Bronchoscopic navigation and tissue diagnosis

AbstractDiagnosis of early-stage lung cancer has become increasingly important as the detection of peripheral pulmonary lesions (PPLs) grows with widespread adoption of CT-based lung cancer screening. Although CT-guided transthoracic needle aspiration has been the standard diagnostic approach for PPLs, transbronchial sampling by bronchoscopy is often performed due to its reduced rate of adverse events. However, the diagnostic yield of conventional bronchoscopy is often poor. Various bronchoscopic technologies have emerged over recent years to address this limitation, including thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (RP-EBUS), virtual navigation bronchoscopy (VBN), electromagnetic navigation bronchoscopy (ENB), and robotic bronchoscopy. Bronchoscopic transparenchymal nodule access (BTPNA) and transbronchial access tool (TBAT) are novel techniques that leverage navigational bronchoscopic technologies to further improve access to lesions throughout the lung. The devices used for sampling tissue have similarly evolved, such as the introduction of cryobiopsy. These innovative bronchoscopic techniques allows higher diagnostic yield even in small PPLs. Given the complexity of these new techniques and technologies, it is important for physicians to understand their strengths and limitations.
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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We present the case of an asymptomatic woman, a chronic heavy smoker, who presented with an incidental lung mass and mediastinal lymphadenopathy. Bronchoscopy with transbronchial biopsy and endobronchial ultrasound-guided transbronchial needle aspiration did not show malignancy. A positron emission tomography/computed tomography scan showed increased uptake with a standardized uptake value of 26.4 in the mediastinal lymph node and an additional hypermetabolic right supraclavicular lymph node. Surgical biopsy of the supraclavicular node revealed non-necrotizing granuloma. Discussion of the clinical dilemma is provided.
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
Introduction: The EBUS-TBNA is a minimally invasive technique widely used in the diagnosis, staging and immunohistochemistry analysis of lung cancer.1PDL-1 is a checkpoint on NSCLC that can be targeted with immunotherapy.2Routine PDL-1 testing was introduced at Oxford University Hospital NHS Foundation Trust (OUHFT) in 2017 and it is unclear if EBUS-TBNA provides adequate tissue for testing. In our current practice at the OUHFT, all NSCLC cases (Squamous Cell Lung Carcinoma and Lung Adenocarcinoma) identified on cytopathology are subsequently tested for PDL-1 tumour percentage score (TPS). The aim of this study was to see ...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Lung cancer Source Type: research
Conclusion: We conclude that it is feasible for pulmonologist to perform FLB immediately after endoscopy as a combined triple approach in a fast-track workup of suspected lung cancer.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Lung cancer Source Type: research
Background and Aims: Prompt diagnosis and staging of lung cancer are important to rapidly determine treatment options. The feasibility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and bronchoscopic sampling of peripheral lesions in a single procedure was evaluated.Methods: This was a retrospective observational study on patients who underwent bronchoscopy at our hospital from January 2015 to December 2018 for suspected cancer. We compared the diagnostic yields among bronchoscopy procedures for both peripheral and coexistent mediastinal lesions in a single procedure (group 1), for peripher...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional pulmonology Source Type: research
Conclusion: There were no differences in adequacy and diagnosis between samples obtained using EBUS-TBNA and those obtained using EBUS-TBNCS. According to this study, there is no advantage in using suction or no suction to EBUS-guided biopsies.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional pulmonology Source Type: research
Conclusion: These results confirm that the rate of serious complications in patients with space-occupying brain lesions who undergo bronchoscopy with general anesthesia is similar to that in patients without brain lesions, indicating that bronchoscopy can be performed safely in this patient population.
Source: Clinical Pulmonary Medicine - Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Condition:   Lung Carcinoma Interventions:   Procedure: Bronchoscopy;   Procedure: Ultrasound-Guided Transbronchial Needle Aspiration Sponsors:   Ohio State University Comprehensive Cancer Center;   National Cancer Institute (NCI) Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
In this case series, we describe three cases of lung malignancy diagnosed using three distinct applications of endobronchial ultrasound ‐guided transbronchial needle aspiration (EBUS‐TBNA) and endoscopic ultrasound with bronchoscope‐guided fine‐needle aspiration (EUS‐B‐FNA). Both procedures can be performed in a single session and by a single operator; this translates into an overall reduction in the healthcare cost. Whe n EBUS‐TBNA and EUS‐B‐FNA are combined, the technique allows for the augmentation of diagnostic potentials and increased precision in staging procedures. Endobronchial ultrasound (EBUS) i...
Source: Respirology Case Reports - Category: Respiratory Medicine Authors: Tags: Case Series Source Type: research
Conclusion Diagnostic procedures should be chosen based on the clinical character in EBUS-TBNA negative patients with suspected lung cancer. Long time follow-up is very important in patients whose diagnosis is apparently unknown. 
 DOI: 10.3779/j.issn.1009-3419.2019.04.04
Source: Chinese Journal of Lung Cancer - Category: Cancer & Oncology Source Type: research
Programmed death ligand 1 (PD-L1) immunohistochemistry (IHC) assays are widely used for complementary or companion diagnostic purposes during treatment with immune checkpoint inhibitors. However, limited information is available on the clinical reliability of the PD-L1 IHC assay using small biopsy samples. Participants included 46 patients with nonsmall cell lung cancer who underwent PD-L1 testing using 3 PD-L1 IHC assays (22C3, SP142, and SP263) for both small biopsy samples and surgical specimens from November 2017 to June 2018. The PD-L1 IHC assay results were analyzed with cut-off values of 1%, 5%, 10%, and 50%. The P...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
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