10 research outputs found

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

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    ┬á 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 endoscopistÔÇÖs 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.

    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 endoscopistÔÇÖs 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

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

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A┬ágeneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing itÔÇÖs 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┬águide 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 5ÔÇô8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.Results: From March 2017 to September 2019 ÔÇö 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┬áchest tube drainage and a┬áminor 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 itÔÇÖs 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 5ÔÇô8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 ÔÇö 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

    Wst─Öpne polskie do┼Ťwiadczenia z u┼╝yciem ig┼éy Flex 19G do przezoskrzelowej biopsji pod kontrol─ů ultrasonografii wewn─ůtrzoskrzelowej

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    WST─śP: EBUS (endobronchial ultrasonography) jest ma┼éoinwazyjn─ů metod─ů diagnostyczn─ů o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii ┼Ťr├│dpiersia i wn─Ök p┼éucnych. ViziShotFlex 19G needle to nowa ig┼éa przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firm─Ö Olympus w 2015 roku. Jej konstrukcja ma zapewni─ç wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz uzyskanie wi─Ökszej ilo┼Ťci materia┼éu tkankowego do analizy. Cele niniejszej pracy to ocena wydolno┼Ťci diagnostycznej procedury EBUS-TBNA (EBUS ÔÇö transbronchial needle aspiration) z zastosowaniem ig┼éy Flex 19G oraz prezentacja opinii endoskopist├│w na temat badania z jej u┼╝yciem. MATERIA┼ü I METODY: Ig┼éy Flex 19G zastosowano w diagnostyce pacjent├│w z adenopati─ů ┼Ťr├│dpiersia i/lub wn─Ök w dw├│ch o┼Ťrodkach pulmonologicznych w Polsce. Wykonywano zar├│wno rozmazy cytologiczne, jak i bloki kom├│rkowe (CB ÔÇö cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dw├│ch wybranych pacjent├│w z adenopati─ů potwierdzon─ů w tomografii komputerowej (┼Ťrednia wieku 58 ┬▒ 12 lat) podano badaniu EBUS-TBNA z u┼╝yciem igie┼é Flex 19G. Wszystkie wykonane rozmazy cytologiczne okaza┼éy si─Ö diagnostyczne (wydolno┼Ť─ç diagnostyczna 100%). Z┼éo┼Ťliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast ┼éagodn─ů adenopati─Ö u 7 pacjent├│w (31,8%). W 12 z 14 przypadk├│w raka p┼éuca wykonane CB mog┼éy by─ç u┼╝yte do oznacze┼ä immunohistochemicznych i molekularnych. Po biopsji w─Öz┼é├│w ch┼éonnych, zw┼éaszcza wn─Ökowych, nie obserwowano nasilonego krwawienia. W por├│wnaniu ze standardow─ů procedur─ů EBUS-TBNA z u┼╝yciem ig┼éy 21/22G endoskopi┼Ťci podkre┼Ťlali wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz jako┼Ť─ç bioptatu, natomiast w pozosta┼éych aspektach biopsji r├│┼╝nice by┼éy nieznacz─ůce. WNIOSKI: Pierwsze polskie do┼Ťwiadczenia z u┼╝yciem igie┼é Flex 19G okazuj─ů si─Ö by─ç podobne do standardowej techniki z u┼╝yciem igie┼é 21/22G oraz prezentuj─ů wysok─ů wydolno┼Ť─ç diagnostyczn─ů w raku p┼éuca, szczeg├│lnie z zastosowaniem CB. Profil bezpiecze┼ästwa biopsji jest akceptowalny.WST─śP: EBUS (endobronchial ultrasonography) jest ma┼éoinwazyjn─ů metod─ů diagnostyczn─ů o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii ┼Ťr├│dpiersia i wn─Ök p┼éucnych. ViziShotFlex 19G needle to nowa ig┼éa przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firm─Ö Olympus w 2015 roku. Jej konstrukcja ma zapewni─ç wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz uzyskanie wi─Ökszej ilo┼Ťci materia┼éu tkankowego do analizy. Cele niniejszej pracy to ocena wydolno┼Ťci diagnostycznej procedury EBUS-TBNA (EBUS ÔÇö transbronchial needle aspiration) z zastosowaniem ig┼éy Flex 19G oraz prezentacja opinii endoskopist├│w na temat badania z jej u┼╝yciem. MATERIA┼ü I METODY: Ig┼éy Flex 19G zastosowano w diagnostyce pacjent├│w z adenopati─ů ┼Ťr├│dpiersia i/lub wn─Ök w dw├│ch o┼Ťrodkach pulmonologicznych w Polsce. Wykonywano zar├│wno rozmazy cytologiczne, jak i bloki kom├│rkowe (CB ÔÇö cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dw├│ch wybranych pacjent├│w z adenopati─ů potwierdzon─ů w tomografii komputerowej (┼Ťrednia wieku 58 ┬▒ 12 lat) podano badaniu EBUS-TBNA z u┼╝yciem igie┼é Flex 19G. Wszystkie wykonane rozmazy cytologiczne okaza┼éy si─Ö diagnostyczne (wydolno┼Ť─ç diagnostyczna 100%). Z┼éo┼Ťliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast ┼éagodn─ů adenopati─Ö u 7 pacjent├│w (31,8%). W 12 z 14 przypadk├│w raka p┼éuca wykonane CB mog┼éy by─ç u┼╝yte do oznacze┼ä immunohistochemicznych i molekularnych. Po biopsji w─Öz┼é├│w ch┼éonnych, zw┼éaszcza wn─Ökowych, nie obserwowano nasilonego krwawienia. W por├│wnaniu ze standardow─ů procedur─ů EBUS-TBNA z u┼╝yciem ig┼éy 21/22G endoskopi┼Ťci podkre┼Ťlali wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz jako┼Ť─ç bioptatu, natomiast w pozosta┼éych aspektach biopsji r├│┼╝nice by┼éy nieznacz─ůce. WNIOSKI: Pierwsze polskie do┼Ťwiadczenia z u┼╝yciem igie┼é Flex 19G okazuj─ů si─Ö by─ç podobne do standardowej techniki z u┼╝yciem igie┼é 21/22G oraz prezentuj─ů wysok─ů wydolno┼Ť─ç diagnostyczn─ů w raku p┼éuca, szczeg├│lnie z zastosowaniem CB. Profil bezpiecze┼ästwa 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 endosonographyÔÇĹguided approach is yet to be determined. Objectives The aim of our study was to assess the relative diagnostic yield of combined ultrasoundÔÇĹguided needle aspiration (CUSÔÇĹbÔÇĹNA), which includes endobronchial ultrasoundÔÇĹguided transbronchial needle aspiration (EBUSÔÇĹTBNA) with endoscopic ultrasound fineÔÇĹneedle aspiration (EUSÔÇĹbÔÇĹFNA), 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. CUSÔÇĹbÔÇĹNA 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 followÔÇĹup were scheduled. Results Out of 77 screened patients, 54 signed written consent and 50 were enrolled for the final analysis. The overall sensitivity of EBUSÔÇĹTBNA, EUSÔÇĹbÔÇĹFNA, and CUSÔÇĹbÔÇĹNA was 76.6%, 70.2%, and 91.7%, respectively. There were no differences between EBUSÔÇĹTBNA and EUSÔÇĹbÔÇĹFNA (P = 0.52) but CUSÔÇĹbÔÇĹNA 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 CUSÔÇĹbÔÇĹNA 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

