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Tian S, Li X, Liu J, Wang X, Chen H, Dai Z, Chen Q, Shi H, Li Y, Huang H, Bai C. Radial endobronchial ultrasound - guided bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis of prospective trials. Heliyon 2024; 10:e29446. [PMID: 38660275 PMCID: PMC11040069 DOI: 10.1016/j.heliyon.2024.e29446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Background The diagnostic yield of radial endobronchial ultrasound (r-EBUS) for the diagnosis of peripheral pulmonary lesions (PPLs) varies between studies and is affected by multiple factors. We aimed to evaluate the efficacy and safety of r-EBUS, and to explore the factors influencing the diagnostic yield of r-EBUS in patients with PPLs. Methods The PubMed, Web of Science, and EMBASE databases were searched to identify relevant studies that used r-EBUS for diagnosing PPLs from the date of inception to Dec 2022. Meta-analysis was conducted using Review Manager 5.4 and Stata 15.1. Results An analysis of 46 studies with a total of 7252 PPLs was performed. The pooled diagnostic yield of r-EBUS was 73.4 % (95 % CI: 69.9%-76.7 %), with significant heterogeneity detected among studies (I2 = 90 %, P < 0.001). Further analysis demonstrated PPLs located in the middle or lower lobe, >2 cm in size, malignant in type, solid in appearance on computerized tomography (CT), present in bronchus sign, the within probe location, and the addition of rapid on-site evaluation (ROSE) were associated with increased diagnostic yield, whereas use of a guide sheath (GS), bronchoscopy type, and a multimodality approach failed to influence the outcome. The pooled incidence rates of overall complications, pneumothorax and moderate and severe bleeding were 3.1 % (95 % CI: 2.1%-4.3 %), 0.4 % (95 % CI: 0.1%-0.7 %) and 1.1 % (95 % CI: 0.5%-2.0 %), respectively. Conclusions r-EBUS has an appreciable diagnostic yield and an excellent safety manifestation when used to deal with PPLs.
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Affiliation(s)
- Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Xiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Jian Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xinyu Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hui Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Zeyu Dai
- Department of Orthopaedic Oncology, The Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qian Chen
- Department is Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department is Cardiothoracic surgery, No. 904 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Wuxi, China
| | - Hui Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yonghua Li
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Lin CK, Ruan SY, Fan HJ, Chang HC, Lin YT, Ho CC. Using cryoprobes of different sizes combined with cone-beam computed tomography-derived augmented fluoroscopy and endobronchial ultrasound to diagnose peripheral pulmonary lesions: a propensity-matched study. Respir Res 2024; 25:65. [PMID: 38317222 PMCID: PMC10840252 DOI: 10.1186/s12931-024-02700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) and cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) are utilized for the diagnosis of peripheral pulmonary lesions (PPLs). Combining them with transbronchial cryobiopsy (TBC) can provide sufficient tissue for genetic analysis. However, cryoprobes of different sizes have varying degrees of flexibility, which can affect their ability to access the target bronchus and potentially impact the accuracy. The aim of this study was to compare the diagnostic efficacy of cryoprobes of varying sizes in CBCT-AF and EBUS for the diagnosis of PPLs. METHODS Patients who underwent endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) and TBC combined with CBCT-AF for PPLs diagnosis between January 2021 and May 2022 were included. Propensity score matching and competing-risks regression were utilized for data analysis. Primary outcome was the diagnostic accuracy of TBC. RESULTS A total of 284 patients underwent TBC, with 172 using a 1.7-mm cryoprobe (1.7 group) and 112 using a 1.1-mm cryoprobe (1.1 group). Finally, we included 99 paired patients following propensity score matching. The diagnostic accuracy of TBC was higher in the 1.1 group (80.8% vs. 69.7%, P = 0.050), with a similar rate of complications. Subgroup analysis also revealed that the 1.1 group had better accuracy when PPLs were located in the upper lobe (85.2% vs. 66.1%, P = 0.020), when PPLs were smaller than 20 mm (78.8% vs. 48.8%, P = 0.008), and when intra-procedural CBCT was needed to be used (79.5% vs. 42.3%, P = 0.001). TBC obtained larger specimens than TBB in both groups. There is still a trend of larger sample size obtained in the 1.7 group, but there is no statistically different between our two study groups (40.8 mm2 vs. 22.0 mm2, P = 0.283). CONCLUSIONS The combination of TBC with CBCT-AF and EBUS is effective in diagnosing PPLs, and a thin cryoprobe is preferred when the PPLs located in difficult areas.
