scholarly journals Evaluation of Pulmonary Nodules Using the Spyglass Direct Visualization System Combined With Radial Endobronchial Ultrasound: A Clinical Feasibility Study

2016 ◽  
Vol 10 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Krystelle Godbout ◽  
Simon Martel ◽  
Mathieu Simon ◽  
Noël Lampron ◽  
Antoine Delage
Keyword(s):  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
Final Diagnosis ◽  
Endobronchial Ultrasound ◽  
Tissue Sampling ◽  
Direct Visualization ◽  
Bronchial Mucosa ◽  
Procedure Time ◽  
Visualization System ◽  
Spyglass Direct Visualization System

Background: Sampling of peripheral pulmonary nodules with radial endobronchial ultrasound (p-EBUS) increases diagnostic yield of bronchoscopy. However, diagnostic yield is influenced by numerous factors. Objective: We evaluated the use of SpyGlass, a one millimeter diameter optic fiber, to obtain images of the distal mucosa and of pulmonary lesions detected with p-EBUS to determine if visual aspect of the distal mucosa was predictive of diagnosis. Methods: We prospectively recruited subjects investigated for peripheral nodules. Bronchoscopy was performed and p-EBUS was used to locate the lesion through a guide sheath. The Spyglass fiber was introduced in the sheath to obtain images of the distal bronchial mucosa. Tissue sampling was subsequently done. Results: Fifteen patients were enrolled in the study. A final diagnosis of malignancy was confirmed in 80%. All lesions could be located using p-EBUS (100%). Diagnostic sensitivity for p-EBUS was 58.3%. Distal mucosa could be imaged with SpyGlass in 14/15 patients (93.3%). Mucosal appearance was described as abnormal in 7 out of the 15 subjects. Mean SpyGlass procedure time was 6.5 minutes. No direct complication was reported. Conclusion: Spyglass can be used in combination with p-EBUS to obtain images of the distal bronchial mucosa and peripheral pulmonary nodules. More patients will be needed to confirm whether mucosal appearance can be predictive of malignancy.

scholarly journals Interobserver Agreement for Single Operator Choledochoscopy Imaging: Can We Do Better?

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Amrita Sethi ◽  
Theodore Doukides ◽  
Divyesh V. Sejpal ◽  
Douglas K. Pleskow ◽  
Adam Slivka ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Final Diagnosis ◽  
Boston Scientific ◽  
Direct Visualization ◽  
Visualization System ◽  
Video Clips ◽  
Average Accuracy ◽  
Single Operator ◽  
Biliary Pathology ◽  
Spyglass Direct Visualization System

Background. The SpyGlass Direct Visualization System (Boston Scientific, Natick, MA) is routinely used during single operator choledochoscopy (SOC) to identify biliary lesions or strictures with a diagnostic accuracy up to 88%. The objective of this study was to determine the interobserver agreement (IOA) of modified scoring criteria for diagnosing biliary lesions/strictures. Methods. 27 SPY SOC video clips were reviewed and scored by 9 interventional endoscopists based on published criteria that included the presence and severity of surface structure, vasculature visualization, lesions, and findings. Results. Overall IOA was “slight” for all variables. The K statistics are as follows: surface (K=0.12, SE = 0.02); vessels (K=0.14, SE = 0.02); lesions (K=0.11, SE = 0.02); findings (K=0.08, SE = 0.03); and final diagnosis (K=0.08, SE = 0.02). The IOA for “findings” and “final diagnosis” was also only “slight.” The final diagnosis was malignant (11), benign (11), and indeterminate (5). Conclusion. IOA using the modified criteria of SOC images was slight to almost poor. The average accuracy was less than 50%. These findings reaffirm that imaging criteria for benign and malignant biliary pathology need to be formally established and validated.

scholarly journals Virtual Bronchoscopy Planner and Radial-EBUS Guided Biopsy for Organizing Pneumonia Diagnosis

2021 ◽  
Vol 11 (1) ◽  
pp. 104
Author(s):  
Samy Lachkar ◽  
Mathieu Salaün ◽  
Loic Perrot ◽  
Diane Gervereau ◽  
Marielle De Marchi ◽  
...  
Keyword(s):  
Ct Scan ◽  
Diagnostic Yield ◽  
Ultrasound Image ◽  
Pulmonary Nodules ◽  
Final Diagnosis ◽  
University Hospital ◽  
Endobronchial Ultrasound ◽  
Virtual Bronchoscopy ◽  
Histopathological Diagnosis ◽  
Organizing Pneumonia

