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Nogawa H, Matsumoto Y, Tanaka M, Tsuchida T. Diagnostic usefulness of bronchoscopy for peripheral pulmonary lesions in patients with idiopathic pulmonary fibrosis. J Thorac Dis 2022; 13:6304-6313. [PMID: 34992810 PMCID: PMC8662480 DOI: 10.21037/jtd-21-1067] [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: 07/25/2021] [Accepted: 09/17/2021] [Indexed: 11/06/2022]
Abstract
Background As lung cancers arising in a background of idiopathic pulmonary fibrosis (IPF) are known to show high malignancy grades, early pathologic diagnosis of peripheral pulmonary lesions (PPLs) is important. Meanwhile, the risk of complications associated with diagnostic procedures is high, which prompted us to investigate the role of bronchoscopy, a relatively safe diagnostic procedure. Therefore, we conducted this study to evaluate the usefulness of bronchoscopy for the diagnosis of PPLs in patients with IPF. Methods Data of consecutive patients with IPF who underwent bronchoscopy under radial endobronchial ultrasound (R-EBUS) guidance for PPLs at our institution between April 2014 and March 2019 were retrospectively reviewed. IPF was defined as usual interstitial pneumonia (UIP) or probable UIP, in accordance with the classification in the latest global guidelines. The diagnostic outcomes and the factors independently related to the diagnostic yield were analyzed. Results A total of 92 patients were included in the analysis. The median (range) size of the target PPLs was 27.1 (11.4-75.3) mm, and the diagnostic yield was 82.6%. Multivariable analysis identified a larger size [P=0.017; odds ratio (OR), 5.33; 95% confidence interval (CI), 1.29-22.01], positive bronchus sign (P=0.035; OR, 4.99; 95% CI, 1.12-22.18), and not involved with UIP/probable UIP pattern (P=0.023; OR and 95% CI, unmeasurable) as being associated with a significantly higher diagnostic yield. Meanwhile, none of the patients developed acute exacerbation of IPF or pneumothorax following the diagnostic bronchoscopy. Conclusions Bronchoscopy using R-EBUS was safe and showed an acceptable diagnostic yield for PPLs, even in patients with IPF.
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Affiliation(s)
- Hitomi Nogawa
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Sánchez-Font A, Chalela R, Martín-Ontiyuelo C, Albero-González R, Dalmases A, Longarón R, Alonso-Espinaco V, Curull V, Bellosillo B, Pijuan L. Molecular analysis of peripheral lung adenocarcinoma in brush cytology obtained by EBUS plus fluoroscopy-guided bronchoscopy. Cancer Cytopathol 2018; 126:860-871. [PMID: 30291816 DOI: 10.1002/cncy.22053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND More than 60% of patients with lung cancer are diagnosed at advanced stages. The introduction of targeted therapies requires molecular diagnosis to guide treatment. The aim of this study was to evaluate the feasibility of performing mutational analysis with brushing specimens obtained by radial-miniprobe endobronchial ultrasound (R-EBUS) plus fluoroscopy-guided bronchoscopy in patients with peripheral pulmonary adenocarcinoma. METHODS Brushing specimens were deposited on cytological slides and were conserved in Roswell Park Memorial Institute (RPMI) culture medium. DNA was isolated to perform a mutational analysis with real-time quantitative polymerase chain reaction and Sanger sequencing for epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene homolog (KRAS). RESULTS Thirty patients with adenocarcinoma were prospectively included. In 100% of the patients, the molecular study was viable with brushing specimens. In 16 (53.3%), KRAS or EGFR mutations were detected: 10 KRAS mutations (33.3%) and 6 EGFR mutations (20%). In a comparison with histological samples, a correlation of 86.6% was detected, and only 2 patients with wild-type results from brushing specimens presented with an EGFR mutation in histological samples. CONCLUSIONS Brushing specimens conserved in RPMI medium and obtained by R-EBUS plus fluoroscopy-guided bronchoscopy are valid for molecular studies. They allow the detection of EGFR/KRAS mutations in patients with peripheral adenocarcinoma. In addition, invasive techniques are avoided, the risk of complications is reduced, and the obtained samples are optimized.