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Affiliation(s)
- Ching-Kai Lin
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hsin-Chu Hospital, Hsin-Chu 300, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No.17 Xu-Zhou Road, Taipei, 10020, Taiwan
| | - Hung-Jen Fan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu County 302, Taipei, Taiwan
| | - Hao-Chun Chang
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu County 302, Taipei, Taiwan
| | - Yen-Ting Lin
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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Tang Y, Tian S, Chen H, Li X, Pu X, Zhang X, Zheng Y, Li Y, Huang H, Bai C. Transbronchial lung cryobiopsy for peripheral pulmonary lesions. A narrative review. Pulmonology 2023:S2531-0437(23)00163-0. [PMID: 37914556 DOI: 10.1016/j.pulmoe.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 11/03/2023] Open
Abstract
An increasing number of peripheral pulmonary lesions (PPLs) requiring tissue verification to establish a definite diagnosis for further individualized management are detected due to the growing adoption of lung cancer screening by chest computed tomography (CT), especially low-dose CT. However, the morphological diagnosis of PPLs remains challenging. Transbronchial lung cryobiopsy (TBLC) that can retrieve larger specimens with more preserved cellular architecture and fewer crush artifacts in comparison with conventional transbronchial forceps biopsy (TBFB), as an emerging technology for diagnosing PPLs, has been demonstrated to have the potential to resolve the clinical dilemma pertaining to currently available sampling devices (e.g., forceps, needle and brush) and become a diagnostic cornerstone for PPLs. Of note, with the introduction of the 1.1 mm cryoprobe that will be more compatible with advanced bronchoscopic navigation techniques, such as radial endobronchial ultrasound (r-EBUS), virtual bronchoscopic navigation (VBN) and electromagnetic navigation bronchoscopy (ENB), the use of TBLC is expected to gain more popularity in the diagnosis of PPLs. While much remains for exploration using the TBLC technique for diagnosing PPLs, it can be envisaged that the emergence of additional studies with larger data accrual will hopefully add to the body of evidence in this field.
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Affiliation(s)
- Yilian Tang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China; Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China; Basic Medical School, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China; Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Hui Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China; Department of Respiratory and Critical Care Medicine, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Xiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China; Department of Respiratory and Critical Care Medicine, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Xiang Pu
- Basic Medical School, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Xiaoqin Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Yan Zheng
- Basic Medical School, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Yonghua Li
- Department of Respiratory and Critical Care Medicine, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
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Sun X, Su Y, Li S, Tian Y, Zhao L. [Diagnostic Value and Safety of Electromagnetic Navigation Bronchoscopy
in Peripheral Pulmonary Lesions: A Meta-analysis]. Zhongguo Fei Ai Za Zhi 2023; 26:119-134. [PMID: 36872051 PMCID: PMC10033244 DOI: 10.3779/j.issn.1009-3419.2023.102.07] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The incidence and mortality of lung cancer have always been at the forefront of malignant tumors. With the development of lung cancer detection techniques, more peripheral pulmonary lesions (PPLs) have been detected. The diagnostic accuracy of procedures for PPLs keeps controversial. This study aims to systematically evaluate the diagnostic value and the safety of electromagnetic navigation bronchoscopy (ENB) in the diagnosis of PPLs. METHODS The relevant literatures in the diagnostic yield of PPLs by ENB were systematically retrieved from Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, Embase, PubMed, Cochrane Library and Web of Science. The software of Stata 16.0, RevMan 5.4 and Meta-disc 1.4 were used to conduct the meta-analysis. RESULTS A total of 54 literatures with 55 studies were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ENB in the diagnosis of PPLs were 0.77 (95%CI: 0.73-0.81), 0.97 (95%CI: 0.93-0.99), 24.27 (95%CI: 10.21-57.67), 0.23 (95%CI: 0.19-0.28) and 104.19 (95%CI: 41.85-259.37), respectively. The area under curve (AUC) was 0.90 (95%CI: 0.87-0.92). Meta-regression and subgroup analyses indicated that the potential heterogeneity resulted from study type, additional localization techniques, sample size, lesion size and type of sedation. The use of additional localization techniques and general anesthesia have improved the diagnostic efficiency of ENB in PPLs. The incidence of adverse reactions and complications associated with ENB was very low. CONCLUSIONS ENB provides well diagnostic accuracy and safety.
