Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiff...Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration （EBUS-TBNA）. The current study was conducted to investigate the diagnostic value of EBUS elastography tbr mediastinal and hilar lymph node metastasis in lung cancers. Methods： From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was perfornaed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a tbrmal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results： Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes （P = 0.000）. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score （r = 0.561, P = 0.000）. Conclusions： EBUS elastograp展开更多
Background:Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children.The aim of the study was to analyze characteristics and clinical role of bronchoscopy ...Background:Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children.The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB.Methods:A retrospective,descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014.Results:The median age of the enrolled patients was 3.4 years,with 73.2% of patients under five years old.The most common subtype was tumorous type (145/157,92.4%).If only involved bronchus were considered,the common affected sites were right middle lobe bronchus (49/228,21.5%),left upper lobe bronchus (41/228,18.0%),right upper lobe bronchus (41/228,18.0%),right main bronchus (35/228,15.4%),respectively.Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044),with an odds ratio of 2.313 (95% confidence interval:1.009-5.299).Before the bronchoscopy,only 16 (10.2%)patients were highly suspected of EBTB,while the others were diagnosed as PTB without EBTB (69.4%),or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission.Conclusions:The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions.The most frequent subtype of EBTB in children is tumorous type.The lesions are seen in the right bronchial system more frequently.FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.展开更多
Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple an...Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.展开更多
Background A new technique developed in 2002, aspiration （EBUS-TBNA）, has been one of the most real time endobronchial ultrasound-guided transbronchial needle important tools in lymph nodes （LNs） staging before lu...Background A new technique developed in 2002, aspiration （EBUS-TBNA）, has been one of the most real time endobronchial ultrasound-guided transbronchial needle important tools in lymph nodes （LNs） staging before lung cancer surgery. EBUS-TBNA was introduced into China in 2008. Methods Between June 2009 and October 2009, 30 patients with mediastinal/hilar lymphadenopathy and thoracic masses previously detected with CT scan underwent EBUS-TBNA without rapid onsite cytological examination. Results From 30 patients, 33 samples were obtained from LNs and seven samples from intrapulmonary lesions. Twenty out of the 23 lung cancer diagnoses were clarified through the procedure, with sensitivity, specificity, positive predictive value, negative predictive value and accuracy being 87%, 100%, 100%, 70% and 90%, respectively. All three false negative cases were found in the first five procedures. Additionally, among the 33 LNs examined, three specimens that had no lymphocytes were also found within the first five procedures. There were no major complications, and the procedures were uneventful. Conclusions EBUS-TBNA seems a safe and effective technique in making diagnosis for mediastinal/hilar LNs and intrapulmonary masses. For pulmonologists experienced in bronchoscopy, the sensitivity of the procedure for diagnosing lung cancer should be no less than 90% after the initial five procedures.展开更多
Endobronchial metastasis(EBM) is a rare form of metas-tasis from extrapulmonary malignant tumors,although there are few reports of EBM from gastric cancer specifically.We report the case of a 51-year-old woman who had...Endobronchial metastasis(EBM) is a rare form of metas-tasis from extrapulmonary malignant tumors,although there are few reports of EBM from gastric cancer specifically.We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography.On diagnosis of primary lung cancer,she underwent pulmonary lobectomy,but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer.Six months later,she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen.She is still alive at 33 mo after the lobectomy.Generally,the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival.Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.展开更多
Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy...Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy, photodynamics treatment, radiofrequency ablation and stenting, etc. The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan. This study used radial probe endobronchial ultrasound （RP-EBUS） scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall, and the influence of RP-EBUS scanning in treatment plan making and guidance. Methods This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy. We performed EBUS scanning after common bronchoscopy under local anesthesia. A radial ultrasonic probe （2.0 mm in diameter with 20-MHz frequency） with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope. The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control. The circular image of EBUS, which revealed the layered structure of the tracheobronchial wall, could be achieved. Results Total of 125 patients were enrolled in the study. Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90% （27/30）, sensitivity and specificity were 88.89% （24/27） and 100% （3/3）, respectively. In response to EBUS images, 40 approaches were altered or guided： lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration （TBNA） （n=8）; Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility （n=13）, stents size were changed （n=14）, operation was canceled （n=3） and foreign body was 展开更多