Background: The diagnosis of organizing pneumonia (OP) often requires histological confirmation. The aim of this retrospective study was to evaluate the diagnostic yield and complication rate of radial endobronchial ultrasound (r-EBUS) for OP. Methods: All patients who had r-EBUS as a first diagnostic procedure for a peripheral pulmonary lesion at Rouen University Hospital, France, between April 2008 and December 2020 were included. Cases without a final diagnosis of OP or follow-up were excluded. Patients, lesions, and r-EBUS characteristics were retrospectively analyzed. Results: 2735 r-EBUS procedures were performed, and 33 cases with final OP could be analyzed. Procedures were performed under local anesthesia in 28/33 cases (85%). Among the 33 final OP cases, 17 were considered cryptogenic, and 16 secondary. The lesions were patchy alveolar opacities in 23 cases (70%), masses or pulmonary nodules in 8 cases (24%), and diffuse infiltrative opacities in 2 cases (6%). A bronchus sign on CT scan was found in all cases. In 22 cases (67%), a histopathological diagnosis was obtained from the r-EBUS samples. In 4 cases (12%), histopathological diagnosis was made by surgery, and in 7 cases (21%) the diagnosis was made based on clinical, radiological, and evolution features. An ultrasound image was found in 100% (22/22) of cases in the r-EBUS positive (r-EBUS+) group vs. 60% (6/10) in the r-EBUS negative (r-EBUS-) group, respectively (p < 0.002). The diagnostic yield of r-EBUS for OP was 67% and increased to 79% (22/28) when an ultrasound image was obtained. The median time between CT scan and r-EBUS procedure was 14 days (3–94): 11.5 days in the r-EBUS+ group and 22 days in the r-EBUS- group (p < 0.0001). No severe complications were reported. Conclusion: r-EBUS, when performed shortly after a CT scan showing a bronchus sign, is an efficient and safe technique for OP diagnosis.

CT-guided transthoracic fine-needle aspiration versus transbronchial fluoroscopy-guided needle aspiration in pulmonary nodules

1998 ◽  
Vol 39 (4) ◽  
pp. 395-399 ◽  
Author(s):  
S. Shankar ◽  
Madhu Gulati ◽  
D. Gupta ◽  
A. Rajwanshi ◽  
S. Suri
Keyword(s):  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Definitive Diagnosis ◽  
Ct Guided ◽  
Fine Needle ◽  
Group A ◽  
Made In

Purpose: To evaluate the diagnostic yield of CT-guided (CTNAB) and fluoroscopy-guided transbronchial (TBNA) fine-needle aspiration cytology in pulmonary nodules and to compare their complications. Material and Methods: Thirty patients with pulmonary nodules not abutting upon the chest wall and inaccessible to bronchoscopy were randomised for CTNAB or TBNA. Eighteen patients underwent CTNAB and 16 TBNA. Four patients underwent both procedures. Results: In the CTNAB group, a definitive diagnosis could be made in 14 (78%) out of 18 patients whereas in the TBNA group, a definitive diagnosis was made in 11 (69%) out of 16 patients. This difference was not statistically significant ( p>0.05). The final diagnosis in 29 out of 30 patients comprised primary bronchogenic carcinoma in 14 patients, metastases in 5 patients, and benign lesions in 10 patients (34%) of which 3 lesions (30%) were of tuberculous aetiology. There were 2 asymptomatic pneumothoraces in the CTNAB group and no complication was observed in the TBNA group. Conclusion: Both techniques were safe and effective in the diagnosis of peripheral pulmonary lesions. TBNA was best suited for lesions larger than 3 cm and located in the middle and lower lobes while CTNAB could be used for any lesions.

scholarly journals Efficacy of Combined Endoscopic Lithotomy and Extracorporeal Shock Wave Lithotripsy, and Additional Electrohydraulic Lithotripsy Using the SpyGlass Direct Visualization System or X-Ray Guided EHL as Needed, for Pancreatic Lithiasis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Ken Ito ◽  
Yoshinori Igarashi ◽  
Naoki Okano ◽  
Takahiko Mimura ◽  
Yui Kishimoto ◽  
...  
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Direct Visualization ◽  
Visualization System ◽  
X Ray ◽  
Electrohydraulic Lithotripsy ◽  
Extracorporeal Shock Wave ◽  
Pancreatic Lithiasis ◽  
Spyglass Direct Visualization System

Introduction. To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis.Methods. For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options.Results. Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P=0.0003).Conclusions. In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

Assessment of SPYGLASS Direct Visualization System for Cholangioscopy and Pancreatoscopy in 102 Consecutive Patients

2009 ◽  
Vol 69 (5) ◽  
pp. AB273 ◽  
Author(s):  
Jayde Kurland ◽  
Nuri Ozden ◽  
Suck-Ho Lee ◽  
Rishi Pawa ◽  
Mandeep Sawhney ◽  
...  
Keyword(s):  
Direct Visualization ◽  
Visualization System ◽  
Spyglass Direct Visualization System

scholarly journals The Safety and Feasibility of Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy in Diffuse Pulmonary Infiltrate Diseases