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Affiliation(s)
- Xin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu Su
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Shangyao Li
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yu Tian
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Liang Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Lou L, Huang X, Tu J, Xu Z. Endobronchial ultrasound-guided transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis. Clin Exp Metastasis 2023; 40:45-52. [PMID: 36401666 DOI: 10.1007/s10585-022-10190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
The diagnosis of peripheral pulmonary lesions (PPLs) remains a challenge for physicians. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been applied in the diagnosis of PPLs, but its diagnostic rate varies widely. The systematic review and meta-analysis was conducted to figure out the accuracy and safety of EBUS-TBNA in the diagnosis of PPLs. We searched the PubMed and Embase databases for relevant studies published from January 1, 2000 to December 30, 2021 and used PICO (Participants, Intervention, Comparison, and Outcome) to worked out the diagnostic rate of EBUS-TBNA in PPLs. Two reviewers independently performed the data extraction and assessed study quality. Statistical analysis was carried out via R software. In 7 studies of totally 510 patients of PPLs, the overall EBUS-TBNA diagnosis yield is 0.75 (95% CI 0.67-0.84) by the random effect model. EBUS-TBNA showed a higher accuracy of 0.64 (95% CI 0.53-0.74) compared to 0.46 (95% CI 0.19-0.72) of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) when EBUS probe is adjacent to lesions. In the case of malignant lesions, the diagnostic rate of EBUS-TBNA is 0.79 (95% CI 0.72-0.88). Combined EBUS-TBNA with conventional bronchoscopy procedures showed the highest diagnostic yield (0.83 (95% CI 0.79-0.87)). Collectively, EBUS-TBNA should be performed firstly in patients with PPLs suspected to lung cancer especially when the EBUS probe was adjacent to the lesions. No serious procedure-related complications were observed.
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Affiliation(s)
- Lingyun Lou
- Department of Respiratory and Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, China.
| | - Xiu Huang
- Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Junwei Tu
- Department of Respiratory and Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Zhihao Xu
- Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
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Qi JC, Liao L, Zhao Z, Zeng H, Wang T, Hu M, Wang L, Wu Z, Ye Y, Ou Y, Cai Z, Wu Q, Xu Q, Zhang W, Huang W, Li H, Lin L. Impact of rapid on-site evaluation combined with endobronchial ultrasound and virtual bronchoscopic navigation in diagnosing peripheral lung lesions. BMC Pulm Med 2022; 22:117. [PMID: 35361163 PMCID: PMC8969361 DOI: 10.1186/s12890-022-01917-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). METHODS Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in expected consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, based on the calculation of expected diagnostic yield of R-EBUS biopsy and drop out, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. RESULTS In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, respectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, respectively, and the average expense was 643.44 ± 706.56 US.$ (4093.15 ± 4494.67 yuan ¥). In the controls, the positive rate of brushing and biopsy were 44%, 74%, respectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, respectively. And the average expense during diagnosis was 1009.27 ± 713.89 US.$ (6420.28 ± 4541.33 yuan ¥). There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤ 2 cm in diameter was significant. CONCLUSION In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.
