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Li D, Li Z, Li S, Zhang H, Yao S, Li Y, Chen J. Development and Validation of a Prediction Model for Positive Findings of Preoperative Flexible Bronchoscopy in Patients with Peripheral Lung Cancer. Curr Oncol 2022; 30:315-325. [PMID: 36661674 PMCID: PMC9858296 DOI: 10.3390/curroncol30010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: It has yet to be determined whether preoperative flexible bronchoscopy (FB) should be routinely performed in patients with peripheral lung cancer. The aim of this study was to construct a model to predict the probability of positive FB findings, which would help assess the necessity of preoperative FB. (2) Methods: A total of 380 consecutive patients with peripheral lung cancer who underwent preoperative FB were recruited for this study. A prediction model was developed through univariate and multivariate logistic regression, with predictors including gender, age, body mass index (BMI), smoking, history of chronic lung diseases, respiratory symptoms, lesion size, lesion type, lesion location in the bronchi, and lesion location in the lobe. The predictive performance of the model was evaluated by validation using 1000 iterations of bootstrap resampling. Model discrimination was assessed using the area under the receiver operating characteristics curve (AUC), and calibration was assessed using the Brier score and calibration plots. (3) Results: The model suggested that male patients with respiratory symptoms, decreased BMI, solid lesions, and lesions located in lower-order bronchi were more likely to have positive FB findings. The AUC and Brier score of the model for internal validation were 0.784 and 0.162, respectively. The calibration curve for the probability of positive FB findings showed convincing concordance between the predicted and actual results. (4) Conclusions: Our prediction model estimated the pretest probability of positive FB findings in patients with peripheral lung cancers. Males and patients with lower BMI, the presence of respiratory symptoms, larger lesions, solid lesions, and lesions located in lower-order bronchi were associated with increased positive FB findings. The use of our model can be of assistance when making clinical decisions about preoperative FB.
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Affiliation(s)
- Dongyu Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Yuncheng Central Hospital, Yuncheng 044000, China
| | - Zaishan Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Shaolei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Siqing Yao
- Yuncheng Central Hospital, Yuncheng 044000, China
| | - Yi Li
- Yuncheng Central Hospital, Yuncheng 044000, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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2
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Tokoro Y, Yasuo M, Kobayashi T, Hama M, Ichiyama T, Horiuchi T, Ushiki A, Kawakami S, Honda T, Hanaoka M. Computed tomography-guided bronchoscopy in the diagnosis of small peripheral pulmonary lesions: A retrospective study of 240 examinations in a single academic center. Respir Investig 2016; 54:347-354. [PMID: 27566383 DOI: 10.1016/j.resinv.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/12/2016] [Accepted: 04/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Factors that affect the diagnostic yield in computed tomography (CT)-guided bronchoscopy have not yet been fully evaluated. To improve the diagnostic yield of peripheral pulmonary lesions (PPLs) by CT-guided bronchoscopy, we quantitatively analyzed factors affecting the diagnostic yield. METHODS The data were collected for 240 PPLs in 237 patients examined by using CT-guided bronchoscopy between October 2003 and November 2011 in our respiratory center. The association of diagnostic yield with the CT bronchus sign (CT-BS), lesion size, location, number of tissue specimens, and type of bronchoscope was retrospectively assessed. RESULTS The diagnostic yield of PPLs with negative CT-BS was significantly lower (2.9%) than that for PPLs with positive CT-BS (52.2%; p<0.01). Among the PPLs with positive CT-BS, the yield was significantly higher in those in the left S(3) than for lesions in other bronchial segments (83.3% vs. 50.3%; p<0.05). Lesion size was not significantly associated with diagnostic yield. The yield was significantly lower in PPLs without lung tissue specimens than in lesions with biopsy specimens (p<0.01). Moreover, a thin bronchoscope produced a higher yield in comparison with other bronchoscope types (66.0% vs. 47.6%; p<0.05). Multivariate analysis revealed that the number of biopsy specimens was an independent factor affecting diagnostic yield. CONCLUSIONS CT-guided bronchoscopy is valuable in the diagnosis of PPLs with positive CT-BS regardless of lesion size; however, PPLs with negative CT-BS are not good candidates for CT-guided bronchoscopy. Obtaining tissue specimens by biopsy is a critical factor in diagnosing PPLs.
