy and/or sampling from different locations. 128 peripheral pulmonary lesions were located by endobronchial ultrasound in 118 patients. The final bronchoscopic diagnoses included nonsmall cell lung cancer (n=76), carcinoid (n=3), and metastatic malignancy (n=3). Procedure times were significantly shorter for procedures when rapid on-site examinations demonstrated malignancy compared to those where rapid on-site examination was non-diagnostic (19±8 min versus 31±11 min, respectively; p<0.0001). In four procedures, initial negative rapid on-site examination results prompted redirection of sampling from alternate bronchial segments, resulting in positive diagnostic tissue being obtained. Positive and negative predictive value of rapid on-site examination for a malignant bronchoscopic diagnosis was 63 (97%) out of 65, and 43 (68%) out of 63, respectively. Rapid on-site examination of brushing specimens has a very high, positive, predictive value for bronchoscopic diagnosis of cancer and shortens the bronchoscopy procedure times. It has the potential to reduce complications, improve cost-effectiveness, and may improve diagnostic performance via live feedback.
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Affiliation(s)
- Daniel P Steinfort
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia Dept of Medicine, University of Melbourne, Parkville, VC, Australia
| | - Tracy L Leong
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia
| | - Irena F Laska
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia
| | - Anne Beaty
- Dept Pathology, Royal Melbourne Hospital, Parkville, VC, Australia
| | - Alpha Tsui
- Dept Pathology, Royal Melbourne Hospital, Parkville, VC, Australia
| | - Louis B Irving
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia
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Ucar EY, Ozkaya AL, Araz O, Akgun M, Meral M, Kaynar H, Saglam L, Aksoy H, Akcay F. Serum and bronchial aspiration fluid HE-4 levels in lung cancer. Tumour Biol 2014; 35:8795-9. [PMID: 24879624 DOI: 10.1007/s13277-014-2134-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/21/2014] [Indexed: 12/21/2022] Open
Abstract
Human epididymis 4 (HE-4) protein has been proposed as a tumor marker for lung and ovarian cancer. This study was designed to measure HE-4 levels in bronchial aspiration fluid (BAF) of patients with lung cancer and to describe the relationship of BAF HE-4 with known systemic increase in serum HE-4 levels. Sixty-four patients with lung cancer, 38 with benign lung disease and 19 healthy subjects, were enrolled in our study. The BAF was obtained during routine bronchoscopic procedure in patient groups. HE-4 levels in serum and BAF were measured with the commercially available kit by an enzyme-linked immunosorbent assay. Serum HE-4 levels were significantly higher in patients with lung cancer group (204.2 ± 22.9 pmol/L) than in benign lung disease group (135 ± 26.9 pmol/L, p = 0.001) and healthy subjects (14.8 ± 7.0 pmol/L, p < 0.0001). No significant difference was observed in terms of BAF HE-4 values in two patient groups. BAF HE-4 levels were significantly higher than those of serum levels in both patient groups (p < 0.0001). Serum HE-4 level was correlated with tumor stage (p = 0.001) and age (p < 0.0001) in the lung cancer group. The areas under the receiver operating characteristic (ROC) curve of serum HE-4 was 0.784 (95 % confidence interval (CI), 0.701-0.867) and that of BAF HE-4 was 0.496 (95 % CI, 0.382-0.610). This study shows that a systemic increase in serum of HE-4 is more prominent than a local increase of HE-4 (BAF), so this may suggest the feasibility of using serum instead of BAF samples for HE-4 measurements in lung cancer cases.
