1
|
Kalverda KA, Ninaber MK, Wijmans L, von der Thüsen J, Jonkers RE, Daniels JM, Miedema JR, Dickhoff C, Hölters J, Heineman D, Kant M, Radonic T, Shahin G, Cohen D, Boerrigter B, Nijman S, Nossent E, Braun J, Mathot B, Poletti V, Hetzel J, Dijkgraaf M, Korevaar DA, Bonta PI, Annema JT. Transbronchial cryobiopsy followed by as-needed surgical lung biopsy versus immediate surgical lung biopsy for diagnosing interstitial lung disease (the COLD study): a randomised controlled trial. Lancet Respir Med 2024:S2213-2600(24)00074-2. [PMID: 38640934 DOI: 10.1016/s2213-2600(24)00074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND An adequate diagnosis for interstitial lung disease (ILD) is important for clinical decision making and prognosis. In most patients with ILD, an accurate diagnosis can be made by clinical and radiological data assessment, but in a considerable proportion of patients, a lung biopsy is required. Surgical lung biopsy (SLB) is the most common method to obtain tissue, but it is associated with high morbidity and even mortality. More recently, transbronchial cryobiopsy has been introduced, with fewer adverse events but a lower diagnostic yield than SLB. The aim of this study is to compare two diagnostic strategies: a step-up strategy (transbronchial cryobiopsy, followed by SLB if the cryobiopsy is insufficiently informative) versus immediate SLB. METHODS The COLD study was a multicentre, randomised controlled trial in six hospitals across the Netherlands. We included patients with ILD with an indication for lung biopsy as assessed by a multidisciplinary team discussion. Patients were randomly assigned in a 1:1 ratio to the step-up or immediate SLB strategy, with follow-up for 12 weeks from the initial procedure. Patients, clinicians, and pathologists were not masked to the study treatment. The primary endpoint was unexpected chest tube drainage, defined as requiring any chest tube after transbronchial cryobiopsy, or prolonged (>24 h) chest tube drainage after SLB. Secondary endpoints were diagnostic yield, in-hospital stay, pain, and serious adverse events. A modified intention-to-treat analysis was performed. This trial is registered with the Dutch Trial Register, NL7634, and is now closed. FINDINGS Between April 8, 2019, and Oct 24, 2021, 122 patients with ILD were assessed for study participation; and 55 patients were randomly assigned to the step-up strategy (n=28) or immediate SLB (n=27); three patients from the immediate SLB group were excluded. Unexpected chest tube drainage occurred in three of 28 patients (11%; 95% CI 4-27%) in the step-up group, and the number of patients for whom the chest tube could not be removed within 24 h was 11 of 24 patients (46%; 95% CI 2-65%) in the SLB group, with an absolute risk reduction of 35% (11-56%; p=0·0058). In the step-up strategy, the multidisciplinary team diagnostic yield after transbronchial cryobiopsy alone was 82% (64-92%), which increased to 89% (73-96%) when subsequent SLB was performed after inconclusive transbronchial cryobiopsy. In the immediate surgery strategy, the multidisciplinary team diagnostic yield was 88% (69-97%). Total in-hospital stay was 1 day (IQR 1-1) in the step-up group versus 5 days (IQR 4-6) in the SLB group. One (4%) serious adverse event occurred in step-up strategy versus 12 (50%) in the immediate SLB strategy. INTERPRETATION In ILD diagnosis, if lung tissue assessment is required, a diagnostic strategy starting with transbronchial cryobiopsy, followed by SLB when transbronchial cryobiopsy is inconclusive, appears to result in a significant reduction of patient burden and in-hospital stay with a similar diagnostic yield versus immediate SLB. FUNDING Netherlands Organisation for Health Research and Development (ZonMW) and Amsterdam University Medical Centers.
Collapse
Affiliation(s)
- Kirsten A Kalverda
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Maarten K Ninaber
- Department of Respiratory Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Lizzy Wijmans
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - René E Jonkers
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes M Daniels
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle R Miedema
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jürgen Hölters
- Department of Respiratory Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - David Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Merijn Kant
- Department of Respiratory Diseases, Amphia Hospital, Breda, Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ghada Shahin
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Boerrigter
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Suzan Nijman
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Esther Nossent
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bas Mathot
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Venerino Poletti
- Department of Medical Specialties, Giovan Battista Morgagni Hospital, University of Forlì, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany; Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel A Korevaar
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter I Bonta
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
2
|
Kramer T, Wijmans L, van Heumen S, Bansal S, Jeannerat D, Manley C, de Bruin M, Bonta PI, Annema JT. Needle-based confocal laser endomicroscopy for real-time granuloma detection. Respirology 2023; 28:934-941. [PMID: 37562791 DOI: 10.1111/resp.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos. METHODS In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE-videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice. RESULTS Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54-0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy. CONCLUSION nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.