2019 ◽  
Author(s):  
wen chien Cheng ◽  
Meng-Fang Shen ◽  
Biing-Ru Wu ◽  
Wei-Chih Liao ◽  
Chih-Yu Chen ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Medical Center ◽  
Pulmonary Nodules ◽  
Pulmonary Infiltrate ◽  
Sample Volume ◽  
Endobronchial Ultrasound ◽  
Severe Bleeding ◽  
Forceps Biopsy ◽  
Diffuse Parenchymal Lung Diseases ◽  
Transbronchial Lung Cryobiopsy

Abstract Background Transbronchial lung cryobiopsy (TBLC) has emerged as a new bronchoscopic procedure which can improve specimen size and obtain crush artifact-free tissue to increase diagnostic yield in various diffuse parenchymal lung diseases (DPLDs). However, TBLC has been associated with a higher incidence of complications, and variability in diagnostic yield. Radial probe endobronchial ultrasound (R-EBUS) may be able to overcome these problems. We evaluated the safety and feasibility of TBLC in combination with R-EBUS to diagnose DPLDs.Methods We conducted this retrospective study at a single medical center from January 2015 to March 2019. Patients with DPLDs who underwent R-EBUS to locate target lesions and confirm the absence of adjacent vessels, followed by sampling with conventional transbronchial lung forceps biopsy (TBLB) and cryobiopsy (TBLC) were enrolled. TBLC and TBLB samples were sent to the pathology department for diagnostic analysis. The sample size, diagnostic yield and complications after the procedure were recorded.Results A total 30 patients with DPLD were analyzed, of whom 17 had diffuse lung infiltrates and 13 had pulmonary nodules/masses. The overall diagnostic rate was 80% (24/30) and the diagnostic yield increased from 46.7% with the forceps biopsy to 73.3% after adding cryobiopsy (p=0.038). Compared to conventional transbronchial biopsy with forceps, cryobiopsy provided a larger specimen and sample volume (40 mm3 vs 6 mm3; p<0.001). Twenty-two (73.3%) patients had mild bleeding, two (6.7%) had moderate to severe bleeding, and one (3%) had pneumothorax. Ten patients who initially had non-diagnostic results by TBLB received a definite diagnosis after adding TBLC. Among these patients, eight (8/10) were ultimately diagnosed with interstitial lung disease (ILD) (p<0.001).Conclusions TBLC with R-EBUS guidance increased the diagnostic yield in patients with DPLD, particularly in those with ILD. The samples obtained by TBLC were significantly larger and there were no severe complications after the procedure. Larger studies are needed to confirm the safety and feasibility of R-EBUS-guided TBLC.

scholarly journals Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens

CytoJournal ◽  
2011 ◽  
Vol 8 ◽  
pp. 20 ◽  
Author(s):  
Adrienne Carruth Griffin ◽  
Lauren Ende Schwartz ◽  
Zubair W. Baloch
Keyword(s):  
Clinical Decision Making ◽  
Malignant Tumors ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Cytologic Diagnosis ◽  
Transbronchial Needle Aspiration ◽  
Site Evaluation

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) samples has been advocated for as a guide for assessing the accuracy and adequacy of biopsy samples. Although ROSE has proven useful for numerous sites and procedures, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. The intention of this study was to explore the utility of ROSE for EBUS-TBNA specimens. Materials and Methods: The pathology files at our institution were searched for all EBUS-TBNA cases performed between January 2010 and June 2010. The data points included number of sites sampled per patient, location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, surgical pathology follow-up, cell blocks, and ancillary studies performed. Results: A total of 294 EBUS-TBNA specimens were reviewed and included in the study; 264 of 294 (90%) were lymph nodes and 30 of 294 (10%) were lung mass lesions. ROSE was performed for 140 of 294 (48%) specimens. The on-site and final diagnoses were concordant in 104 (74%) and discordant in 36 (26%) cases. Diagnostic specimens were obtained in 132 of 140 (94%) cases with on-site evaluation and 138 of 154 (90%) without on-site evaluation. The final cytologic diagnosis was malignant in 60 of 132 (45%) cases with ROSE and 46 of 138 (33%) cases without ROSE, and the final diagnosis was benign in 57 of 132 (47%) with ROSE and 82 of 138 (59%) without ROSE. A cell block was obtained in 129 of 140 (92%) cases with ROSE and 136 of 154 (88%) cases without ROSE. Conclusions: The data demonstrate no remarkable difference in diagnostic yield, the number of sites sampled per patient, or clinical decision making between specimens collected via EBUS-TBNA with or without ROSE. As a result, this study challenges the notion that ROSE is beneficial for the evaluation of EBUS-TBNA specimens.

Sign in / Sign up

Export Citation Format

Share Document