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Affiliation(s)
- Elif Yilmazel Ucar
- Department of Pulmonary Diseases, School of Medicine, Ataturk University, 25240, Erzurum, Turkey,
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Sánchez-Font A, Giralt L, Vollmer I, Pijuan L, Gea J, Curull V. Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Lesions. A Controlled Study With Fluoroscopy. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.arbr.2014.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shital P, Rujuta A, Sanjay M. Transbronchial needle aspiration cytology (TBNA) in endobronchial lesions: a valuable technique during bronchoscopy in diagnosing lung cancer and it will decrease repeat bronchoscopy. J Cancer Res Clin Oncol 2014; 140:809-15. [PMID: 24531973 DOI: 10.1007/s00432-014-1602-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy. METHODS This is a prospective study conducted between June 2012 and September 2013 at Bronchoscopy unit of MIMSR Medical College Latur, India, to find the role of TBNA in exophytic endobronchial lesions in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In exophytic endobronchial lesions, predominant endoscopic findings were cauliflower, polypoidal-like or nodular or multinodular endobronchial growth. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi-square test. RESULTS Total 150 patients, between age group 24-80 years, mean age was 57.93 years, male population constitutes 86.17 % of total. 76.14 % cases were smoker of them 61.87 % cases having history of >40 pack years. Commoner symptoms were cough (91.33 %), hemoptysis (54.00 %) and chest pain (46.66 %), and mass lesion (40.66 %), hilar opacity (31.33 %) and collapse segmental/lobar (29.33 %) were commoner radiological abnormalities. Yield of TBNA, CDT and TBNA plus CDT in exophytic lesions is 60.66, 79.33 and 84.66 %, respectively, in diagnosis of lung malignancies (P < 0.001). Sensitivity of forcep biopsy and TBNA in diagnosing lung malignancy was 88.18 and 71.65 %, respectively (P < 0.01). FOB-related hypoxemia documented in two cases and minor bleeding in six cases. Other complications such as significant bleeding, pneumothorax and death were not seen. Minor bleeding was seen with forcep biopsy mainly in 4.0 % cases. TBNA has decreased repeat procedure, decreases cost for diagnosis. IHC on TBNA specimens had increased histological-type confirmation. CONCLUSION Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA considered safe, especially when fleshy vascular endobronchial growth is present and risk of bleeding is high with forcep biopsy. Inadequate tissue sampling due to the presence of necrosis, blood clot over the lesion and formation of crush artifacts by FB makes TBNA valuable in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.
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Affiliation(s)
- Patil Shital
- Pulmonary Medicine, MIMSR Medical College Latur, Latur, Maharashtra, India,
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Endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions. A controlled study with fluoroscopy. Arch Bronconeumol 2014; 50:166-71. [PMID: 24439465 DOI: 10.1016/j.arbres.2013.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Fluoroscopy-guided bronchoscopy is usually performed for the diagnosis of peripheral pulmonary lesions (PPL), but the diagnostic yield varies widely among studies. Endobronchial ultrasound (EBUS) can increase the diagnostic yield of bronchoscopic diagnosis of PPL. OBJECTIVE To compare the diagnostic yield of fluoroscopy-guided bronchoscopy and EBUS with fluoroscopy-guided bronchoscopy in the study of PPL. METHODS All patients who underwent bronchoscopy to study PPL from January 2009 to December 2012 were prospectively included. 145 consecutive patients were randomly distributed in two groups: EBUS and fluoroscopy (50 patients, 71.3 ± 8.2 years) or fluoroscopy alone (95 patients, 68 ± 10.5 years). The mean diameter of the lesions was 41.97 ± 19.22 mm. Cytological brushing and transbronchial biopsies were obtained. All procedures were performed under fluoroscopic guidance with intravenous conscious sedation. EBUS was performed using an endoscopic ultrasound system equipped with a 20-MHz radial miniprobe introduced via a guide-sheath. Bronchoscopist, cytologist, study protocol, techniques and tools were the same throughout the whole study. RESULTS 129 (89%) patients had malignant disease. A diagnosis with bronchoscopy was established in 105 (72.4%) patients. EBUS plus fluoroscopy obtained a diagnostic yield in 78% of patients and fluoroscopy alone in 69.5% (non-significant). In contrast, for lesions smaller than 30 mm, EBUS plus fluoroscopy guidance provided significantly greater diagnostic performance than fluoroscopy alone (90 vs. 52%; P=.05). CONCLUSIONS Bronchoscopy under EBUS plus fluoroscopy guidance is a technique that has become useful for the diagnostic of LPPs, especially those smaller than 30 mm in diameter.