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Affiliation(s)
- Yayoi Tokoro
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Takashi Kobayashi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Mineyuki Hama
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Takashi Ichiyama
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Toshimichi Horiuchi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Takayuki Honda
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan.
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Zhang Y, Zhang Y, Chen S, Li Y, Yu Y, Sun Y, Chen H. Is bronchoscopy necessary in the preoperative workup of a solitary pulmonary nodule? J Thorac Cardiovasc Surg 2015; 150:36-40. [PMID: 25841658 DOI: 10.1016/j.jtcvs.2015.02.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/25/2015] [Accepted: 02/03/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study evaluated the role of conventional bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules (SPNs). METHODS Patients with SPNs of unknown origin were enrolled for preoperative bronchoscopy at our institution. Bronchoscopic findings were prospectively collected, and their impact on planned therapy was analyzed. RESULTS A total of 1026 patients were included. Bronchoscopy identified unsuspected findings in 80 (7.8%) of them, with a total of 826 (80.5%) malignant nodules. Referent values for bronchoscopic detection of malignant SPNs were: accuracy, 24.3% (95% confidence interval [CI]: 21.7%-27.0%); sensitivity, 5.9% (95% CI: 4.5%-7.4%); specificity, 100%; and negative predictive value, 20.5% (95% CI: 18.0%-22.9%). Malignant bronchoscopic findings were more common in male patients (odds ratio [OR] = 2.1, 95% CI: 1.1-3.9, P = .021) and large nodules (OR = 2.3, 95% CI: 1.6-3.3, P < .001). Surgery was cancelled in 2 (0.2%) patients and modified in 36 (3.5%) patients because of bronchoscopic findings. In all, for 268 (26.1%) SPNs that presented with ground-glass opacity, the bronchoscopy was unrevealing. CONCLUSIONS In the preoperative evaluation of SPN, bronchoscopy is most likely to reveal malignancy in larger SPNs and in male patients. Bronchoscopy is not indicated in SPNs that present with ground-glass opacity on computed tomography scan.
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Affiliation(s)
- Yiliang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Sufeng Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yongfu Yu
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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4
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Asano F, Matsuno Y, Tsuzuku A, Anzai M, Shinagawa N, Yamazaki K, Ishida T, Moriya H. Diagnosis of peripheral pulmonary lesions using a bronchoscope insertion guidance system combined with endobronchial ultrasonography with a guide sheath. Lung Cancer 2007; 60:366-73. [PMID: 18055063 DOI: 10.1016/j.lungcan.2007.10.022] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 10/15/2007] [Accepted: 10/23/2007] [Indexed: 11/29/2022]
Abstract
We developed a bronchoscope insertion guidance system that produces virtual images by extracting the bronchi by automatic threshold adjustment, and searching for the bronchial route to the determined target. We used this system in combination with a thin bronchoscope and endobronchial ultrasonography with a guide sheath (EBUS-GS), and evaluated its practicability, usefulness and safety. The subjects were 31 patients with 32 peripheral pulmonary lesions. Computed tomography (CT) data were transferred into this system, and virtual bronchial images were automatically produced by setting the lesion as the target. While virtual images with the target were displayed for comparison with real images by the system, a thin bronchoscope was advanced to the target bronchus. Transbronchial biopsy (TBB) was then performed by EBUS-GS. The system automatically produced virtual images to a median of fifth- (third- to seventh-) order bronchi. In all patients, the thin bronchoscope could be guided along the planned route, and observation to a median of fifth- (third- to seventh-) order bronchi was possible. Thirty lesions (93.8%) were successfully visualized by EBUS, and 27 (84.4%) could be pathologically diagnosed. In lesions < or =30mm in size, the EBUS visualization yield was 91.7% (22/24), and the diagnostic yield was 79.2% (19/24). The median total examination time was 22.3 (9.8-41.5) min. In summary, using the bronchoscope insertion guidance system, virtual images can be readily produced, and the bronchoscope can be successfully guided to the target. This method is promising as a routine examination method in the biopsy of peripheral pulmonary lesions.
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Affiliation(s)
- Fumihiro Asano
- Department of Pulmonary Medicine and Bronchoscopy, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu 500-8717, Japan.