    Endosonography and endosonography guided needle aspiration for left adrenal gland assessment in lung cancer patients ÔÇĽ 10 yearsÔÇÖ experience

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    Introduction: Lung cancer patients (LCP) require invasive evaluation of left adrenal glands (LAG) if distant metastases (M1b/1c) are suspected in CT or PET-CT. Only few studies showed utility of endosonography and particularly EUS-b-FNA as minimally invasive endoscopic method of LAG analysis.Material and methods: A retrospective study of consecutive LCP was conducted in two pulmonology centers between January 2010 and December 2019. Records of complete endosonographic staging with use of single ultrasound bronchoscope or two scopes were overviewed. The analysis included cases of enlarged LAG (body size or limbs > 10 mm) examined and sampled by EUS-b-FNA or EUS-FNA.Results: 142 of 2596 LCP staged by complete endosonography (M: 88, F: 54 mean age 64.7) had enlarged LAG, which were biopsied by conventional EUS-FNA (52) and/or by EUS-b-FNA (90). Strong correlation with gland diameter (P < 0.001) was observed. The incidence of LAG metastases in analyzed group was 52.1% (74/142) and regarding histology: SCLC 76.9% (10/13), adenocarcinoma 66.7% (44/66), NSCLC 56.3% (9/16) and SCC 17.5% (7/40). A specificity and PPV for both methods were 100%. A sensitivity, accuracy and NPV for EUS-FNA were 91.7%, 96.2%, 93.3% and for EUS-b-FNA 88%, 93.3% and 87%, respectively and no significant differences for both methods were noted (P = 0.62, 0.44, 0.35). No severe complications afterall biopsies were observed. A six months clinical follow up included all negative LCP with enlarged LAG.Conclusions: After our study EUS-b-FNA seems to be a reasonable method of choice for LAG assesssment in LCP

    Endosonography and Endosonography Guided Needle Aspiration for Left Adrenal Gland Assessment in Lung Cancer PatientsÔÇĽ10 YearsÔÇÖ Experience

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    Introduction: Lung cancer patients (LCP) require invasive evaluation of left adrenal glands (LAG) if distant metastases (M1b/1c) are suspected in CT or PET-CT. Only few studies showed utility of endosonography and particularly EUS-b-FNA as minimally invasive endoscopic method of LAG analysis. Material and Methods: A retrospective study of consecutive LCP was conducted in two pulmonology centers between January 2010 and December 2019. Records of complete endosonographic staging with use of single ultrasound bronchoscope or two scopes were overviewed. The analysis included cases of enlarged LAG (body size or limbs > 10 mm) examined and sampled by EUS-b-FNA or EUS-FNA. Results: 142 of 2596 LCP staged by complete endosonography (M: 88, F: 54 mean age 64.7) had enlarged LAG, which were biopsied by conventional EUS-FNA (52) and/or by EUS-b-FNA (90). Strong correlation with gland diameter (p < 0.001) was observed. The incidence of LAG metastases in analyzed group was 52.1% (74/142) and regarding histology: SCLC 76.9% (10/13), adenocarcinoma 66.7% (44/66), NSCLC 56.3% (9/16) and SCC 17.5% (7/40). A specificity and PPV for both methods were 100%. A sensitivity, accuracy and NPV for EUS-FNA were 91.7%, 96.2%, 93.3% and for EUS-b-FNA 88%, 93.3% and 87%, respectively and no significant differences for both methods were noted (p = 0.62, 0.44, 0.35). No severe complications afterall biopsies were observed. A six months clinical follow up included all negative LCP with enlarged LAG. Conclusions: After our study EUS-b-FNA seems to be a reasonable method of choice for LAG assesssment in LCP
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