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Affiliation(s)
- Jia-Chao Qi
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Liping Liao
- Department of Ultrasonic Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Zhiwei Zhao
- Department of Otolaryngology, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - HuiXue Zeng
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Tiezhu Wang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Miaofen Hu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - LiJv Wang
- Department of Pathology, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Zhi Wu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Yuming Ye
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Yangwu Ou
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Zhiming Cai
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Qiyin Wu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Qiaozhen Xu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Weiliang Zhang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Wensen Huang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Hao Li
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China.
| | - Li Lin
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China.
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Li Q, Nie F, Yang D, Dong T, Liu T, Wang Y. Role of Contrast-Enhanced Ultrasound in Pulmonary Lesions: 5-Year Experience at a Single Center. Ultrasound Med Biol 2022; 48:257-264. [PMID: 34819236 DOI: 10.1016/j.ultrasmedbio.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) for the differentiation of benign and malignant peripheral pulmonary lesions has been considered experimental for many years. This study was aimed at evaluating the feasibility of CEUS as a diagnostic modality in this area of discussion. CEUS diagnostic accuracy was explored by comparison with contrast-enhanced computed tomography (CECT). The collective included 449 patients with 449 definitive diagnoses (benign, 178; malignant, 271). Logistic regression analysis of CEUS data revealed that delayed time to enhancement, chaotic pattern of distribution of vessels and mild extent of enhancement were independent risk factors for predicting malignancy. Time to wash-out and homogeneity of enhancement did not differ between the two groups (p > 0.05). Based on histopathology or clinical follow-up as a reference standard, CEUS and CECT had similar diagnostic accuracies of 80.16% and 81.75%, respectively. CEUS is a potentially useful imaging tool for diagnosing peripheral pulmonary lesions.
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Affiliation(s)
- Qi Li
- Department of Ultrasound, Lanzhou University Second Hospital, Gansu, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Gansu, China.
| | - Dan Yang
- Department of Ultrasound, Lanzhou University Second Hospital, Gansu, China
| | - Tiantian Dong
- Department of Ultrasound, Lanzhou University Second Hospital, Gansu, China
| | - Ting Liu
- Department of Ultrasound, Lanzhou University Second Hospital, Gansu, China
| | - Yanfang Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Gansu, China
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Sumi T, Shijubou N, Sawai T, Kamada K, Yamada Y, Nakata H, Mori Y, Chiba H. Transbronchial needle aspiration with endobronchial ultrasonography and ultrathin bronchoscopy for peripheral pulmonary lesions. Respir Investig 2021; 59:766-771. [PMID: 33992599 DOI: 10.1016/j.resinv.2021.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/06/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the efficacy of lung cancer treatment has improved, it is dependent on a reliable diagnosis via bronchoscopy. Transbronchial biopsy using ultrathin bronchoscopy can help detect small peripheral pulmonary lesions (PPLs), with a high diagnostic yield. However, the diagnosis rate using forceps biopsy when the radial endobronchial ultrasonography (rEBUS) probe is adjacent to a lesion tends to be low. Transbronchial needle aspiration (TBNA) may improve the diagnostic yield from adjacent lesions. Recently, PeriView FLEX, a new TBNA needle that can be inserted into ultrathin bronchoscopes, has become available. We examined whether TBNA with PeriView FLEX and forceps biopsy improved adjacent lesion diagnosis when using ultrathin bronchoscopes. METHODS We retrospectively examined 51 consecutive patients who underwent TBNA and forceps biopsy using ultrathin bronchoscopes under rEBUS for small PPLs at the Hakodate Goryoukaku Hospital between November 2019 and August 2020. The histological diagnosis rate using TBNA and forceps biopsy, TBNA alone, or forceps biopsy alone was compared between cases where the rEBUS probe was "Within" and "Adjacent To" the lesions. RESULTS The diagnosis rate using TBNA and forceps biopsy was 86.3% (95.7% vs. 78.6%; p = 0.08) for all lesions (Within cases vs. Adjacent To cases). The corresponding rate using TBNA alone was 68.6% (69.6% vs. 67.9%; p = 0.57), and that using forceps biopsy alone was 72.5% (91.3% vs. 57.1%; p = 0.0067). CONCLUSIONS Forceps biopsy with TBNA during ultrathin bronchoscopy for small PPLs improved the diagnostic yield when lesions were adjacent to the rEBUS probe.