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5
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Asano F, Matsuno Y, Shinagawa N, Yamazaki K, Suzuki T, Ishida T, Moriya H. A virtual bronchoscopic navigation system for pulmonary peripheral lesions. Chest 2006; 130:559-66. [PMID: 16899859 DOI: 10.1378/chest.130.2.559] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES We performed ultrathin bronchoscopy for pulmonary peripheral lesions using a system that displays virtual bronchoscopy (VB) images to the lesion simultaneously with actual images and navigates the bronchoscope to the target bronchus. We then evaluated the system with regard to its usefulness and problems. DESIGN A pilot study. SETTING A tertiary teaching hospital. PATIENTS The subjects were consecutive patients with small pulmonary peripheral lesions (< or = 30 mm). INTERVENTIONS Using this system, the rotation, advancement, and retreat of VB images were possible, and the bronchus into which the bronchoscope was to be advanced was displayed. VB images were displayed along with actual images, and the ultrathin bronchoscope was advanced to the target bronchus under direct vision. Under CT and radiographic fluoroscopy, a pair of forceps was inserted into the lesion via the bronchoscope. Thin-section CT images were obtained; after confirming the advancement of the bronchoscope into the target bronchus and the arrival of the forceps at the lesion, a biopsy was performed. RESULTS Study subjects included 37 patients with 38 lesions. VB images to a median of the sixth- (third- to ninth-) order bronchi could be produced. Using this system, the ultrathin bronchoscope could be advanced into the planned route for 36 of the 38 lesions (94.7%). The system was used for a median of 2.6 min, and the median examination time was 24.9 min. The biopsy forceps could be advanced to the lesion in 33 of the 38 lesions (86.8%), and diagnosis was possible for 31 lesions (81.6%). CONCLUSIONS This navigation system is useful for ultrathin bronchoscopy for pulmonary peripheral lesions.
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Affiliation(s)
- Fumihiro Asano
- Department of Respiratory Medicine, Gifu Prefectural Gifu Hospital, Japan.
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Lacasse Y, Martel S, Hébert A, Carrier G, Raby B. Accuracy of virtual bronchoscopy to detect endobronchial lesions. Ann Thorac Surg 2004; 77:1774-80. [PMID: 15111185 DOI: 10.1016/j.athoracsur.2003.10.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Virtual bronchoscopy (VB) could obviate flexible bronchoscopy (FB) if no endobronchial lesion is detected in patients presenting with a suspicion of malignancy. Our objectives were to evaluate the accuracy (in terms of sensitivity and specificity) of VB in detecting endobronchial lesions, and to determine the anatomical limit of detection of endobronchial lesions by VB. METHODS This study involved, in a blind comparison of VB and FB, consecutive patients presenting with symptoms or plain chest radiography abnormalities raising the suspicion of pulmonary neoplasm. After the standard chest computed tomography (CT), additional helical CT data were acquired from the aortic arch to the origin of the segmental bronchi of the inferior lobes in one 20-second breath hold using an helicoidal CT scan (3.0-mm collimation with a pitch of 1.5 and 1.5-mm reconstruction intervals). RESULTS One hundred ninety patients were enrolled; 136 patients (including 63 with an endobronchial lesion at FB) contributed to the primary analysis. The sensitivity and specificity of VB to detect endobronchial lesions were 68% (95% confidence interval [CI]: 55% to 79%) and 90% (95% CI: 81% to 96%), respectively. Overall, the agreement between VB and FB regarding the location on endobronchial lesions was substantial (weighted kappa: 0.66). However, VB detected only 26 of the 34 lobar lesions (sensitivity: 76%; CI: 59% to 89%) and 11 of the 23 segmental lesions (sensitivity: 48%; CI: 27% to 69%). CONCLUSIONS Beyond the mainstem bronchi, VB is not accurate enough to detect endobronchial lesions and to obviate FB in patients presenting with a suspicion of malignancy.
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Affiliation(s)
- Yves Lacasse
- Centre de Recherche and Department of Radiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Quebec, Canada.
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7
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Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K, Richardson C, Sawicka E. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58:920-36. [PMID: 14586042 PMCID: PMC1746503 DOI: 10.1136/thorax.58.11.920] [Citation(s) in RCA: 289] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Manhire
- Department of Radiology, Nottingham City Hospital, UK.