Collapse
Affiliation(s)
- Tess Kramer
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lizzy Wijmans
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia van Heumen
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandeep Bansal
- The Lung Center, Penn Highlands Healthcare, DuBois, Pennsylvania, USA
| | - Dawn Jeannerat
- The Lung Center, Penn Highlands Healthcare, DuBois, Pennsylvania, USA
| | - Christopher Manley
- Department of Respiratory Medicine and Critical Care, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Martijn de Bruin
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Wijmans L, Kalverda K, de Bruin D, Brinkman P, van den Berk I, Roelofs JJ, Jonkers R, Bonta PI, Annema J. Bronchoscopic Journey of in vivo Real-Time Microscopic Imaging in ILD: A Case Series. Respiration 2022; 101:1006-1014. [PMID: 36044868 PMCID: PMC9811420 DOI: 10.1159/000526045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with interstitial lung diseases (ILDs) frequently present with nondiagnostic high-resolution CT (HRCT) scan and bronchoalveolar lavage (BAL) results, resulting in the need for invasive surgical or cryo-lung biopsy that is associated with significant morbidity. Confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) are high-resolution laser and light-based techniques that provide real-time imaging of the alveolar compartment during bronchoscopy with a different depth and field of view. OBJECTIVES The aim of the study was to correlate OCT and CLE imaging to HRCT imaging in ILD. METHODS This is a retrospective case series of 20 ILD patients who underwent alveolar CLE and OCT imaging during a standard bronchoscopy with BAL, followed by a lung biopsy when indicated. CLE and OCT imaging were compared to four main HRCT patterns and histology. The final diagnosis was based on the multidisciplinary discussion diagnosis. RESULTS Bronchoscopic CLE and OCT imaging were feasible and safe and provided additional high-detailed anatomical information compared to the HRCT. Bronchoscopic real-time CLE was capable of identification of "alveolar cells" (ground glass opacities) and lung fibrosis (increased alveolar elastin fibers). Bronchoscopic real-time OCT allowed for visualization of "patchy fibrotic disease", "honeycombing" (microcysts), and mucosal granulomas in the airways. CONCLUSIONS Bronchoscopic CLE and OCT of the alveolar compartment is feasible and safe and enables minimally invasive, high-resolution detection of specific ILD features with the potential to improve ILD diagnostics and monitoring and decrease the need for surgical or cryo-lung biopsies.
Collapse
Affiliation(s)
- Lizzy Wijmans
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands,*Lizzy Wijmans,
| | - Kirsten Kalverda
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Daniel de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - René Jonkers
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter I. Bonta
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jouke Annema
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Kalverda KA, Vaselli M, Wijmans L, de Bruin DM, Jonkers RE, Poletti V, de Boer J, Annema JT, Bonta PI. Endobronchial Optical Coherence Tomography: Shining New Light on Diagnosing Usual Interstitial Pneumonitis? Am J Respir Crit Care Med 2022; 205:967-968. [PMID: 35148494 PMCID: PMC9838632 DOI: 10.1164/rccm.202111-2619le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kirsten A. Kalverda
- Amsterdam University Medical CentersAmsterdam, the Netherlands,Corresponding author (e-mail: )
| | | | - Lizzy Wijmans
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| | | | - René E. Jonkers
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| | - Venerino Poletti
- Ospedale GB MorgagniForli, Italy,Aarhus University HospitalAarhus, Denmark
| | | | - Jouke T. Annema
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| | - Peter I. Bonta
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| |
Collapse
|
5
|
Kramer T, Wijmans L, de Bruin M, van Leeuwen T, Radonic T, Bonta P, Annema JT. Bronchoscopic needle-based confocal laser endomicroscopy (nCLE) as a real-time detection tool for peripheral lung cancer. Thorax 2021; 77:370-377. [PMID: 34172559 PMCID: PMC8938671 DOI: 10.1136/thoraxjnl-2021-216885] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/21/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Diagnosing peripheral lung cancer with the bronchoscope is challenging with near miss of the target lesion as major obstacle. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic tumour visualisation at the needle tip (smart needle). AIM To investigate feasibility and safety of bronchoscopic nCLE imaging of suspected peripheral lung cancer and to assess whether nCLE imaging allows real-time discrimination between malignancy and airway/lung parenchyma. METHODS Patients with suspected peripheral lung cancer based on (positron emission tomography-)CT scan underwent radial endobronchial ultrasound (rEBUS) and fluoroscopy-guided flexible bronchoscopy. After rEBUS lesion detection, an 18G needle loaded with the CLE probe was inserted in the selected airway under fluoroscopic guidance. The nCLE videos were obtained at the needle tip, followed by aspirates and biopsies. The nCLE videos were reviewed and compared with the cytopathology of the corresponding puncture and final diagnosis. Five blinded raters validated nCLE videos of lung tumours and airway/lung parenchyma twice. RESULTS The nCLE imaging was performed in 26 patients. No adverse events occurred. In 24 patients (92%) good to high quality videos were obtained (final diagnosis; lung cancer n=23 and organising pneumonia n=1). The nCLE imaging detected malignancy in 22 out of 23 patients with lung cancer. Blinded raters differentiated nCLE videos of malignancy from airway/lung parenchyma (280 ratings) with a 95% accuracy. The inter-observer agreement was substantial (κ=0.78, 95% CI 0.70 to 0.86) and intra-observer reliability excellent (mean±SD κ=0.81±0.05). CONCLUSION Bronchoscopic nCLE imaging of peripheral lung lesions is feasible, safe and allows real-time lung cancer detection. Blinded raters accurately distinguished nCLE videos of lung cancer from airway/lung parenchyma, showing the potential of nCLE imaging as real-time guidance tool.