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Affiliation(s)
- Toshiyuki Sumi
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Naoki Shijubou
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeyuki Sawai
- Department of Pulmonary Medicine, Hakodate General Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Koki Kamada
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuichi Yamada
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - Hisashi Nakata
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - Yuji Mori
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - Hirofumi Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Chen Q, An Z, Cheng J, Lv W, Hu J. [Advances of Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions]. Zhongguo Fei Ai Za Zhi 2021; 23:440-445. [PMID: 32517447 PMCID: PMC7309552 DOI: 10.3779/j.issn.1009-3419.2020.102.04] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of peripheral pulmonary lesions (PPLs) is growing following the adoption of lung cancer screening by low-dose chest CT. The diagnosis and treatment of pulmonary nodules is one of the most difficult problems. Based on the electromagnetic positioning technology, the electromagnetic navigation bronchoscope is guided to the pulmonary nodules for biopsy or treatment, providing a new minimally invasive diagnosis and treatment method for suspicious lung lesions. This paper provides an overview of the current status and progress of electromagnetic navigation bronchoscopy in the diagnosis and treatment of peripheral pulmonary diseases.
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Affiliation(s)
- Qiuming Chen
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zhou An
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jun Cheng
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
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Adachi T, Machida H, Nishikawa M, Arai T, Kariyasu T, Koyanagi M, Yokoyama K. Improved delineation of CT virtual bronchoscopy by ultrahigh-resolution CT: comparison among different reconstruction parameters. Jpn J Radiol 2020; 38:884-889. [PMID: 32297061 PMCID: PMC7452872 DOI: 10.1007/s11604-020-00972-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/03/2020] [Indexed: 01/21/2023]
Abstract
Purpose We compared the maximal recognizable bronchial bifurcation order (MRBBO) in CT virtual bronchoscopy (CTVB) using ultrahigh-resolution CT (UHRCT) and different reconstruction parameters. Materials and methods We enrolled 38 patients undergoing noncontrast chest CT by UHRCT and reconstructed CTVB utilizing 3 different combinations of reconstruction parameters, as classified into Group A (matrix size, 512; slice thickness, 1.0 mm), Group B (matrix size, 512; slice thickness, 0.5 mm), and Group C (matrix size, 1024; slice thickness, 0.25 mm). In right S1, left S1 + 2, and both S3 and S10, two reviewers counted the number of consecutively identified bronchial bifurcations to compare MRBBO among these groups using Kruskal–Wallis test. Results In these segments, MRBBO increased from Group A to C. MRBBO was significantly higher in Group C than in both Groups A and B in all the segments except left S10 (P < 0.05 for all). In left S10, it was significantly higher in Group C than in Group A (P < 0.05) but comparable between Groups B and C (P = 0.122). Conclusions MRBBO is higher in CTVB by UHRCT utilizing 1024-matrix size and 0.25-mm thickness than parameters currently recommended for CTVB (matrix size, 512; slice thickness, 0.5–1.0 mm).
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Affiliation(s)
- Takuya Adachi
- Department of Radiology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Haruhiko Machida
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Makiko Nishikawa
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takahiro Arai
- Department of Radiology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Toshiya Kariyasu
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masamichi Koyanagi
- Department of Radiology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kenichi Yokoyama
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Yasokawa N, Yorizumi N, Kurose K, Abe M, Oga T. Detachment and recovery of an X-ray opaque tip of a disposable guide sheath kit: A rare complication of endobronchial ultrasound-guided transbronchial biopsy. Respir Med Case Rep 2020; 29:101030. [PMID: 32154100 PMCID: PMC7052504 DOI: 10.1016/j.rmcr.2020.101030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Endobronchial ultrasound with a guide sheath (EBUS-GS)-guided transbronchial biopsy offers advantages and is frequently used for the diagnosis of peripheral pulmonary lesions. A previously healthy 75-year-old man was hospitalized to undergo bronchoscopy for the diagnosis of a mass with a diameter of about 40 mm in right S3 area. The mass was detected during a regular medical check-up, and lung cancer was suspected. EBUS-GS guided transbronchial biopsy was performed through the right B3. Following the bronchoscopic procedure and removal of the GS, we observed that an X-ray opaque tip attached to the point of the GS was missing. We examined the lung field through X-ray fluoroscopy and found that the detached opaque tip was located in the right middle lung field. We re-inserted the bronchoscope, and successfully recovered it using transbronchial biopsy forceps. The rate of complications in EBUS-GS is low, and the complication presented in this report is rare. Physicians should exercise caution when performing this procedure and carefully check the condition of the kit to reduce the risk of such complications.
