Trans-esophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA) : a road map for the chest physician

The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice

Transbronchial lung cryobiopsy guided by endobronchial ultrasound radial miniprobe in interstitial lung diseases : preliminary results of a prospective study

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Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes

This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion

Szybka diagnostyka patomorfologiczna i molekularna chorych na raka płuca na podstawie techniki telepatologii

Telepathology is an emerging form of diagnostic process introducing digitalization of slides prepared from formalin-fixed paraffin-embedded materials and stained cytological smears. The use of whole slide imaging (WSI) systems could accelerate and improve the diagnosis of malignant neoplasms without the need of on-site pathologist or transporting diagnostic material in-between different locations. The implementation of endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) with fine needle aspiration (FNA) in diagnostic process of advanced lung cancer creates a new field for telepathology utilization. In selected patients, pathomorphological and genetic diagnosis may take less than a week and therapeutic decisions can be made in a short time. There are several important issues that concern the use of telepathology and WSI in everyday clinical environment. This short review presents the pros and cons of this technology and its applicability in rapid diagnosis of lung cancer, its utilization in connection with novel sampling methods and molecular analysis.Telepatologia to nowa forma procesu diagnostycznego wprowadzająca cyfryzację preparatów przygotowanych z bloczków parafinowych lub wybarwionych rozmazów cytologicznych. Wykorzystanie systemu skanowania całych preparatów może polepszyć i znacząco przyspieszyć diagnostykę nowotworów złośliwych bez wymaganej obecności patomorfologa w miejscu wykonywania diagnostyki oraz bez potrzeby transportowania pobranego materiału pomiędzy różnymi lokalizacjami. Wprowadzenie biopsji aspiracyjnej cienkoigłowej (FNA) przeprowadzanej pod kontrolą przezoskrzelowego lub przezprzełykowego USG (EBUS lub EUS) do procesu diagnostycznego zaawansowanego raka płuca tworzy nowe pole do zastosowania telepatologii. U wybranych chorych diagnoza patomorfologiczna i genetyczna może trwać poniżej tygodnia, a decyzje terapeutyczne mogą zostać podjęte w krótkim czasie. Istnieje kilka istotnych kwestii związanych z wykorzystaniem telepatologii oraz skanowania całych preparatów w codziennej praktyce klinicznej. Ten krótki przegląd ma na celu przybliżenie wad i zalet opisanej technologii i ich możliwości wykorzystania w szybkiej diagnostyce raka płuca w połączeniu z nowoczesnymi metodami pobierania materiału i koniecznością prowadzenia diagnostyki genetycznej

Expression of insulin-like growth factor-I (IGF-I) in alveolar macrophages and lymphocytes obtained by bronchoalveolar lavage (BAL) in interstitial lung diseases (ILD). Assessment of IGF-I as a potential local mitogen and antiapoptotic cytokine.

Little is known about IGF-I expression in the alveolar lymphocytes (AL), and about local role of IGF-I in physiological conditions and in interstitial lung diseases. Bronchoalveolar lavage was carried out in patients with silicosis, asbestosis, idiopathic pulmonary fibrosis (IPF) and sarcoidosis, as well as in control subjects (n = 13, 9, 12, 56, 15, resp). Alveolar macrophages (AM) and lymphocytes (AL) were studied for (1) IGF-I, BCL-2, Fas and Fas Ligand expression and (2) cell cycle (incl. sub-G1 peak of late apoptosis) with propidium iodide (PI). Flow cytometry (FC) and immunocytochemistry were used. AL early apoptosis was detected by Annexin V FITC/PI staining. IGF-I was present in AL of all tested groups. The number of IGF-I positive AL was significantly higher in IPF (52 +/- 6.7%) and in later (II and III) stages of sarcoidosis (39 +/- 7.8 vs 16 +/- 4.0% in controls, p < 0.05). Increased BCL-2 expression in AL was detected in IPF and sarcoidosis. In all tested groups, AL were almost exclusively Fas+ T cells. Generally, a low number of AL entered apoptosis; no significant differences were found between patient groups, except decreased apoptosis rate in sarcoidosis (0.60 +/- 0.17 vs 1.15 +/- 0.33% in controls, p < 0.05). Proportion of AL positive for IGF-I was significantly correlated with parameters reflecting AL and AM cell proliferation and BCL-2 expression (e.g. AL IGF-I+ vs AM in S phase of cell cycle: r(S) = +0.50, p = 0.001), but not with apoptosis. The results show that human alveolar lymphocytes express IGF-I in normal conditions, as well as in ILD. The proportion of IGF-I+ lymphocytes was significantly increased in IPF and at later stages of sarcoidosis. In our material there was no evidence for profibrogenic or antiapoptotic activity of IGF-I. We suggest that IGF-I originating from AL may be locally active as a mitogen for alveolar macrophages and lymphocytes in ILD

Transbronchial lung biopsy as a diagnostic method of peripheral lesions

The aim of the study was to assess the diagnostic yield of transbronchial lung biopsy (TBLB) without fluoroscopicguidanceinperipherallesionsofdiameter2,5-6cm.TBLBwasperformedin65consecutivepatientswithout abnormalities in bronchial tree in standard bronchofiberoscopyandprecededbycomputedtomography(CT). The CT guidance helped to select the segment of lung to be biopsied. In 39 patients (60%) TBLB enabled to diagnose 36 cases of lung cancer, 2 cases of carcinoid and 1 case of malignant lymphoma. There were 26 cases (including 21 cases of lung cancer) undiagnosed by means of TBLB. In 24 patients the diagnosis was established by means of other methods like transbronchial needle aspiration (TBNA) – 5 cases, thin needle biopsy (TNB) – 12 cases, open lung biopsy (OLB) – 7 cases and in the remaining 2 patients a regression of clinical and radiological features was observed. Transbronchial lung biopsy was found to be efficientdiagnosticmethodinperipherallesionshigher than 2,5cm. However, in 40% of cases this technique doesn’t allow to establish a diagnosis. This, in turn implicates the necessity for further diagnostic procedures including TBNA, TNB or even OLB