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8
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Yankelevitz DF, Wisnivesky JP, Henschke CI. Comparison of biopsy techniques in assessment of solitary pulmonary nodules. Semin Ultrasound CT MR 2000; 21:139-48. [PMID: 10776886 DOI: 10.1016/s0887-2171(00)90020-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A wide variety of diagnostic tests are available to evaluate solitary pulmonary nodules, ranging from noninvasive to invasive. Given the virulence of lung cancer, those techniques that can provide cytological and pathological information are often chosen. However, the choice of which procedure to perform is complicated by numerous factors, including the sensitivity and specificity of the test, as well as the prevalence of disease. Additional considerations also include complications, availability and expertise in performing procedures, and overall cost of the diagnostic algorithm. Rather than make specific recommendations for diagnostic workup, it is more appropriate to consider that this will vary from institution to institution based on the above factors.
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Affiliation(s)
- D F Yankelevitz
- Department of Radiology, Weill Medical College of Cornell University--The New York-Presbyterian Hospital, NY 10021, USA
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9
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Aristizabal JF, Young KR, Nath H. Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma? Chest 1998; 113:1244-9. [PMID: 9596301 DOI: 10.1378/chest.113.5.1244] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Fiberoptic bronchoscopy (FOB) is frequently used to diagnose and stage bronchogenic carcinoma (BC). However, the value of FOB in diagnosis/staging BC presenting as a pulmonary nodule or mass (PNM) is controversial. Since chest CT is usually obtained in these patients, it may be used in patient selection for preoperative FOB. OBJECTIVE Evaluation of the role of chest CT in determining the predictive value of FOB in diagnosing/staging a PNM, by comparing the results of CT and bronchoscopy. DESIGN Retrospective review of chest CTs and medical records. PATIENTS Consecutive patients with BC between 1992 and 1994 who had diagnostic FOB and CT in our institution, but without radiographic evidence of (1) pulmonary atelectasis, (2) endobronchial tumor or narrowing of the central airways, and (3) the PNM abutting the central airways. RESULTS Sixty-four patients met the selection criteria. The size of the PNM ranged from 1.5 to 10 cm; the size was < or = 4 cm in 62 patients. FOB provided a diagnosis in 22 patients. Bronchoscopy detected endobronchial lesions in 11 patients (17%); 3 had lesions in more than one lobe. In three patients, the PNM was <3 cm. The radiographically undetected endobronchial tumor increased the tumor stage in only two patients. The "CT bronchus" sign had a positive and negative predictive value of 75% and 68%, respectively. CONCLUSIONS (1) In this study, CT failed to detect endobronchial tumor in 11 of 64 patients (17%). Because of the implications of a new staging system, more studies are necessary before abandoning staging FOB. (2) The CT bronchus sign has a very high positive and negative predictive value in the use of diagnostic FOB and should be used to guide the method of biopsy of a PNM.
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Affiliation(s)
- J F Aristizabal
- Department of Pulmonary and Critical Care Medicine, University of Alabama Hospitals, Birmingham, USA
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10
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Abstract
Cytologic detection of lung cancer is accepted, accurate, and time-honored. Typically, cytologic workup of a radiologic abnormality proceeds sequentially from sputum to bronchoalveolar cytology, and, if necessary, to fine-needle aspiration biopsy (FNA). Initial use of FNA in lung cancer diagnosis is controversial, but increasingly popular. We therefore decided to objectively assess current practice in cytologic lung cancer diagnosis at our institution. All pulmonary cytologic diagnoses for 1993 and the first half of 1994 were retrieved. Positive diagnoses were then used to access all patient data. Patients were stratified according to the specimen from which the first positive diagnosis was obtained. Of 542 pulmonary cytology specimens, 15% were sputa, 65% were bronchoalveolar, and 20% were FNAs. One hundred sixty-one of 172 malignant diagnoses were first diagnoses. Three percent of first malignant diagnoses were made from sputa, 47% were from lavages, and 50% were from FNAs. Although FNAs comprised just 20% of all pulmonary cytologies, 50% of all new malignant cytologic diagnoses were made by FNA. Initial use of FNA is successful, has a high diagnostic yield and low complication rate, and offers the most direct approach to diagnosis.