Background Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial...Background Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities. Methods We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People＇s Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out. Results Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.展开更多
We are reporting 3 cases of pediatric endobronchialtumors presented with recurrent pneumonia. The median age of patients, at time of presentation, was 10.6 years. All patients presented with recurrent pneumonia with a...We are reporting 3 cases of pediatric endobronchialtumors presented with recurrent pneumonia. The median age of patients, at time of presentation, was 10.6 years. All patients presented with recurrent pneumonia with a mean time to occurrence, after onset of symptoms, of 14 mo. Bronchoscopy was early performed as part of diagnostic work-up and it revealed an endobronchial mass in every case. Complete surgical resection was performed in all cases, with lung preservation in two of them. Neither post-operative chemotherapy nor radiotherapy was required. The mean duration of follow-up was 7 years and all patients are still alive and disease-free. Recurrent pneumonia, in pediatrics, should raise the suspicion of an obstructing lesion, congenital malformation or systemic disease. A systematic approach is useful for organize the clinicians initial workup. Prompt diagnosis allows parenchymal-sparing surgery, which offers the best chance of cure and reduces clinical and functional complications in these patients.展开更多
Background： Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound （CP-EBUS） has allow...Background： Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound （CP-EBUS） has allowed for performing real-time transbronchial needle aspiration （TBNA） of enlarged hilar and mediastinal lymph nodes and therefore could also be used as a means of diagnosing proximal peribronchial lesions. Methods： We retrospectively analyzed the results related to 72 patients who underwent CP-EBUS for peribronchial lesions without endobronchial involvement and adjacent to three-grade bronchi based on chest computed tomography （CT） scan. We recorded the images during EBUS as well as the diagnostic results of TBNA and conventional-transbronchial lung biopsy/brush （C-TBLB/b）, and final diagnoses were based on pathologic analysis and follow-up. Results： In all cases, the mass was able to be identified using EBUS in 97.2% patients （70/72） who were performed with EBUS-TBNA ＋ C-TBLB/b. Sixty-six patients had a final diagnosis, 80.0% patients （56/70） had malignancies, and 14.3% patients （10/70） had benign disease. In malignancies, the diagnostic yield of C-TBLB/b was 57.1% （32/56） and in EBUS-TBNA was 85.7% （48/56）, whereas pathologic diagnosis reached 94.6% when EBUS-TBNA was combined with C-TBLB/b. C-TBLB/b ＋ EBUS-TBNA also exhibited stronger potency of histolytic diagnosis for malignancies than either EBUS-TBNA or C-TBLB/b alone. Furthermore, there are data supporting the value of EBUS-TBNA for the diagnosis of benign lung disease. Conclusion： The combined endoscopic approach with EBUS-TBNA and C-TBLB/b is an accurate and effective method for the evaluation of peribronchial lesions, with better results than using each technique alone.展开更多
Background： Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standar...Background： Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods. Methods： We searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 （Nordic Cochrane Center, Copenhagen, Denmark） and Stata 12.0 software （Stata Corporation, College Station, TX, USA）. The Mantel-Haenszel method was used to calculate the pooled odds ratio （OR） and 95% confidence intervals （Cls）. Results： Sixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy （TBLB） for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 （95% CI, 2.20-15.79, P = 0.0004）. These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA ＋ TBLB ＋ endobronchial biopsy （EBB） versus TBNA ＋ TBLB ＋ EBB was 1.54 （95% C1, 0.61-3.93, P = 0.36）, implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables. Conclusions： The results of this meta-analysis suggest that EBUS-TBNA ＋ TBLB ＋ EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA ＋ TBLB ＋ EBB could be used instead.展开更多