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Affiliation(s)
- Naoya Yasokawa
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Noboru Yorizumi
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Koji Kurose
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Masaaki Abe
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Toru Oga
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Yarmus LB, Mallow C, Pastis N, Thiboutot J, Lee H, Feller-Kopman D, Lerner AD, Tanner N, Silvestri G, Chen A. First-in-Human Use of a Hybrid Real-Time Ultrasound-Guided Fine-Needle Acquisition System for Peripheral Pulmonary Lesions: A Multicenter Pilot Study. Respiration 2019; 98:527-533. [PMID: 31707384 DOI: 10.1159/000504025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/10/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The ability to successfully perform a biopsy on pulmonary lesions by means of bronchoscopy varies widely due to anatomic and technological limitations. One major limitation is the lack of the ability to utilize real-time guidance during tissue sampling in the periphery. A novel system has been developed that enables real-time visualization and sampling of peripheral lesions by displaying an ultrasound image of the lesion and needle simultaneously. METHODS We performed a multicenter, prospective pilot in patients with peripheral pulmonary lesions undergoing a clinically indicated bronchoscopy. The purpose of this study was to demonstrate the feasibility of visualizing, accessing, and obtaining specimens adequate for the cytology of lung lesions when using a novel hybrid real-time ultrasound-guided fine-needle aspiration system for peripheral pulmonary lesions. RESULTS Twenty-three patients underwent bronchoscopic sampling of a peripheral pulmonary lesion with the study device. Mean lesion size was 3.6 (range 1.7-5.7) cm. Targeted lesions were located in all lobes of the lung. All lesions were successfully visualized and sampled under real-time visualization with specimens adequate for cytological evaluation. The needle was visualized in all lesions throughout targeting and sampling. There were no incidents of pneumothorax or moderate-to-severe bleeding. CONCLUSION In this feasibility study, we report the first-in-human use of a continuous real-time endobronchial ultrasound guidance system to sample peripheral pulmonary lesions. Future generations of this device may improve usability and further studies are needed to determine the true diagnostic capabilities of this novel technique.
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Affiliation(s)
- Lonny B Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
| | - Christopher Mallow
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Pastis
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey Thiboutot
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Feller-Kopman
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew D Lerner
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Tanner
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gerard Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexander Chen
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Qian K, Deng Y, Shen C, Feng YG, Deng B, Tan QY. Combination of electromagnetic navigation bronchoscopy-guided biopsy with a novel staining for peripheral pulmonary lesions. World J Surg Oncol 2019; 17:158. [PMID: 31506081 PMCID: PMC6737641 DOI: 10.1186/s12957-019-1704-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background The diagnosis of peripheral pulmonary lesions (PPLs) is a challenging task for pulmonologists, especially for small PPLs. Conventional localization of these small PPLs, which are > 1 cm away from the visceral pleura in operation, is quite difficult. Currently used methods inevitably damage the visceral pleura and may cause a series of complications, such as pneumothorax and hemothorax. Hence, the present study aimed to find out an intraoperative localization method with no damage to the visceral pleura. Methods We retrospectively reviewed 21 patients with PLLs who underwent electromagnetic navigation bronchoscopy (ENB)-guided biopsy plus a new methylene blue staining with the help of massage (Massage Staining) in our department between August 2017 and December 2018. Results The median age of these 21 patients was 51.3 ± 2.1 years. The diameter of the PPLs was 8.2 ± 2.3 mm. The rate of successful biopsy was 76.2%, and the rate of excellent or satisfactory of Massage Staining was 81.0%, while all lesions of these 21 cases were included in the range of staining, and the median distance from the edge of the stained site to the edge of the lesion was 29 ± 18 mm. The duration of ENB-guided biopsy plus Massage Staining was 26.7 ± 5.3 min, and the intraoperative blood loss was 3.3 ± 1.5 ml. No pneumothorax, hemorrhage, and tracheal injury occurred intraoperatively. Conclusions The ENB-guided biopsy combined with Massage Staining is an innovative one-stop strategy designed to enhance the precision of thoracic surgery. The Massage Staining avoids damage to the visceral pleura, causes the low incidence of complications, but yields precise localization of PPLs.
