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

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

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

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

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