INTRODUCTIONCryptogenic organizing pneumonia （COP） is a distinct type of idiopathic interstitial pneumonia with a response rate of 65 85% on corticosteroid therapy. The difficulty of COP diagnosis is that the clinic...INTRODUCTIONCryptogenic organizing pneumonia （COP） is a distinct type of idiopathic interstitial pneumonia with a response rate of 65 85% on corticosteroid therapy. The difficulty of COP diagnosis is that the clinical features and the radiological findings are nonspecific. The pathological hallmark of organizing pneumonia （OP） needs to be confirmed. It can also occur in a variety of other interstitial pneumonia, infectious diseases, vasculitis, and so on. To increase the pathological reliability, larger and more tissue samples are required. According to the current classification of interstitial lung disease and guidelines, the surgical lung biopsy is recommended and is considered to be the best way of obtaining a representative lung specimen However, the invasive diagnostic procedures require general anesthesia and also increase the morbidity and mortality risks; therefore, only few patients undergo such biopsy. Thus, safer and more acceptable methods for identifying COP are urgently needed.展开更多
Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to i...Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway. Methods From September 2009 to March 2013, 66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA. Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a surgical procedure. ResuLts Among the 66 cases, 59 were confirmed as pulmonary malignancies by EBUS-TBNA, of which 48 cases were non-small cell lung cancer, nine were small cell lung cancer, and two were metastatic lung tumors. No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases. Thoracoscopy or thoracotomy was subsequently undergone for them. Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung, one case of lymphoma, two cases of sclerosing hemangioma, and one case of pulmonary tuberculoma. The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%, 100.0%, and 93.9%, respectively. The positive and negative predictive values were 100.0% and 42.9%, respectively. The EBUS-TBNA procedures were well-tolerated by all patients. No associated complications were observed. Conclusions For intrapulmonary lesions near the central airway highly suspected of cancer, EBUS-TBNA has satisfactory diagnostic value. However, the negative predictive value of this technique is low, so negative results obtained by EBUSTBNA should be confirmed by other methods.展开更多
Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosi...Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA）.Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed.Of these,there were 14 males and 6 females （mean age of 59.1 years） with SVCS who received EBUS-TBNA that were included in the analysis.Results The mean short axis diameter of the paratracheal lesions was （3.32±1.79） cm （range,1.69 to 9.50 cm） and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of （2.14±0.49） cm （range,1.73 to 3.01 cm）.An average of 4.3 punctures was performed per lesion.Malignancy was confirmed in 16 cases （10 small cell carcinomas,4 adenocarcinomas,1 squamous cell carcinoma and 1 Hodgkin lymphoma）.In two patients,pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up.One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC.One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin＇s lymphoma.The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.展开更多
Endobronchial tuberculosis （EBTB） is an infectious disease occurring in the trachea or the bronchus with microbiological and histological evidences of tuberculosis. It is assumed a specific form or complication of t...Endobronchial tuberculosis （EBTB） is an infectious disease occurring in the trachea or the bronchus with microbiological and histological evidences of tuberculosis. It is assumed a specific form or complication of tuberculosis. EBTB is combined in 10% to 40% of patients with active pulmonary tuberculosis.展开更多
BACKGROUND Endobronchial metastases(EBMs)are tumours that metastasise from a malignant tumour outside the lungs to the central and subsegmental bronchi,and are visible under a bronchofibrescope.Most EBMs are formed by...BACKGROUND Endobronchial metastases(EBMs)are tumours that metastasise from a malignant tumour outside the lungs to the central and subsegmental bronchi,and are visible under a bronchofibrescope.Most EBMs are formed by direct invasion or metastasis of intrathoracic malignant tumours,such as lung cancer,oesophageal cancer or mediastinum tumours.Renal cell carcinoma(RCC),accounting for 2%to 3%of all tumours,is a common malignant tumour of the urinary system.Renal clear cell carcinoma(RCCC)constitutes the predominant pathological subtype of RCC,comprising approximately 70%to 80%of all RCC cases.RCCC can spread and metastasise through arterial,venous and lymphatic circulation to almost all organs of the body.Moreover,lung,bone,liver,brain and local recurrence are the most common metastatic neoplasms of RCCC.However,EBM from RCCC has a low complication rate and is often misdiagnosed as primary lung cancer.CASE SUMMARY A 71-year-old male patient who had undergone radical left nephrectomy 7 years prior due to RCCC was referred to our hospital due to a 1-mo history of productive cough.The results of an enhanced chest CT scan indicated the presence of a soft tissue nodule in the upper lobe of the left lung,and flexible bronchoscopy revealed a hypervascular lesion in the bronchus of the left lung's superior lobe.Therefore,the patient underwent thoracoscopic left superior lobe wedge resection,and pathology confirmed EBM from the RCCC.CONCLUSION EBM from RCCC has a low incidence and no characteristic clinical manifestations in the early stage.If a bronchial tumour is found in a patient with RCCC,the possibility of bronchial metastatic cancer should be considered.展开更多