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Affiliation(s)
- Kai Qian
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Deng
- Department of Oncology, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
| | - Cheng Shen
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
| | - Yong-Geng Feng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Deng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China.
| | - Qun-You Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China.
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Arimura K, Kondo M, Nagashima Y, Kanzaki M, Kobayashi F, Takeyama K, Tamaoki J, Tagaya E. Comparison of tumor cell numbers and 22C3 PD-L1 expression between cryobiopsy and transbronchial biopsy with endobronchial ultrasonography-guide sheath for lung cancer. Respir Res 2019; 20:185. [PMID: 31420048 PMCID: PMC6698028 DOI: 10.1186/s12931-019-1162-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/14/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022] Open
Abstract
Background We previously reported cryobiopsy (Cryo) with endobronchial ultrasonography-guide sheath (EBUS-GS) for peripheral pulmonary lesions (PPLs) provides significantly larger tissues than transbronchial biopsy (TBB) and provides high quantity and quality DNA for gene analysis by next generation sequencing. However, the tumor cell yields and programmed death ligand 1 (PD-L1) expression between each approach have not been compared. Here, we assessed the tumor cell numbers and PD-L1 expression for Cryo with EBUS-GS for PPLs and TBB in patients with lung cancer. Methods Sixteen patients were enrolled in this prospective study from June to November 2017 at Tokyo Women’s Medical University Hospital. The number of tumor cells from a single biopsy, total number of tumor cells, average number of tumor cells, and 22C3 PD-L1 expression (≥ 50% and ≥ 1%) were compared between Cryo and TBB. Results The numbers of tumor cells from a single biopsy, total numbers of tumor cells, and average numbers of tumor cells obtained by Cryo were significantly larger than those obtained by TBB (Cryo [means ± standard errors of the means]: 1321 ± 303.7, 1981 ± 411.7, and 1406 ± 310.3; TBB: 208.8 ± 38.24, 1044 ± 189.0, and 208.8 ± 37.81; P < 0.0001, P = 0.0474, P = 0.0006, respectively). PD-L1 ≥ 50% and ≥ 1% patients for Cryo were 18.8 and 56.3%, respectively, whereas those for TBB were 12.5 and 37.5%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, concordance, and κ coefficient based on Cryo for TBB were 66.7, 100, 100, 92.9, 93.8%, and 0.7647, respectively, for PD-L1 ≥ 50%; and 44.4, 71.4, 66.7, 50, 56.3%, and 0.1515, respectively, for PD-L1 ≥ 1%. Conclusion Cryo with EBUS-GS may be a useful diagnostic approach for lung cancer, with advantages over TBB for gene analysis and whole exon sequencing. Particularly, it could contribute to patients taking pembrolizumab as first-line therapy when PD-L1 was negative by evaluating TBB specimens. It could also provide ample tissue for PD-L1 expression analysis in addition to accurate diagnosis and gene analysis.