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Fleischhacker M, Dietrich D, Liebenberg V, Field JK, Schmidt B. The role of DNA methylation as biomarkers in the clinical management of lung cancer. Expert Rev Respir Med 2014; 7:363-83. [DOI: 10.1586/17476348.2013.814397] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Detection of FHIT and p16 mRNA deletion in biopsy specimens obtained by bronchoscopy for the diagnosis of lung cancer. Int J Biol Markers 2013; 28:259-66. [PMID: 23709347 DOI: 10.5301/jbm.5000021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to investigate the diagnostic value of the deletion of fragile histidine triad (FHIT) and p16INK4a (p16) mRNA in biopsies obtained by bronchoscopy. Biopsies were analyzed using RT-PCR in 52 patients with lung cancer and 19 patients with benign lung disease. The results showed that the detection rates of FHIT and p16 gene transcript deletion were significantly higher in lung cancer patients than in patients with benign lung disease (65.4% versus 10.5%, p=0.001 and 59.6% versus 5.3%, p<0.001, respectively). The sensitivities for detecting FHIT and p16 transcript deletion in biopsies were 65.4% and 59.6% (combined 80.8%), respectively, which were markedly better than those of histology and cytology (42.3% and 34.6%, respectively; combined 57.7%). In 22 lung cancer patients with negative histology and cytology at initial bronchoscopy, FHIT and p16 mRNA loss was detected in 40.9% (9/22) and 36.4% (8/22) cases, respectively. FHIT mRNA loss was associated with smoking status in lung cancer patients. In conclusion, deletion of FHIT and p16 mRNA can be identified in biopsies obtained during bronchoscopic procedures. FHIT and p16 mRNA deletion can be used as biomarkers in the clinical diagnosis of lung cancer and may serve as adjuncts to histology and cytology in lung cancer diagnosis.
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Cryobiopsy: should this be used in place of endobronchial forceps biopsies? BIOMED RESEARCH INTERNATIONAL 2013; 2013:730574. [PMID: 24066296 PMCID: PMC3771258 DOI: 10.1155/2013/730574] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/15/2013] [Accepted: 07/15/2013] [Indexed: 11/29/2022]
Abstract
Forceps biopsies of airway lesions have variable yields. The yield increases when combining techniques in order to collect more material. With the use of cryotherapy probes (cryobiopsy) larger specimens can be obtained, resulting in an increase in the diagnostic yield. However, the utility and safety of cryobiopsy with all types of lesions, including flat mucosal lesions, is not established.
Aims. Demonstrate the utility/safety of cryobiopsy versus forceps biopsy to sample exophytic and flat airway lesions.
Settings and Design. Teaching hospital-based retrospective analysis.
Methods. Retrospective analysis of patients undergoing cryobiopsies (singly or combined with forceps biopsies) from August 2008 through August 2010.
Statistical Analysis. Wilcoxon signed-rank test.
Results. The comparative analysis of 22 patients with cryobiopsy and forceps biopsy of the same lesion showed the mean volumes of material obtained with cryobiopsy were significantly larger (0.696 cm3 versus 0.0373 cm3, P = 0.0014). Of 31 cryobiopsies performed, one had minor bleeding. Cryopbiopsy allowed sampling of exophytic and flat lesions that were located centrally or distally. Cryobiopsies were shown to be safe, free of artifact, and provided a diagnostic yield of 96.77%.
Conclusions. Cryobiopsy allows safe sampling of exophytic and flat airway lesions, with larger specimens, excellent tissue preservation and high diagnostic accuracy.
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Narula T, Machuzak MS, Mehta AC. Newer modalities in the work-up of peripheral pulmonary nodules. Clin Chest Med 2013; 34:395-415. [PMID: 23993812 DOI: 10.1016/j.ccm.2013.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Technological advances in recent years have translated into the availability of newer modalities to establish the cause of peripheral pulmonary nodules (PPN). Even though the verdict is still out on the ideal diagnostic modality, there is no doubt that the bronchoscope is becoming a popular tool in the armamentarium of physicians who deal with PPN. This article focuses on newer bronchoscopic modalities being studied for the work-up of PPN. The authors also summarize the value of established diagnostic modalities to provide a balanced perspective.