文摘Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration （EBUS-TBNA）. The current study was conducted to investigate the diagnostic value of EBUS elastography tbr mediastinal and hilar lymph node metastasis in lung cancers. Methods： From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was perfornaed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a tbrmal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results： Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes （P = 0.000）. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score （r = 0.561, P = 0.000）. Conclusions： EBUS elastograp
文摘Background:Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children.The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB.Methods:A retrospective,descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014.Results:The median age of the enrolled patients was 3.4 years,with 73.2% of patients under five years old.The most common subtype was tumorous type (145/157,92.4%).If only involved bronchus were considered,the common affected sites were right middle lobe bronchus (49/228,21.5%),left upper lobe bronchus (41/228,18.0%),right upper lobe bronchus (41/228,18.0%),right main bronchus (35/228,15.4%),respectively.Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044),with an odds ratio of 2.313 (95% confidence interval:1.009-5.299).Before the bronchoscopy,only 16 (10.2%)patients were highly suspected of EBTB,while the others were diagnosed as PTB without EBTB (69.4%),or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission.Conclusions:The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions.The most frequent subtype of EBTB in children is tumorous type.The lesions are seen in the right bronchial system more frequently.FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.
文摘Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.
文摘Background A new technique developed in 2002, aspiration （EBUS-TBNA）, has been one of the most real time endobronchial ultrasound-guided transbronchial needle important tools in lymph nodes （LNs） staging before lung cancer surgery. EBUS-TBNA was introduced into China in 2008. Methods Between June 2009 and October 2009, 30 patients with mediastinal/hilar lymphadenopathy and thoracic masses previously detected with CT scan underwent EBUS-TBNA without rapid onsite cytological examination. Results From 30 patients, 33 samples were obtained from LNs and seven samples from intrapulmonary lesions. Twenty out of the 23 lung cancer diagnoses were clarified through the procedure, with sensitivity, specificity, positive predictive value, negative predictive value and accuracy being 87%, 100%, 100%, 70% and 90%, respectively. All three false negative cases were found in the first five procedures. Additionally, among the 33 LNs examined, three specimens that had no lymphocytes were also found within the first five procedures. There were no major complications, and the procedures were uneventful. Conclusions EBUS-TBNA seems a safe and effective technique in making diagnosis for mediastinal/hilar LNs and intrapulmonary masses. For pulmonologists experienced in bronchoscopy, the sensitivity of the procedure for diagnosing lung cancer should be no less than 90% after the initial five procedures.
文摘Endobronchial metastasis(EBM) is a rare form of metas-tasis from extrapulmonary malignant tumors,although there are few reports of EBM from gastric cancer specifically.We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography.On diagnosis of primary lung cancer,she underwent pulmonary lobectomy,but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer.Six months later,she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen.She is still alive at 33 mo after the lobectomy.Generally,the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival.Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.
文摘Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques, such as laser, afterloading radiotherapy, cryotherapy, photodynamics treatment, radiofrequency ablation and stenting, etc. The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan. This study used radial probe endobronchial ultrasound （RP-EBUS） scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall, and the influence of RP-EBUS scanning in treatment plan making and guidance. Methods This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy. We performed EBUS scanning after common bronchoscopy under local anesthesia. A radial ultrasonic probe （2.0 mm in diameter with 20-MHz frequency） with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope. The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control. The circular image of EBUS, which revealed the layered structure of the tracheobronchial wall, could be achieved. Results Total of 125 patients were enrolled in the study. Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90% （27/30）, sensitivity and specificity were 88.89% （24/27） and 100% （3/3）, respectively. In response to EBUS images, 40 approaches were altered or guided： lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration （TBNA） （n=8）; Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility （n=13）, stents size were changed （n=14）, operation was canceled （n=3） and foreign body was
文摘Background Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities. Methods We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People＇s Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out. Results Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.
