20 research outputs found

    Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

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      INTRODUCTION: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist’s feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIAL AND METHODS: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. RESULTS: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. CONCLUSIONS: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.

    The influence of lung volume reduction with intrabronchial valves on the quality of life of patients with heterogeneous emphysema — a prospective study

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    Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used — bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single center prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years old), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p < 0.001) and in domains and differences were for: “symptoms” (–8.5; p < 0.001), “activity” (–13.9; p < 0.001) and “influence on life”(–13.5; p < 0.002). Conclusions: The presented study revealed the significant improvement of the quality of life measured by SGRQ after the IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used — bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p < 0.001) and in domains and the differences were for: “symptoms” (–8.5; p < 0.001), “activity” (–13.9; p < 0.001) and “influence on life”(–13.5; p < 0.002). Conclusions: The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment

    Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases — a multicenter prospective study

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A general anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use.Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a guide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a chest tube drainage and a minor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

    Transbronchial lung cryobiopsy guided by radial "mini-probe" endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

    Wstępne polskie doświadczenia z użyciem igły Flex 19G do przezoskrzelowej biopsji pod kontrolą ultrasonografii wewnątrzoskrzelowej

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    WSTĘP: EBUS (endobronchial ultrasonography) jest małoinwazyjną metodą diagnostyczną o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii śródpiersia i wnęk płucnych. ViziShotFlex 19G needle to nowa igła przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firmę Olympus w 2015 roku. Jej konstrukcja ma zapewnić większą giętkość uzbrojonego endoskopu oraz uzyskanie większej ilości materiału tkankowego do analizy. Cele niniejszej pracy to ocena wydolności diagnostycznej procedury EBUS-TBNA (EBUS — transbronchial needle aspiration) z zastosowaniem igły Flex 19G oraz prezentacja opinii endoskopistów na temat badania z jej użyciem. MATERIAŁ I METODY: Igły Flex 19G zastosowano w diagnostyce pacjentów z adenopatią śródpiersia i/lub wnęk w dwóch ośrodkach pulmonologicznych w Polsce. Wykonywano zarówno rozmazy cytologiczne, jak i bloki komórkowe (CB — cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dwóch wybranych pacjentów z adenopatią potwierdzoną w tomografii komputerowej (średnia wieku 58 ± 12 lat) podano badaniu EBUS-TBNA z użyciem igieł Flex 19G. Wszystkie wykonane rozmazy cytologiczne okazały się diagnostyczne (wydolność diagnostyczna 100%). Złośliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast łagodną adenopatię u 7 pacjentów (31,8%). W 12 z 14 przypadków raka płuca wykonane CB mogły być użyte do oznaczeń immunohistochemicznych i molekularnych. Po biopsji węzłów chłonnych, zwłaszcza wnękowych, nie obserwowano nasilonego krwawienia. W porównaniu ze standardową procedurą EBUS-TBNA z użyciem igły 21/22G endoskopiści podkreślali większą giętkość uzbrojonego endoskopu oraz jakość bioptatu, natomiast w pozostałych aspektach biopsji różnice były nieznaczące. WNIOSKI: Pierwsze polskie doświadczenia z użyciem igieł Flex 19G okazują się być podobne do standardowej techniki z użyciem igieł 21/22G oraz prezentują wysoką wydolność diagnostyczną w raku płuca, szczególnie z zastosowaniem CB. Profil bezpieczeństwa biopsji jest akceptowalny.WSTĘP: EBUS (endobronchial ultrasonography) jest małoinwazyjną metodą diagnostyczną o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii śródpiersia i wnęk płucnych. ViziShotFlex 19G needle to nowa igła przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firmę Olympus w 2015 roku. Jej konstrukcja ma zapewnić większą giętkość uzbrojonego endoskopu oraz uzyskanie większej ilości materiału tkankowego do analizy. Cele niniejszej pracy to ocena wydolności diagnostycznej procedury EBUS-TBNA (EBUS — transbronchial needle aspiration) z zastosowaniem igły Flex 19G oraz prezentacja opinii endoskopistów na temat badania z jej użyciem. MATERIAŁ I METODY: Igły Flex 19G zastosowano w diagnostyce pacjentów z adenopatią śródpiersia i/lub wnęk w dwóch ośrodkach pulmonologicznych w Polsce. Wykonywano zarówno rozmazy cytologiczne, jak i bloki komórkowe (CB — cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dwóch wybranych pacjentów z adenopatią potwierdzoną w tomografii komputerowej (średnia wieku 58 ± 12 lat) podano badaniu EBUS-TBNA z użyciem igieł Flex 19G. Wszystkie wykonane rozmazy cytologiczne okazały się diagnostyczne (wydolność diagnostyczna 100%). Złośliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast łagodną adenopatię u 7 pacjentów (31,8%). W 12 z 14 przypadków raka płuca wykonane CB mogły być użyte do oznaczeń immunohistochemicznych i molekularnych. Po biopsji węzłów chłonnych, zwłaszcza wnękowych, nie obserwowano nasilonego krwawienia. W porównaniu ze standardową procedurą EBUS-TBNA z użyciem igły 21/22G endoskopiści podkreślali większą giętkość uzbrojonego endoskopu oraz jakość bioptatu, natomiast w pozostałych aspektach biopsji różnice były nieznaczące. WNIOSKI: Pierwsze polskie doświadczenia z użyciem igieł Flex 19G okazują się być podobne do standardowej techniki z użyciem igieł 21/22G oraz prezentują wysoką wydolność diagnostyczną w raku płuca, szczególnie z zastosowaniem CB. Profil bezpieczeństwa biopsji jest akceptowalny

    Usefulness of combined endobronchial and endoscopic ultrasound-guided needle aspiration in the diagnosis of sarcoidosis : a prospective multicenter trial

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    Introduction Needle biopsy of enlarged lymph nodes is an accepted method for the diagnostic workup of sarcoidosis, but the optimal endosonography‑guided approach is yet to be determined. Objectives The aim of our study was to assess the relative diagnostic yield of combined ultrasound‑guided needle aspiration (CUS‑b‑NA), which includes endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA) with endoscopic ultrasound fine‑needle aspiration (EUS‑b‑FNA), as well as the role of the cell block (CB) technique and lymph node localization in the diagnostic workup of sarcoidosis. Patients and methods This was a prospective multicenter study including consecutive patients with clinical suspicion of stage I or II sarcoidosis. CUS‑b‑NA with smears and CB technique were performed in the whole study group. If a biopsy result was not conclusive, an invasive diagnostic workup and a 6-month follow‑up were scheduled. Results Out of 77 screened patients, 54 signed written consent and 50 were enrolled for the final analysis. The overall sensitivity of EBUS‑TBNA, EUS‑b‑FNA, and CUS‑b‑NA was 76.6%, 70.2%, and 91.7%, respectively. There were no differences between EBUS‑TBNA and EUS‑b‑FNA (P = 0.52) but CUS‑b‑NA had a higher diagnostic yield (P = 0.005 and P = 0.001, respectively). Adding the CB method to smear technique (P = 0.008) and biopsy of the subcarinal lymph nodes increased the diagnostic yield (P = 0.001). Conclusions The diagnostic yield of CUS‑b‑NA is higher than that of endosonographic techniques alone in the diagnostic workup of stage I and II sarcoidosis. The preparation of cytological material including CB and the choice of the subcarinal lymph node station for the biopsy increase the diagnostic efficacy
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