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Affiliation(s)
- Albert Sánchez-Font
- Pulmonology Department, Hospital del Mar-Parc de Salut Mar, CIBER Respiratory Diseases, Carlos III Institute of Health, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Roberto Chalela
- Pulmonology Department, Hospital del Mar-Parc de Salut Mar, CIBER Respiratory Diseases, Carlos III Institute of Health, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Clara Martín-Ontiyuelo
- Pulmonology Department, Hospital del Mar-Parc de Salut Mar, CIBER Respiratory Diseases, Carlos III Institute of Health, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Alba Dalmases
- Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pathology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Raquel Longarón
- Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pathology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Víctor Curull
- Pulmonology Department, Hospital del Mar-Parc de Salut Mar, CIBER Respiratory Diseases, Carlos III Institute of Health, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Beatriz Bellosillo
- Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pathology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Lara Pijuan
- Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pathology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
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Maekura T, Sugimoto C, Tamiya A, Saijo N, Naoki Y, Koba T, Kimura Y, Matsuda Y, Kanazu M, Takeuchi N, Sasaki Y, Naito Y, Tsuji T, Sugawara R, Kobayashi T, Nakao K, Taniguchi Y, Okishio K, Omachi N, Kasai T, Atagi S. Combination of virtual bronchoscopic navigation, endobronchial ultrasound, and rapid on-site evaluation for diagnosing small peripheral pulmonary lesions: a prospective phase II study. J Thorac Dis 2017; 9:1930-1936. [PMID: 28839991 DOI: 10.21037/jtd.2017.06.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The diagnostic yield of peripheral pulmonary lesions (PPLs) by flexible bronchoscopy (FB) is still insufficient. To improve the diagnostic yield of bronchoscopy, several techniques such as endobronchial ultrasound (EBUS), virtual bronchoscopic navigation (VBN), and rapid on-site evaluation (ROSE) have been examined. The primary purpose of the present study was to evaluate the usefulness of combining EBUS, VBN, and ROSE for diagnosing small PPLs. METHODS Patients with PPLs 30 mm or less on chest computed tomography (CT) were prospectively enrolled. We determined the responsible bronchus for the target lesions using VBN before bronchoscopy was performed. EBUS and ROSE were performed during the examination to determine whether the bronchus and specimen were adequate. On the basis of previous studies, we assumed that the diagnostic yield of 85% among eligible patients would indicate potential usefulness, whereas, the diagnostic yield of 75% would indicate the lower limit of interest. The required number of patients was estimated as 45 for a one-sided α value of 0.2 and a β value of 0.8. The primary study endpoint was the diagnostic yield. RESULTS Between June 2014 and July 2015, we enrolled 50 patients in the present study, and we excluded 5 patients. The total diagnostic yield of 45 PPLs was 77.7%. In cases of lung cancer, the diagnostic yield was 84.2%. The sensitivity, specificity, positive predictive value, and negative predictive value of ROSE were 90.6%, 92.3%, 96.7%, and 80.0%, respectively. The diagnostic yield of PPLs from 20 to 30 mm was 87.5%, and the diagnostic yield of PPLs less than 20 mm was 66.7%. PPLs for which the probe was located within the lesion had the highest diagnostic yield. CONCLUSIONS We could not demonstrate usefulness for diagnosing small PPLs by combining EBUS, VBN, and ROSE. However, combining these techniques may be useful for diagnosing lung cancer.
