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.

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.

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 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 Transthoracic Ultrasound in Infectious Organizing Pneumonia: A Useful Guide for Percutaneous Needle Biopsy

2021 ◽  
Vol 8 ◽  
Author(s):  
Donato Lacedonia ◽  
Carla Maria Irene Quarato ◽  
Cristina Borelli ◽  
Lucia Dimitri ◽  
Paolo Graziano ◽  
...  
Keyword(s):  
Ct Scan ◽  
Needle Biopsy ◽  
Final Diagnosis ◽  
Organizing Pneumonia ◽  
Percutaneous Needle Biopsy ◽  
Aggressive Approach ◽  
Additional Information ◽  
Ultrasound Findings ◽  
Chest X Ray ◽  
Transthoracic Ultrasound

In patients presenting with classical features of CAP (i.e., new peripheral pulmonary consolidations and symptoms including fever, cough, and dyspnea), a clinical response to the appropriate therapy occurs in few days. When clinical improvement has not occurred and chest imaging findings are unchanged or worse, a more aggressive approach is needed in order to exclude other non-infective lesions (including neoplasms). International guidelines do not currently recommend the use of transthoracic ultrasound (TUS) as an alternative to chest X-ray (CXR) or chest computed tomography (CT) scan for the diagnosis of CAP. However, a fundamental role for TUS has been established as a guide for percutaneous needle biopsy (US-PNB) in pleural and subpleural lesions. In this retrospective study, we included 36 consecutive patients whose final diagnosis, made by a US-guided percutaneous needle biopsy (US-PTNB), was infectious organizing pneumonia (OP). Infective etiology was confirmed by additional information from microbiological and cultural studies or with a clinical follow-up of 6–12 months after a second-line antibiotic therapy plus corticosteroids. All patients have been subjected to a chest CT and a systematic TUS examination before biopsy. This gave us the opportunity to explore TUS performance in assessing CT findings of infective OP. TUS sensitivity and specificity in detecting air bronchogram and necrotic areas were far lower than those of CT scan. Conversely, TUS showed superiority in the detection of pleural effusion. Although ultrasound findings did not allow the characterization of chronic subpleural lesions, TUS confirmed to be a valid diagnostic aid for guiding percutaneous needle biopsy of subpleural consolidations.

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.

scholarly journals Computed tomography-guided cutting needle biopsy of pulmonary lesions

2002 ◽  
Vol 57 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Liao Shin Yu ◽  
Daniel Deheinzelin ◽  
Riad N. Younes ◽  
Rubens Chojniak
Keyword(s):  
Computed Tomography ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
Thoracic Wall ◽  
Radiology Department ◽  
Histopathological Diagnosis ◽  
Lung Lesions ◽  
Malignant Lesions ◽  
Cutting Needle

PURPOSE: To report the experience of a radiology department in the use of computed tomography - guided cutting needle biopsy of pulmonary nodules, by evaluating diagnostic yield and incidence of complications. METHODS: This is a retrospective analysis of 52 consecutive patients who underwent lung lesion biopsy guided by computed tomography, performed between May 1997 and May 2000. Thirty-five patients were male and 17 were female, with ages ranging from 5 to 85 years (median, 62 years). The size of the lesions ranged from 1.8 to 15 cm (median, 5.4 cm). RESULTS: In a total of 52 biopsies of lung lesions, 51 biopsies (98.1%) supplied appropriate material for histopathological diagnosis, with 9 diagnosed (17.3%) as benign and 42 (80.8%) as malignant lesions. Specific diagnosis was obtained in 44 (84.6%) biopsies: 4 benign (9.1%) and 40 (90.9%) malignant lesions. The sensitivity, specificity, and accuracy of the cutting needle biopsies for determining presence of malignancy were 96.8%, 100%, and 97.2%, respectively. Complications occurred in 9 cases (17.3%), including 6 cases (11.5%) of small pneumothorax, 1 (1.9%) of hemoptysis, 1 (1.9%) of pulmonary hematoma, and 1 (1.9%) of thoracic wall hematoma. All had spontaneous resolution. There were no complications requiring subsequent intervention. CONCLUSION: The high sensitivity and specificity of the method and the low rate of complications have established cutting needle biopsy as an efficient and safe tool for the diagnosis of lung lesions. In our hospital, cutting needle biopsy is considered a reliable procedure for the evaluation of indeterminate pulmonary nodules.