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Affiliation(s)
- Ken Arimura
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Mitsuko Kondo
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Fumi Kobayashi
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kiyoshi Takeyama
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Jun Tamaoki
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Etsuko Tagaya
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
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Kosaka M, Yasuo M, Kinota F, Machida R, Kitaguchi Y, Ushiki A, Yamamoto H, Uehara T, Hamanaka K, Kawakami S, Hanaoka M. Probe-based optical fiberscopy for the direct observation of peripheral pulmonary lesions. Respir Investig 2019; 57:481-489. [PMID: 31353288 DOI: 10.1016/j.resinv.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Peripheral pulmonary lesions are rarely observed directly before transbronchial biopsy. This study aimed to characterize the differences between malignant and benign peripheral pulmonary lesions according to the findings of direct observation using probe-based optical fiberscopy. METHODS Thirty patients who underwent probe-based optical fiberscopy in combination with bronchoscopy using endobronchial ultrasonography with a guide sheath for the evaluation of peripheral pulmonary lesions were prospectively included in this study. The patients were divided into the malignant and benign groups according to their final diagnosis. The findings of probe-based optical fiberscopy in the two groups were compared. RESULTS The numbers of patients who were diagnosed using histological or bacteriological analyses via bronchoscopic sampling in the malignant and benign groups were 20/23 (87.0%) and 2/7 (28.6%), respectively. On probe-based optical fiberscopy, angiogenesis and vascular engorgement were observed only in the malignant group. The disappearance of subepithelial microvessel transparency and presence of bronchiolar stenosis were observed more frequently in the malignant group (78.3% and 60.9%) than in the benign group (28.6% and 28.6%), whereas increased mucus secretion was observed more frequently in the benign group (71.4%) than in the malignant group (8.7%). CONCLUSIONS These results suggest that the findings of direct observation using probe-based optical fiberscopy are useful for differentiating malignant from benign peripheral pulmonary lesions. TRIAL REGISTRY UMIN-CTR; UMIN000018796; URL: https://www.umin.ac.jp/ctr/index.htm.
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Affiliation(s)
- Makoto Kosaka
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Masanori Yasuo
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Fumiya Kinota
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Ryosuke Machida
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Yoshiaki Kitaguchi
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Atsuhito Ushiki
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Hiroshi Yamamoto
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Kazutoshi Hamanaka
- The Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Masayuki Hanaoka
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
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Boonsarngsuk V, Kanoksil W, Laungdamerongchai S. Diagnosis of peripheral pulmonary lesions with radial probe endobronchial ultrasound-guided bronchoscopy. Arch Bronconeumol 2014; 50:379-83. [PMID: 24745823 DOI: 10.1016/j.arbres.2014.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/17/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The diagnosis of peripheral pulmonary lesions (PPLs) is a challenging task for pulmonologists. Radial probe endobronchial ultrasound (R-EBUS) has been developed to enhance diagnostic yield. The objective of this study was to evaluate the effectiveness of R-EBUS in the diagnosis of PPLs. METHODS A retrospective study was conducted on 174 patients diagnosed with PPLs who underwent EBUS-guided bronchoscopy. Histological examination of specimens obtained by transbronchial lung biopsy (TBLB) and cytological examinations of brushing smear, brush rinse fluid and bronchoalveolar lavage fluid (BALF) were evaluated for the diagnosis. RESULTS The mean diameter of the PPLs was 25.1 ± 10.7 mm. The final diagnoses included 129 malignancies and 45 benign lesions. The overall diagnostic yield of EBUS-guided bronchoscopy was 79.9%. Neither size nor etiology of the PPLs influenced the diagnostic performance of EBUS-guided bronchoscopy (82.9% vs. 74.6% for PPLs>20mm and PPLs≤20mm; p=0.19, and 82.9% vs. 71.1% for malignancy and benign diseases; p=0.09). TBLB rendered the highest yield among these specimens (69.0%, 50.6%, 42.0%, and 44.3% for TBLB, brushing smear, brush rinse fluid, and BALF, respectively; p<0.001). The combination of TBLB, brush smear, and BALF provided the greatest diagnostic yield, while brush rinse fluid did not add benefits to the outcomes. CONCLUSION R-EBUS-guided bronchoscopy is a useful technique in the diagnosis of PPLs. To achieve the highest diagnostic performance, TBLB, brushing smear and bronchoalveolar lavage should be performed together.
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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. 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] [What about the content of this article? (0)] [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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