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Affiliation(s)
- Tathagat Narula
- Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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HOU GANG, YIN YAN, WANG WEI, WANG QIUYUE, HU XUEJUN, KANG JIAN, WU GUANGPING. Clinical impact of liquid-based cytology test on diagnostic yields from transbronchial needle aspiration. Respirology 2012; 17:1225-8. [DOI: 10.1111/j.1440-1843.2012.02246.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li J, Chen P, Li XQ, Bao QL, Dai CH, Ge LP. Elevated levels of survivin and livin mRNA in bronchial aspirates as markers to support the diagnosis of lung cancer. Int J Cancer 2012; 132:1098-104. [DOI: 10.1002/ijc.27757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/25/2012] [Accepted: 07/18/2012] [Indexed: 11/06/2022]
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van 't Westeinde SC, Horeweg N, Vernhout RM, Groen HJ, Lammers JWJ, Weenink C, Nackaerts K, Oudkerk M, Mali W, Thunnissen FB, de Koning HJ, van Klaveren RJ. The Role of Conventional Bronchoscopy in the Workup of Suspicious CT Scan Screen-Detected Pulmonary Nodules. Chest 2012; 142:377-384. [DOI: 10.1378/chest.11-2030] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Lee GD, Kim HC, Kim YE, Lee SJ, Cho YJ, Jeong YY, Jeon KN, Jang IS, Lee JD, Hwang YS. Value of cytologic analysis of bronchial washings in lung cancer on the basis of bronchoscopic appearance. CLINICAL RESPIRATORY JOURNAL 2012; 7:128-34. [DOI: 10.1111/j.1752-699x.2012.00293.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bronchoscopy in rural areas? Pulm Med 2012; 2012:872327. [PMID: 22448332 PMCID: PMC3289868 DOI: 10.1155/2012/872327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 11/06/2011] [Indexed: 11/17/2022] Open
Abstract
Quality of bronchoscopy performed by one single pulmonologist in a scarcely populated subarctic area was compared to the guidelines provided by the British Thoracic Society (BTS). 103 patients underwent bronchoscopy. Diagnostic yield was increased to 76.6% when the first bronchoscopy was supplemented by bronchial washing fluid and brush cytology and to 86.7% (BTS guidelines >80%) after a second bronchoscopy. Median time from referral to bronchoscopy was 10 days and 8 days from positive bronchoscopy to operative referral to another hospital. 1% of patients that underwent transbronchial lung biopsy had minor complications. One pulmonologist had rate of correct diagnosis based on visible endobronchial tumors that was comparable to the rates of numerous pulmonologists at larger centers performing the same procedure. Time delay was short. Rate of complications was comparable. Bronchoscopy performed by one pulmonologist alone could, in organized settings, be carried out at local hospitals in areas of scattered settlement.
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Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: a randomized pragmatic trial. Respir Med 2011; 105:1704-11. [PMID: 21875783 DOI: 10.1016/j.rmed.2011.08.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 07/26/2011] [Accepted: 08/07/2011] [Indexed: 11/22/2022]
Abstract
In many patients the optimal method of investigation of peripheral pulmonary lesions (PPL) is not clear. We performed a prospective randomized pragmatic trial to determine the comparative effectiveness of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) and CT-guided percutaneous needle biopsy (CT-PNB) for the investigation of PPL. Overall complication rates were higher in those undergoing CT-PNB (27% v 3%, p = 0.03), while diagnostic accuracy of EBUS-TBLB was shown to be non-inferior to that of CT-PNB. Expected diagnostic accuracy and complication rates are likely to differ for individual patients on the basis of specific complex clinicoradiologic factors, which will influence the cost-benefit analysis between EBUS-TBLB and CT-PNB for individual patients. Further studies are required to examine the effect of these factors on clinical decision-making.
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Schneider KU, Dietrich D, Fleischhacker M, Leschber G, Merk J, Schäper F, Stapert HR, Vossenaar ER, Weickmann S, Liebenberg V, Kneip C, Seegebarth A, Erdogan F, Rappold G, Schmidt B. Correlation of SHOX2 gene amplification and DNA methylation in lung cancer tumors. BMC Cancer 2011; 11:102. [PMID: 21426551 PMCID: PMC3070682 DOI: 10.1186/1471-2407-11-102] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 03/22/2011] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND DNA methylation in the SHOX2 locus was previously used to reliably detect lung cancer in a group of critical controls, including 'cytologically negative' samples with no visible tumor cell content, at a high specificity based on the analysis of bronchial lavage samples. This study aimed to investigate, if the methylation correlates with SHOX2 gene expression and/or copy number alterations. An amplification of the SHOX2 gene locus together with the observed tumor-specific hypermethylation might explain the good performance of this marker in bronchial lavage samples. METHODS SHOX2 expression, gene copy number and DNA methylation were determined in lung tumor tissues and matched morphologically normal adjacent tissues (NAT) from 55 lung cancer patients. Quantitative HeavyMethyl (HM) real-time PCR was used to detect SHOX2 DNA methylation levels. SHOX2 expression was assayed with quantitative real-time PCR, and copy numbers alterations were measured with conventional real-time PCR and array CGH. RESULTS A hypermethylation of the SHOX2 locus in tumor tissue as compared to the matched NAT from the same patient was detected in 96% of tumors from a group of 55 lung cancer patients. This correlated highly significantly with the frequent occurrence of copy number amplification (p < 0.0001), while the expression of the SHOX2 gene showed no difference. CONCLUSIONS Frequent gene amplification correlated with hypermethylation of the SHOX2 gene locus. This concerted effect qualifies SHOX2 DNA methylation as a biomarker for lung cancer diagnosis, especially when sensitive detection is needed, i.e. in bronchial lavage or blood samples.