scholarly journals Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

2015 ◽  
Vol 47 (2) ◽  
pp. 607-614 ◽  
Author(s):  
Daniel P. Steinfort ◽  
Asha Bonney ◽  
Katharine See ◽  
Louis B. Irving
Keyword(s):  
Diagnostic Yield ◽  
Lesion Size ◽  
Endobronchial Ultrasound ◽  
Virtual Bronchoscopy ◽  
Cytologic Examination ◽  
Electromagnetic Navigation ◽  
Pulmonary Lesions ◽  
Relative Contribution ◽  
Peripheral Pulmonary Lesions ◽  
Diagnosis Of Lung Cancer

Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±sd). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5versus19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL–hilum distance or PPL–pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63–76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield.

scholarly journals Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.

2015 ◽  
Vol 17 (3) ◽  
pp. 333 ◽  
Author(s):  
Nesrin Kiral ◽  
Benan Caglayan ◽  
Banu Salepci ◽  
Elif Torun Parmaksiz ◽  
Ali Fidan ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Demographic Data ◽  
Positive Culture ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Tuberculous Lymphadenitis ◽  
Ultrasound Guided ◽  
Diagnostic Challenge ◽  
Transbronchial Needle Aspiration

Aims: Patients with suspected tuberculosis without pulmonary lesions and with intrathoracic lymphadenopathy often pose a diagnostic challenge. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isolated intrathoracic lymphadenopathy due to tuberculosis (TB). Materials and methods: Cases with tuberculous lymphadenitis (TBLA) as the final diagnosis were analysed among patients in whom EBUS-TBNA had been performed. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, pathological findings, and microbiological results were recorded. All patients received 6-month antituberculous treatment, followed-up regularly and recovered both on clinical and radiological basis. Results: Fourty-four patients were included. EBUS-TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4%) patients. In 2 patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7%) patients. One of the patients (2.2%) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50%) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation has improved the diagnostic yield from 72.7% to 95.4%. Conclusion: EBUS-TBNA is a safe and effective first line investigation for evaluat- ing isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of EBUS-TBNA.

scholarly journals Factors leading to failure to diagnose pulmonary malignant tumors using endobronchial ultrasound with guide sheath within the target lesion

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yoichi Nishii ◽  
Taro Yasuma ◽  
Kentaro Ito ◽  
Yuta Suzuki ◽  
Fumiaki Watanabe ◽  
...  
Keyword(s):  
Malignant Tumor ◽  
Malignant Tumors ◽  
Diagnostic Yield ◽  
Primary Lung Cancer ◽  
B Cell Lymphoma ◽  
Target Lesion ◽  
Endobronchial Ultrasound ◽  
Histopathological Study ◽  
Histopathological Diagnosis ◽  
Peripheral Pulmonary Lesions

Abstract Background The diagnostic yield of peripheral pulmonary lesions has significantly increased with the use of radial endobronchial ultrasound with guide sheath within the lesion. Here, we retrospectively evaluated factors leading to misdiagnosis of pulmonary malignant tumors using endobronchial ultrasound with the guide sheath within the lesion. Methods We assessed the final histopathological diagnosis of biopsy samples taken from 130 patients with lung malignant tumors that underwent endobronchial ultrasound with guide sheath within the lesion. Results Among 130 patients, 8 (6%) showed no definite malignant findings in biopsy samples but the presence of malignant cells (primary lung cancer 7, diffuse large B cell lymphoma 1) was subsequently confirmed by histopathological study of specimens taken by computed tomography-guided needle biopsy or surgery. Of the eight cases with diagnostic failure, the size of the biopsy sample was insufficient in five due to technical difficulties during the diagnostic procedure, and the diagnosis of malignant tumor was difficult in five cases because of extensive scarring tissue or central necrosis. Conclusions The results of this study showed that technical difficulties and/or pathological heterogeneity of the tumor might lead to failure to diagnose lung malignant tumor in cases using endobronchial ultrasound with guide sheath within the lesion.

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