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Affiliation(s)
- Toshiya Maekura
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Chikatoshi Sugimoto
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Nobuhiko Saijo
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yoko Naoki
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Taro Koba
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yohei Kimura
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yoshinobu Matsuda
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Masaki Kanazu
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yumiko Sasaki
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yujiro Naito
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Taisuke Tsuji
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Reiko Sugawara
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Takehiko Kobayashi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Keiko Nakao
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Kyoichi Okishio
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoki Omachi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Takahiko Kasai
- Department of Laboratory Medicine and Pathology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Shinji Atagi
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
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Chen CH, Cheng WC, Wu BR, Chen CY, Chen WC, Hsia TC, Liao WC, Tu CY, Shih CM, Hsu WH, Wang KP. Improved diagnostic yield of bronchoscopy in peripheral pulmonary lesions: combination of radial probe endobronchial ultrasound and rapid on-site evaluation. J Thorac Dis 2016; 7:S418-25. [PMID: 26807290 DOI: 10.3978/j.issn.2072-1439.2015.12.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions, but few reports had been carried out to confirm the utility in the diagnosis of peripheral pulmonary lesions (PPLs) by radial probe endobronchial ultrasound (R-EBUS). METHODS To evaluate the impact of ROSE on the diagnostic yield of R-EBUS for PPLs, we retrospectively analyzed the diagnostic yields of transbronchial biopsy (TBB) or brushing using R-EBUS for patients with PPLs in a tertiary university hospital from December 2012 to December 2014. RESULTS A total of 815 patients with PPLs were included. A definite diagnosis was made by R-EBUS-guided TBB or brushing for 627 patients (76.9%). A total of 279 patients (34.2%) were examined by a ROSE technique. The combination of R-EBUS guided TBB or brushing with ROSE raised the diagnostic yield in the diagnosis of PPLs, especially difficult cases: right apical and left apical-posterior segment locations, small PPLs <3 cm without bronchus signs on computed tomography (CT) scan, PPLs with pleural effusions, and the position of probe is not within. CONCLUSIONS ROSE can improve the PPLs diagnostic yield when using R-EBUS guided TBB or brushing.
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Affiliation(s)
- Chia-Hung Chen
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wen-Chien Cheng
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Biing-Ru Wu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Chih-Yu Chen
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wei-Chun Chen
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Te-Chun Hsia
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wei-Chih Liao
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Chih-Yen Tu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Chuen-Ming Shih
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wu-Huei Hsu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Ko-Pen Wang
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
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Chavez C, Sasada S, Izumo T, Nakamura Y, Tsuta K, Tsuchida T. Image-guided bronchoscopy for histopathologic diagnosis of pure ground glass opacity: a case report. J Thorac Dis 2014; 6:E81-4. [PMID: 24977033 DOI: 10.3978/j.issn.2072-1439.2014.06.06] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/10/2014] [Indexed: 11/14/2022]
Abstract
Guided bronchoscopy has been found to be useful for the diagnosis of solid peripheral pulmonary lesions (PPLs) but more evidence on ground glass opacities (GGOs), especially those without a solid component, are lacking. A 69-year-old male, asymptomatic, heavy smoker was referred to our department for non-surgical diagnosis of a focal pure GGO in the right upper lobe that was found incidentally on computed tomography (CT). Transbronchial biopsy (TBB) with the aide of endobronchial ultrasound with a guide sheath (EBUS-GS), virtual bronchoscopic navigation (VBN), and fluoroscopy was performed for sampling. There were no complications after the procedure. The diagnosis of adenocarcinoma with lepidic growth pattern was established from the fourth and fifth TBB specimens and was confirmed on subsequent surgical resection. Image-guided bronchoscopy with TBB was successful for the diagnosis of a pure GGO. Use of a larger biopsy device may be helpful for the histopathologic diagnosis of lung adenocarcinoma with lepidic growth.
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Affiliation(s)
- Christine Chavez
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Shinji Sasada
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Takehiro Izumo
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Yukiko Nakamura
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Koji Tsuta
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Takaaki Tsuchida
- 1 Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan ; 2 Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-Cho, Hodogaya-ku, Yokohama, Kanagawa 240-8555, Japan ; 3 Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
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