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Respirology (Carlton, Vic.) Sep 2020Bronchoscopic sampling of PPL was significantly advanced by the development of the endobronchial ultrasound guide sheath method in the 1990s. Since then, a range of... (Review)
Review
Bronchoscopic sampling of PPL was significantly advanced by the development of the endobronchial ultrasound guide sheath method in the 1990s. Since then, a range of technical and procedural techniques have further advanced diagnostic yields. These include the use of thinner bronchoscopes with better working channel diameters, understanding the importance of peripheral transbronchial needle aspiration, and virtual bronchoscopic assistance. These have enabled better sampling of smaller and more technically challenging lesions including ground-glass nodules. Most recently, robotic bronchoscopy has been developed which, among other refinements, allows fine control of visual bronchoscopic navigation by replacing movements directed by the hand with electronic consoles and trackballs, and innovatively integrate virtual with real bronchoscopic pathways. The requirement for PPL diagnosis and treatment is expected to increase with more chest CT performed as part of CT screening programmes.
Topics: Bronchoscopes; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Lung; Lung Neoplasms; Robotic Surgical Procedures; Solitary Pulmonary Nodule
PubMed: 32103596
DOI: 10.1111/resp.13791 -
American Journal of Respiratory and... Sep 2010Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to... (Review)
Review
Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.
Topics: Bronchoscopes; Bronchoscopy; Humans; Lung Diseases; Ultrasonography
PubMed: 20378726
DOI: 10.1164/rccm.201002-0186CI -
European Respiratory Review : An... Sep 2015Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis.... (Review)
Review
Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).
Topics: Airway Obstruction; Bronchial Diseases; Bronchoscopes; Bronchoscopy; Combined Modality Therapy; Critical Pathways; Cryosurgery; Electrocoagulation; Humans; Laser Therapy; Lasers; Lung Neoplasms; Palliative Care; Patient Selection; Photochemotherapy; Risk Factors; Stents; Tracheal Stenosis; Treatment Outcome
PubMed: 26324799
DOI: 10.1183/16000617.00010014 -
The Keio Journal of Medicine Dec 1996We developed new types of ultra-thin bronchofiberscopes, BF-2.2T and BF-2.7T to observe and photograph lesions of 2 mm or less in bronchioli. BF-2.2T and BF-2.7T can be... (Review)
Review
We developed new types of ultra-thin bronchofiberscopes, BF-2.2T and BF-2.7T to observe and photograph lesions of 2 mm or less in bronchioli. BF-2.2T and BF-2.7T can be bent to achieve a vertical range of 120 degrees. BF-2.7T has an additional channel for biopsy and can be used to collect cells. The ultra-thin bronchofiberscopes allowed us to observe all cases of peripheral pulmonary carcinoma and to collect cells. We are now studying IL-6, IL-8 and mRNA in cell specimens collected from patients with lung cancer using the ultra-thin bronchofiberscopes. The development of the ultra-thin bronchofiberscopes have allowed remarkable advances in clinical practice and research because these endoscoped allow bronchioles to be observed directly and to collect bronchial epithelial cells from necessary areas for subsequent incubation and cytological assessment.
Topics: Bronchi; Bronchoscopes; Bronchoscopy; Female; Fiber Optic Technology; History, 19th Century; History, 20th Century; Humans; Lung Neoplasms; Male; Middle Aged; Respiratory Tract Diseases
PubMed: 9023446
DOI: 10.2302/kjm.45.296 -
Thorax Dec 2023Traditional electromagnetic navigation bronchoscopy (ENB) is a real-time image-guided system and used with thick bronchoscopes for the diagnosis of peripheral pulmonary...
BACKGROUND
Traditional electromagnetic navigation bronchoscopy (ENB) is a real-time image-guided system and used with thick bronchoscopes for the diagnosis of peripheral pulmonary nodules (PPNs). A novel ENB that could be used with thin bronchoscopes was developed. This study aimed to evaluate the diagnostic yield and the experience of using this ENB system in a real clinical scenario.
METHODS
This multicentre study enrolled consecutive patients with PPNs adopting ENB from March 2019 to August 2021. ENB was performed with different bronchoscopes, ancillary techniques and sampling instruments according to the characteristics of the nodule and the judgement of the operator. The primary endpoint was the diagnostic yield. The secondary endpoints included the diagnostic yield of subgroups, procedural details and complication rate.
RESULTS
In total, 479 patients with 479 nodules were enrolled in this study. The median lesion size was 20.9 (IQR, 15.9-25.9) mm. The overall diagnostic yield was 74.9% (359/479). A thin bronchoscope was used in 96.2% (461/479) nodules. ENB in combination with radial endobronchial ultrasound (rEBUS), a guide sheath (GS) and a thin bronchoscope was the most widely used guided method, producing a diagnostic yield of 74.1% (254/343). The median total procedural time was 1325.0 (IQR, 1014.0-1676.0) s. No severe complications occurred.
CONCLUSION
This novel ENB system can be used in combination with different bronchoscopes, ancillary techniques and sampling instruments with a high diagnostic yield and safety profile for the diagnosis of PPNs, of which the combination of thin bronchoscope, rEBUS and GS was the most common method in clinical practice.
TRIAL REGISTRATION NUMBER
NCT03716284.