文摘We are reporting 3 cases of pediatric endobronchialtumors presented with recurrent pneumonia. The median age of patients, at time of presentation, was 10.6 years. All patients presented with recurrent pneumonia with a mean time to occurrence, after onset of symptoms, of 14 mo. Bronchoscopy was early performed as part of diagnostic work-up and it revealed an endobronchial mass in every case. Complete surgical resection was performed in all cases, with lung preservation in two of them. Neither post-operative chemotherapy nor radiotherapy was required. The mean duration of follow-up was 7 years and all patients are still alive and disease-free. Recurrent pneumonia, in pediatrics, should raise the suspicion of an obstructing lesion, congenital malformation or systemic disease. A systematic approach is useful for organize the clinicians initial workup. Prompt diagnosis allows parenchymal-sparing surgery, which offers the best chance of cure and reduces clinical and functional complications in these patients.
文摘Background： Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound （CP-EBUS） has allowed for performing real-time transbronchial needle aspiration （TBNA） of enlarged hilar and mediastinal lymph nodes and therefore could also be used as a means of diagnosing proximal peribronchial lesions. Methods： We retrospectively analyzed the results related to 72 patients who underwent CP-EBUS for peribronchial lesions without endobronchial involvement and adjacent to three-grade bronchi based on chest computed tomography （CT） scan. We recorded the images during EBUS as well as the diagnostic results of TBNA and conventional-transbronchial lung biopsy/brush （C-TBLB/b）, and final diagnoses were based on pathologic analysis and follow-up. Results： In all cases, the mass was able to be identified using EBUS in 97.2% patients （70/72） who were performed with EBUS-TBNA ＋ C-TBLB/b. Sixty-six patients had a final diagnosis, 80.0% patients （56/70） had malignancies, and 14.3% patients （10/70） had benign disease. In malignancies, the diagnostic yield of C-TBLB/b was 57.1% （32/56） and in EBUS-TBNA was 85.7% （48/56）, whereas pathologic diagnosis reached 94.6% when EBUS-TBNA was combined with C-TBLB/b. C-TBLB/b ＋ EBUS-TBNA also exhibited stronger potency of histolytic diagnosis for malignancies than either EBUS-TBNA or C-TBLB/b alone. Furthermore, there are data supporting the value of EBUS-TBNA for the diagnosis of benign lung disease. Conclusion： The combined endoscopic approach with EBUS-TBNA and C-TBLB/b is an accurate and effective method for the evaluation of peribronchial lesions, with better results than using each technique alone.
文摘Background： Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods. Methods： We searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 （Nordic Cochrane Center, Copenhagen, Denmark） and Stata 12.0 software （Stata Corporation, College Station, TX, USA）. The Mantel-Haenszel method was used to calculate the pooled odds ratio （OR） and 95% confidence intervals （Cls）. Results： Sixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy （TBLB） for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 （95% CI, 2.20-15.79, P = 0.0004）. These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA ＋ TBLB ＋ endobronchial biopsy （EBB） versus TBNA ＋ TBLB ＋ EBB was 1.54 （95% C1, 0.61-3.93, P = 0.36）, implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables. Conclusions： The results of this meta-analysis suggest that EBUS-TBNA ＋ TBLB ＋ EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA ＋ TBLB ＋ EBB could be used instead.