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Affiliation(s)
- W Blumenfeld
- Department of Pathology, Winthrop-University Hospital, Mineola, NY 11501, USA
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11
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Lai RS, Lee SS, Ting YM, Wang HC, Lin CC, Lu JY. Diagnostic value of transbronchial lung biopsy under fluoroscopic guidance in solitary pulmonary nodule in an endemic area of tuberculosis. Respir Med 1996; 90:139-43. [PMID: 8736205 DOI: 10.1016/s0954-6111(96)90155-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs. The objective of this study is to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) under fluoroscopic guidance in SPNs such as lung cancer or pulmonary tuberculoma in areas with high prevalence of tuberculosis. One hundred and seventy patients with SPNs on chest radiographs were included in the study; all had negative sputum smears for tubercle bacilli and no malignancy by sputum cytology before bronchoscopy. Transbronchial lung biopsy and brushing were performed, routinely, under fluoroscopic guidance. Of 170 patients, 120 (70.6%) had lung cancer (including three with metastatic cancer), 40 (23.5%) patients had pulmonary tuberculosis (Tb), and the remaining 10 (5.9%) patients had other benign pulmonary lesions. The overall diagnostic rate in SPNs was 62.4% (106 of 170). Transbronchial lung biopsy and brushing revealed a diagnostic sensitivity of 70.0% in lung cancer (84 of 120) and a sensitivity of 55% in Tb (22 of 40). In addition, TBLB and brushing also provided rapid microscopic identification of Tb in 18 of 40 patients (45%, including 15 by TBLB, one by brushing smear, and two by postbronchoscopic sputum). The percentage of positive diagnosis correlated with diameter of the SPN. Solitary pulmonary nodules with diameter less than 2 cm were diagnosed in only 35.3% of cases (6 of 17; cancer 40% vs. Tb 29%). In contrast, the diagnostic rates in SPNs with diameters 2-4 cm and greater than 4 cm were 64.5% (78 of 121; cancer 72.0% vs. Tb 62.5%) and 68.8% of cases (22 of 32), respectively. Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule since it may provide additional information to minimize unnecessary thoracotomy and give way for proper medication as early as possible.
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Affiliation(s)
- R S Lai
- Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China
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12
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Rubins JB, Rubins HB. Temporal trends in the prevalence of malignancy in resected solitary pulmonary lesions. Chest 1996; 109:100-3. [PMID: 8549167 DOI: 10.1378/chest.109.1.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE To determine whether there has been an increase in the prevalence of malignancy among resected, indeterminate solitary pulmonary lesions (SPL) over the past 14 years. DESIGN A retrospective review of all thoracotomies for indeterminate SPLs from 1981 through 1994. SETTING A university-affiliated VA Medical Center. PATIENTS Three-hundred seventy resected indeterminate SPLs (all < or = 6 cm) in 360 patients. MEASUREMENTS AND RESULTS Virtually all patients were men with an average age of 63 +/- 9 years. The average lesion size was 2.5 +/- 1.4 cm; 71% were 3 cm or less. Overall, 79% of resected lesions were malignant; 94% of these were bronchogenic carcinomas. Granulomas accounted for more than 50% of benign lesions. The proportion of malignant diagnoses increased from 55 to 60% in 1981 to 1983 to 90 to 100% in 1990 to 1994 (p < 0.005). The increasing proportion of malignancy over time was independent of age at time of operation and lesion size. There was no significant difference in survival among patients with a malignant lesion resected in 1981 to 1983 compared with 1990 to 1994. CONCLUSION We conclude that there has been a striking increase in the prevalence of malignancy among resected indeterminate SPLs over the past 14 years in our institution. We suspect that this trend reflects improvements in our ability to diagnose benign SPLs preoperatively, primarily through the use of CT. Our results should prompt other institutions to review their recent experience with the diagnosis of indeterminate SPLs to provide more timely information to physicians and their patients who are contemplating resection of SPLs.