Topics: Humans; Bronchoscopy; Solitary Pulmonary Nodule; Prospective Studies; Electromagnetic Phenomena; Lung Neoplasms
PubMed: 37734951
DOI: 10.1136/thorax-2022-219664 -
European Respiratory Review : An... Jun 2013Flexible bronchoscopy plays a major role in the diagnosis and staging of lung cancer. One of the most important advances in this field is the development of... (Review)
Review
Flexible bronchoscopy plays a major role in the diagnosis and staging of lung cancer. One of the most important advances in this field is the development of endobronchial ultrasound (EBUS), which has extended the view of the bronchoscopist. These techniques are safe and allow assessment of the depth of tumour invasion in the central airways, detection of peripheral tumours before sampling, localisation of the central tumour in the lung parenchyma close to the central airways for real-time guided sampling, and staging of lymph nodes within the mediastinum. Progress in handling and analyses of the small samples obtained during EBUS procedures also allow modern pathological and molecular studies to be performed. This article reviews the data currently available in the field of convex and radial probe EBUS for the diagnosis and staging of nonsmall cell lung cancer and highlights the strengths but also the weaknesses of these new techniques.
Topics: Bronchoscopes; Bronchoscopy; Carcinoma, Non-Small-Cell Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Equipment Design; Humans; Lung Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Predictive Value of Tests; Prognosis
PubMed: 23728872
DOI: 10.1183/09059180.00001113 -
Respirology (Carlton, Vic.) Aug 2017Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has earned its place as a standard of care in the evaluation of mediastinal and... (Review)
Review
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has earned its place as a standard of care in the evaluation of mediastinal and hilar lymphadenopathy. It is a minimally invasive and a safe procedure with high diagnostic accuracy and efficacy. The increased usage of EBUS-TBNA worldwide has thrown light on its possible complications including death. The complications range from minor to life threatening in few and may occur either early or later in the course after the procedure. The present review summarizes the reported complications from EBUS-TBNA, their outcome and the modalities used for their management.
Topics: Anesthesia; Bronchoscopes; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Hemorrhage; Humans; Hypoxia; Infections; Needles; Pneumothorax
PubMed: 28631863
DOI: 10.1111/resp.13094 -
European Respiratory Review : An... Sep 2010Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the... (Review)
Review
Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.
Topics: Bronchoscopes; Bronchoscopy; Equipment Design; Humans; Lung Diseases
PubMed: 20956198
DOI: 10.1183/09059180.00005710 -
BMC Pulmonary Medicine Sep 2022Transbronchial lung cryobiopsy is useful when diagnosing lung lesions. However, prevention of associated bleeding complications is essential. This study aimed to... (Clinical Trial)
Clinical Trial
BACKGROUND
Transbronchial lung cryobiopsy is useful when diagnosing lung lesions. However, prevention of associated bleeding complications is essential. This study aimed to evaluate the safety and efficacy of our novel bronchoscopic cryobiopsy technique, which uses a long nasobronchial tube to prevent blood flooding the central airway.
METHODS
Patients with localized or diffuse lung lesions were prospectively enrolled and underwent cryobiopsy using a 1.9 mm diameter cryoprobe and a 4.0 mm diameter thin bronchoscope under conscious sedation. For cryobiopsy, a long silicone tube (inner diameter, 5.0 mm) was advanced through the nose to the target bronchus, then wedged to drain blood under thin-tube bronchoscopic control. The primary endpoint was the frequency of bleeding complications.
RESULTS
Of the 80 patients initially enrolled, 73 that underwent at least one cryobiopsy were ultimately included. Mild bleeding during cryobiopsy occurred in 58 patients (79.5%), but there was no moderate or severe bleeding. Other complications occurred in four patients (two pneumothorax, one pneumomediastinum, and one pneumonia). Tube dislocation was noted in eight patients (11%). Cryobiopsy specimens were significantly larger than forceps biopsy specimens (9.0 mm vs. 2.7 mm, P < .001) and allowed specific diagnoses in 50 patients (68.5%).
CONCLUSIONS
Thin bronchoscopic cryobiopsy using a nasobronchial tube in consciously sedated patients is safe and effective. Trial registration Date of registration: 24/06/2019. UMIN-Clinical Trials Registry; Identifier: UMIN000037156 https://www.umin.ac.jp/ctr/index.htm.
Topics: Biopsy; Bronchoscopes; Bronchoscopy; Humans; Lung; Silicones
PubMed: 36153576
DOI: 10.1186/s12890-022-02166-w -
Revista Portuguesa de Pneumologia 2012We reviewed the most important diagnostic procedures implemented by means of flexible bronchoscopy, including bronchoalveolar lavage, bronchial brushing and biopsy,... (Review)
Review
We reviewed the most important diagnostic procedures implemented by means of flexible bronchoscopy, including bronchoalveolar lavage, bronchial brushing and biopsy, transbronchial lung biopsy and transbronchial needle aspiration. We reviewed the tools, techniques and potential complications of this examination.
Topics: Biopsy; Biopsy, Fine-Needle; Bronchoalveolar Lavage; Bronchoscopes; Bronchoscopy; Equipment Design; Humans
PubMed: 22317896
DOI: 10.1016/j.rppneu.2012.01.003