文摘INTRODUCTIONCryptogenic organizing pneumonia （COP） is a distinct type of idiopathic interstitial pneumonia with a response rate of 65 85% on corticosteroid therapy. The difficulty of COP diagnosis is that the clinical features and the radiological findings are nonspecific. The pathological hallmark of organizing pneumonia （OP） needs to be confirmed. It can also occur in a variety of other interstitial pneumonia, infectious diseases, vasculitis, and so on. To increase the pathological reliability, larger and more tissue samples are required. According to the current classification of interstitial lung disease and guidelines, the surgical lung biopsy is recommended and is considered to be the best way of obtaining a representative lung specimen However, the invasive diagnostic procedures require general anesthesia and also increase the morbidity and mortality risks; therefore, only few patients undergo such biopsy. Thus, safer and more acceptable methods for identifying COP are urgently needed.
文摘Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway. Methods From September 2009 to March 2013, 66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA. Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a surgical procedure. ResuLts Among the 66 cases, 59 were confirmed as pulmonary malignancies by EBUS-TBNA, of which 48 cases were non-small cell lung cancer, nine were small cell lung cancer, and two were metastatic lung tumors. No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases. Thoracoscopy or thoracotomy was subsequently undergone for them. Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung, one case of lymphoma, two cases of sclerosing hemangioma, and one case of pulmonary tuberculoma. The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%, 100.0%, and 93.9%, respectively. The positive and negative predictive values were 100.0% and 42.9%, respectively. The EBUS-TBNA procedures were well-tolerated by all patients. No associated complications were observed. Conclusions For intrapulmonary lesions near the central airway highly suspected of cancer, EBUS-TBNA has satisfactory diagnostic value. However, the negative predictive value of this technique is low, so negative results obtained by EBUSTBNA should be confirmed by other methods.
文摘Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA）.Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed.Of these,there were 14 males and 6 females （mean age of 59.1 years） with SVCS who received EBUS-TBNA that were included in the analysis.Results The mean short axis diameter of the paratracheal lesions was （3.32±1.79） cm （range,1.69 to 9.50 cm） and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of （2.14±0.49） cm （range,1.73 to 3.01 cm）.An average of 4.3 punctures was performed per lesion.Malignancy was confirmed in 16 cases （10 small cell carcinomas,4 adenocarcinomas,1 squamous cell carcinoma and 1 Hodgkin lymphoma）.In two patients,pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up.One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC.One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin＇s lymphoma.The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.
文摘Endobronchial tuberculosis （EBTB） is an infectious disease occurring in the trachea or the bronchus with microbiological and histological evidences of tuberculosis. It is assumed a specific form or complication of tuberculosis. EBTB is combined in 10% to 40% of patients with active pulmonary tuberculosis.
文摘BACKGROUND Endobronchial metastases(EBMs)are tumours that metastasise from a malignant tumour outside the lungs to the central and subsegmental bronchi,and are visible under a bronchofibrescope.Most EBMs are formed by direct invasion or metastasis of intrathoracic malignant tumours,such as lung cancer,oesophageal cancer or mediastinum tumours.Renal cell carcinoma(RCC),accounting for 2%to 3%of all tumours,is a common malignant tumour of the urinary system.Renal clear cell carcinoma(RCCC)constitutes the predominant pathological subtype of RCC,comprising approximately 70%to 80%of all RCC cases.RCCC can spread and metastasise through arterial,venous and lymphatic circulation to almost all organs of the body.Moreover,lung,bone,liver,brain and local recurrence are the most common metastatic neoplasms of RCCC.However,EBM from RCCC has a low complication rate and is often misdiagnosed as primary lung cancer.CASE SUMMARY A 71-year-old male patient who had undergone radical left nephrectomy 7 years prior due to RCCC was referred to our hospital due to a 1-mo history of productive cough.The results of an enhanced chest CT scan indicated the presence of a soft tissue nodule in the upper lobe of the left lung,and flexible bronchoscopy revealed a hypervascular lesion in the bronchus of the left lung's superior lobe.Therefore,the patient underwent thoracoscopic left superior lobe wedge resection,and pathology confirmed EBM from the RCCC.CONCLUSION EBM from RCCC has a low incidence and no characteristic clinical manifestations in the early stage.If a bronchial tumour is found in a patient with RCCC,the possibility of bronchial metastatic cancer should be considered.