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Affiliation(s)
- J B Rubins
- Pulmonary Disease Division, Veterans Affairs Medical Center, Minneapolis, USA
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13
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Gasparini S, Ferretti M, Secchi EB, Baldelli S, Zuccatosta L, Gusella P. Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses. Experience with 1,027 consecutive cases. Chest 1995; 108:131-7. [PMID: 7606947 DOI: 10.1378/chest.108.1.131] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A study to evaluate the usefulness of the integration of the transbronchial and percutaneous approaches in the diagnosis of peripheral pulmonary nodules or masses (PPN/M) was conducted. The authors used both procedures, performed by a single diagnostic team, a pulmonologist, radiologist, and cytopathologist, who were all simultaneously present in the radiologic suite during the maneuvers. From January 1985 to June 1993, under fluoroscopic guidance, the authors performed 557 transbronchial pulmonary biopsies (TBPB), 483 transbronchial needle aspirations (TBNA), and 652 percutaneous needle aspirations (PCNA) on 1,027 consecutive patients referred because of a PPN/M (mean diameter, 3.5 cm; range, 0.8 to 8 cm). The procedure used was as follows: (1) bronchoscopy with exploration of the upper airways and bronchial tree, followed by TBNA and immediate cytologic assessment (ICA); (2) at least three TBPB; (3) if TBNA was diagnostic, the procedure was stopped; if not, a second pass with the needle was performed and then the bronchoscope was removed; (4) if the second TBNA was not diagnostic, PCNA with ICA was performed up to a maximum of three needle passes. Diagnostic sensitivity for malignant lesions was as follows: 53.9% for TBPB, 69.3% for TBNA, 75.4% for TBPB and TBNA together, 93.2% for PCNA, and 95.2% overall. The percentage of benign nodules correctly defined was 41.4% for TBPB, 17.4% for TBNA, 45.8% for PCNA, and 59.5% overall. Examination of the upper airways and bronchial tree was positive for lesions endoscopically visible in 12.6% of cases. The authors' experience shows that transbronchial and percutaneous approaches must be considered complementary and that their integrated use not only increases diagnostic yield but also permits important information to be obtained for disease staging. The creation of teams able to use both approaches with the cytopathologist present for ICA should be encouraged to optimize the diagnostic management of PPN/M with a reduction in diagnostic and hospitalization time and consequent cost saving.
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Affiliation(s)
- S Gasparini
- Pulmonary Division, Regional Hospital USL 12, Ancona, Italy
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14
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Santambrogio L, Nosotti M, Bellaviti N, Mezzetti M. Videothoracoscopy versus thoracotomy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Thorac Surg 1995; 59:868-70; discussion 870-1. [PMID: 7695411 DOI: 10.1016/0003-4975(94)00952-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The solitary pulmonary nodule often presents a diagnostic challenge to the specialist because the nature of the nodule is often indeterminate at the end of the usual diagnostic process, and operation frequently is required before a definite diagnosis can be made. We have conducted a randomized, prospective trial to evaluate the diagnostic efficacy of video-assisted thoracic surgery versus muscle-sparing lateral thoracotomy. Between January 1991 and May 1994, 44 patients suffering from solitary pulmonary nodule were divided at random into two groups: the nodule was removed in 22 cases by video-assisted thoracic surgery and in 22 cases by lateral thoracotomy. Nineteen wedge resections, 1 segmentectomy, and 2 lobectomies were performed in the first group and 13 wedge resections, 8 segmentectomies, and 1 lobectomy in the second group. An "access" thoracotomy had to be performed in 5 patients in the video-assisted thoracic surgery group. The operating room time was 97.2 +/- 32.9 minutes in the video-assisted thoracic surgery group and 130.5 +/- 14 minutes in the lateral thoracotomy group (p > 0.05). In both groups a final diagnosis was made in 100% of cases. The postoperative hospital stay was 4.6 +/- 1.08 days in the video-assisted thoracic surgery group and 7.8 +/- 0.89 days in the lateral thoracotomy group (p < 0.01). Pain was evaluated on a visual analogue scale; the scores were 26.5 +/- 11.6 in the video-assisted thoracic surgery group and 48.3 +/- 12.8 in the lateral thoracotomy group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Santambrogio
- Division of General and Thoracic Surgery, University of Milan, Italy
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Cazzadori A, Di Pewrri G, Marocco S, Mazzi R, Fibbia G, Concia E. Staging bronchoscopy in the preoperative assessment of a solitary nodule. Chest 1994; 106:653. [PMID: 7632262 DOI: 10.1378/chest.106.2.653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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