Collapse
Affiliation(s)
- Tess Kramer
- Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | - Lizzy Wijmans
- Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | - Martijn de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | - Ton van Leeuwen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | - Peter Bonta
- Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | - Jouke T Annema
- Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| |
Collapse
|
6
|
Wijmans L. MS16.03 Bronchoscopy and Optical Biopsy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
7
|
Wijmans L, Baas P, Sieburgh TE, de Bruin DM, Ghuijs PM, van de Vijver MJ, Bonta PI, Annema JT. Confocal Laser Endomicroscopy as a Guidance Tool for Pleural Biopsies in Malignant Pleural Mesothelioma. Chest 2019; 156:754-763. [DOI: 10.1016/j.chest.2019.04.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/01/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022] Open
|
8
|
Wijmans L, Mooij - Kalverda KA, Bos L, Goorsenberg A, Smit M, Van Den Berk I, De Bruin D, Bonta P, Schultz M, Annema J. Optical coherence tomography (OCT) in patients with acute respiratory failure on the ICU. Imaging 2019. [DOI: 10.1183/13993003.congress-2019.pa3172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
9
|
Mooij - Kalverda KA, Wijmans L, Bos L, Smit M, Van Den Berk I, De Bruin D, Bonta P, Schultz M, Annema J. Confocal laser endomicroscopy (CLE) in patients with acute respiratory failure on the ICU. Imaging 2019. [DOI: 10.1183/13993003.congress-2019.pa3170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
10
|
Wijmans L, de Bruin DM, Bonta PI, Jonkers RE, Poletti V, Annema JT. Optical Coherence Tomography: A Valuable Novel Tool for Assessing the Alveolar Compartment in Interstitial Lung Disease? Am J Respir Crit Care Med 2019; 197:1231-1232. [PMID: 29244526 DOI: 10.1164/rccm.201711-2152le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lizzy Wijmans
- 1 Academic Medical Center Amsterdam, the Netherlands
| | | | - Peter I Bonta
- 1 Academic Medical Center Amsterdam, the Netherlands
| | | | - Venerino Poletti
- 2 Ospedale GB Morgagni Forlì, Italy and.,3 Aarhus University Hospital Aarhus, Denmark
| | | |
Collapse
|
11
|
Wijmans L, Yared J, de Bruin DM, Meijer SL, Baas P, Bonta PI, Annema JT. Needle-based confocal laser endomicroscopy for real-time diagnosing and staging of lung cancer. Eur Respir J 2019; 53:13993003.01520-2018. [DOI: 10.1183/13993003.01520-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
Abstract
Diagnosing lung cancer in the absence of endobronchial abnormalities is challenging. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging of cells. We assessed the feasibility and safety of using nCLE for real-time identification of lung cancer.In patients with suspected or proven lung cancer scheduled for endoscopic ultrasound (EUS), lung tumours and mediastinal lymph nodes were imaged with nCLE before fine-needle aspiration (FNA) was performed. nCLE lung cancer characteristics were identified by comparison with pathology. Multiple blinded raters validated CLE videos of lung tumours and mediastinal nodes twice.EUS-nCLE-FNA was performed in 22 patients with suspected or proven lung cancer in whom 27 lesions (six tumours, 21 mediastinal nodes) were evaluated without complications. Three nCLE lung cancer criteria (dark enlarged pleomorphic cells, dark clumps and directional streaming) were identified. The accuracy of nCLE imaging for detecting malignancy was 90% in tumours and 89% in metastatic lymph nodes. Both inter-observer agreement (mean κ=0.68, 95% CI 0.66–0.70) and intra-observer agreement (mean±sd κ=0.70±0.15) were substantial.Real-time lung cancer detection by endosonography-guided nCLE was feasible and safe. Lung cancer characteristics were accurately recognised.