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Affiliation(s)
- Katja U Schneider
- University Hospital Heidelberg, Institute of Human Genetics, Heidelberg, Germany
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Schmidt B, Liebenberg V, Dietrich D, Schlegel T, Kneip C, Seegebarth A, Flemming N, Seemann S, Distler J, Lewin J, Tetzner R, Weickmann S, Wille U, Liloglou T, Raji O, Walshaw M, Fleischhacker M, Witt C, Field JK. SHOX2 DNA methylation is a biomarker for the diagnosis of lung cancer based on bronchial aspirates. BMC Cancer 2010; 10:600. [PMID: 21047392 PMCID: PMC2988753 DOI: 10.1186/1471-2407-10-600] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 11/03/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to show that SHOX2 DNA methylation is a tumor marker in patients with suspected lung cancer by using bronchial fluid aspirated during bronchoscopy. Such a biomarker would be clinically valuable, especially when, following the first bronchoscopy, a final diagnosis cannot be established by histology or cytology. A test with a low false positive rate can reduce the need for further invasive and costly procedures and ensure early treatment. METHODS Marker discovery was carried out by differential methylation hybridization (DMH) and real-time PCR. The real-time PCR based HeavyMethyl technology was used for quantitative analysis of DNA methylation of SHOX2 using bronchial aspirates from two clinical centres in a case-control study. Fresh-frozen and Saccomanno-fixed samples were used to show the tumor marker performance in different sample types of clinical relevance. RESULTS Valid measurements were obtained from a total of 523 patient samples (242 controls, 281 cases). DNA methylation of SHOX2 allowed to distinguish between malignant and benign lung disease, i.e. abscesses, infections, obstructive lung diseases, sarcoidosis, scleroderma, stenoses, at high specificity (68% sensitivity [95% CI 62-73%], 95% specificity [95% CI 91-97%]). CONCLUSIONS Hypermethylation of SHOX2 in bronchial aspirates appears to be a clinically useful tumor marker for identifying subjects with lung carcinoma, especially if histological and cytological findings after bronchoscopy are ambiguous.
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Affiliation(s)
- Bernd Schmidt
- Universitätsklinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle (Saale), Halle, Germany
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Ding W, Yue W, Fu Y. [The current research feature and prospect of bronchoalveolar lavage in diagnosing lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:370-4. [PMID: 20677567 PMCID: PMC6000434 DOI: 10.3779/j.issn.1009-3419.2010.04.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Weimin Ding
- Department of Celluar & Molecular Biology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Beijing 101149, China
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Fan YB, Wang QS, Ye L, Wang TY, Wu GP. Clinical application of the SurePath liquid-based Pap test in cytological screening of bronchial brushing for the diagnosis of lung cancer. Cytotechnology 2010; 62:53-9. [PMID: 20401634 DOI: 10.1007/s10616-010-9261-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 03/08/2010] [Indexed: 11/29/2022] Open
Abstract
The SurePath liquid-based Pap test (LPT) is successfully and widely used to assess sputum cytology. This study aimed to compare the cytological findings and diagnostic sensitivity of LPT with those of the conventional Pap smear (CPS) method for diagnosing lung cancer. Bronchial brushing specimens from 204 patients diagnosed with lung cancer were studied. LPT slides showed decreased areas of cell monolayers, a clearer background and distinct, stereoscopic cytological features. The LPT had a significantly higher diagnostic sensitivity for lung cancer (71.6%) than the CPS method (57.8%, p < 0.05), particularly for small cell lung carcinoma and >2 cm lesions (p < 0.05). Combination of the LPT with the CPS method showed obviously higher diagnostic sensitivity for the detection of adenocarcinoma (63.6%), central lesions (85.0%) and >2 cm lesions (81.4%) compared with the CPS method alone (p < 0.05, p < 0.01). Thus, LPT is a useful and easily performed technique that can be widely applied, and is suitable for the early diagnosis of lung cancer.
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Affiliation(s)
- Yi-Bo Fan
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, 110001, Shenyang, China,
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Steinfort DP, Hew MJ, Irving LB. Bronchoscopic evaluation of the mediastinum using endobronchial ultrasound: a description of the first 216 cases carried out at an Australian tertiary hospital. Intern Med J 2009; 41:815-24. [PMID: 20002848 DOI: 10.1111/j.1445-5994.2009.02142.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Performance of linear probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging non-small-cell lung cancer has been extensively studied. Alternate indications for its use are less well characterised, and performance in other clinical settings may differ. METHODS We examined a prospectively collected cohort comprising the first 215 patients undergoing EBUS-TBNA at our institution. Patients were analysed according to the clinical and radiological indication for referral. We also examined the effect of the procedural learning curve on diagnostic sensitivity. RESULTS A total of 215 patients underwent 216 EBUS-TBNA procedures. EBUS-TBNA returned adequate tissue for cytopathological analysis in 202 of 216 procedures (94%). Overall sensitivity for detection of malignancy was 0.92 (95% confidence interval 0.86-0.96); however, this varied according to the primary indication for EBUS-TBNA. Diagnostic sensitivity was high among all sub-groups, but the negative predictive value varied depending on the clinical indication for the procedure. We estimate 104 invasive surgical procedures and 32 inpatient admissions were avoided by use of EBUS-TBNA. Significant improvement in diagnostic performance was seen after 20 procedures were completed, and diagnostic accuracy did not peak until after 50 procedures. CONCLUSIONS EBUS-TBNA is able to confirm accurately histologically a large number of disease processes, both malignant and benign, in all clinical indications studied. The procedure is safe even when carried out by proceduralists with minimal prior experience. Diagnostic performance continues to improve beyond 50 cases carried out.
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Affiliation(s)
- D P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Medford ARL, Bennett JA, Free CM, Agrawal S. Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy. Curr Opin Pulm Med 2009; 15:334-42. [PMID: 19395972 DOI: 10.1097/mcp.0b013e32832b8a45] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW There is increasing awareness of minimally invasive endoscopic techniques for mediastinal staging in lung cancer. Traditionally, cervical mediastinoscopy has been utilized. Endobronchial ultrasound-guided fine needle aspiration (EBUS) has recently emerged as a potential alternative. RECENT FINDINGS EBUS has sensitivity for lung cancer which is at least equivalent (if not superior) to cervical mediastinoscopy. However, cervical mediastinoscopy remains superior to EBUS and other techniques in its high negative predictive value. More recent data suggest EBUS may have a role in presurgical staging of radiologically normal subcentimetre nodes and its negative predictive value may be equivalent to surgical staging. Ongoing comparative studies between EBUS and cervical mediastinoscopy may well clarify relative performance and cost analyses. SUMMARY Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.
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Affiliation(s)
- Andrew R L Medford
- Department of Respiratory Medicine, Allergy and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, Leicestershire, UK.
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Steinfort DP, Wurzel D, Irving LB, Ranganathan SC. Endobronchial ultrasound in pediatric pulmonology. Pediatr Pulmonol 2009; 44:303-8. [PMID: 19283761 DOI: 10.1002/ppul.20991] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endobronchial ultrasound (EBUS) is a recently introduced technique that has significantly advanced bronchoscopic techniques in adult medicine. Use of ultrasound allows far more accurate localization and sampling of both peripheral pulmonary, as well as mediastinal and hilar lesions. This has led to greater diagnostic success, with a reduced rate of complications. Its performance characteristics in adult populations are equivalent to surgical procedures previously considered gold standard, but it has dramatically reduced morbidity and mortality among patients requiring invasive diagnostic procedures, when compared to surgical approaches. We describe the types of EBUS in clinical use, the method of use, the clinical indications for each procedure, and the potential role for EBUS in pediatric pulmonology. Radial probe EBUS is used in the investigation of peripheral lung lesions and could be adopted in children to achieve accurate biopsy of such lesions. Linear probe EBUS allows minimally invasive biopsy of mediastinal and hilar lesions. It has potentially greater performance characteristics than current biopsy techniques, with no significant complications reported to date. It may be useful in the diagnosis of lymphoma, or neurogenic tumors, as well as many other diseases resulting in mediastinal or hilar lymphadenopathy. EBUS is a minimally invasive technique that allows tissue sampling of peripheral lung lesions, or mediastinal/hilar masses, with a high diagnostic accuracy, and a significantly lower morbidity and mortality than alternative approaches. The indications for and the use of EBUS in pediatric patients is certain to increase in the future.
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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García Quero C, García Luján R, González Torralba F, de Miguel Poch E, Alfaro Abreu J, Villena Garrido V, López Ríos F, López Encuentra Á. Rentabilidad de la broncoscopia en el diagnóstico de lesiones pulmonares focales malignas. Rev Clin Esp 2008; 208:551-6. [DOI: 10.1016/s0014-2565(08)76032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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