Collapse
|
12
|
Wijmans L, Bonta PI, Rocha-Pinto R, de Bruin DM, Brinkman P, Jonkers RE, Roelofs JJTH, Poletti V, Hetzel J, Annema JT. Confocal Laser Endomicroscopy as a Guidance Tool for Transbronchial Lung Cryobiopsies in Interstitial Lung Disorder. Respiration 2018; 97:259-263. [PMID: 30428462 DOI: 10.1159/000493271] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transbronchial cryobiopsy (TBCB) of the lung parenchyma is a minimally invasive alternative for surgical lung biopsy in interstitial lung disease (ILD) patients. Drawbacks are the nondiagnostic rate and complication risk of pneumothorax and bleeding. Fluoroscopy is the current guidance tool for TBCB, which is limited by 2D imaging and a radiation dose for the patient. Confocal laser endomicroscopy (CLE) is a high-resolution imaging technique that provides immediate feedback during bronchoscopy about the elastin fiber network of peripheral lung areas. Both the visceral pleura and fibrotic lung areas consist of elastin fibers and are therefore potentially detectable with CLE. OBJECTIVES To investigate whether CLE is capable of (1) distinguishing fibrotic from normal alveolar areas and (2) identifying the pleura. METHODS In and ex vivo CLE imaging obtained during bronchoscopy was compared with histology of lung biopsies in 14 ILD patients. RESULTS CLE imaging of the alveolar compartment was feasible in all patients without adverse events. Based on CLE imaging, key characteristics that influence both diagnostic yield (dense fibrotic areas) and complication rate (pleura and subpleural space) were visualized. CONCLUSIONS CLE seems a promising alternative to fluoroscopy as a guidance tool for TBCB procedures.
Collapse
Affiliation(s)
- Lizzy Wijmans
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rita Rocha-Pinto
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniel M de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - René E Jonkers
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forli, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Internal Medicine II, University Clinic of Tübingen, Tübingen, Germany
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands,
| |
Collapse
|
13
|
Wijmans L, Annema JT. Reply: Exploring Endomicroscopy in the Field of Pulmonology. Am J Respir Crit Care Med 2017; 195:963. [DOI: 10.1164/rccm.201610-2170le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
14
|
Affiliation(s)
- Lizzy Wijmans
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
15
|
|
16
|
Abstract
Background—
The 2010 guidelines for cardiopulmonary resuscitation allow 5 seconds to give 2 breaths to deliver sufficient chest compressions and to keep perfusion pressure high. This study aims to determine whether the recommended short interruption for ventilations by trained lay rescuers and first responders can be achieved and to evaluate its consequence for chest compressions and survival.
Methods and Results—
From a prospective data collection of out-of-hospital cardiac arrest, we used automatic external defibrillator recordings of cardiopulmonary resuscitation by rescuers who had received a standard European Resuscitation Council basic life support and automatic external defibrillator course. Ventilation periods and total compressions delivered per minute during each 2 minutes of cardiopulmonary resuscitation cycle were measured, and the chest compression fraction was calculated. Neurological intact survival to discharge was studied in relation to these factors and covariates. We included 199 automatic external defibrillator recordings. The median interruption time for 2 ventilations was 7 seconds (25th–75th percentile, 6–9 seconds). Of all rescuers, 21% took <5 seconds and 83% took <10 seconds for a ventilation period; 97%, 88%, and 63% of rescuers were able to deliver >60, >70, and >80 chest compressions per minute, respectively. The median chest compression fraction was 65% (25th–75th percentile, 59%–71%). Survival was 25% (49 of 199), not associated with long or short ventilation pauses when controlled for covariates.
Conclusions—
The great majority of rescuers can give 2 rescue breaths in <10 seconds and deliver at least 70 compressions in a minute. Longer pauses for ventilations are not associated with worse outcome. Guidelines may allow longer pauses for ventilations with no detriment to survival.
Collapse
Affiliation(s)
- Stefanie G. Beesems
- From the Academic Medical Center, Department of Cardiology, Amsterdam, the Netherlands
| | - Lizzy Wijmans
- From the Academic Medical Center, Department of Cardiology, Amsterdam, the Netherlands
| | - Jan G.P. Tijssen
- From the Academic Medical Center, Department of Cardiology, Amsterdam, the Netherlands
| | - Rudolph W. Koster
- From the Academic Medical Center, Department of Cardiology, Amsterdam, the Netherlands
| |
Collapse
|