Bronchoscopy For Lung Cancer Research Articles

Equity of access to pathological diagnosis and bronchoscopy for lung cancer in Aotearoa New Zealand.

Māori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services. We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.g., histology, cytology), receipt of bronchoscopy and travel distance and time to access bronchoscopy. We found no differences in access to a pathological diagnosis between ethnic groups regardless of cancer type or stage. We found that Māori within the cohort were marginally more likely to access bronchoscopy than the majority European group; however, we also found that Māori had lower odds of living close to the location of their bronchoscopy, and correspondingly higher odds of living 100-200km (adjusted odds ratio [adj. OR] 1.46, 95% confidence interval [CI] 1.26-1.69) or more than 200km away (1.36, 95% CI 1.15-1.61) than Europeans. Interventions that aim to further support Māori to overcome the systematic and cumulative disadvantages in access to cancer care should be broadly supported and resourced.

Up-to-date in Bronchoscopy for Lung Cancer

Up-to-date in Bronchoscopy for Lung Cancer

Diagnostic Performance of Bronchoscopy in Lung Cancer and/or Pulmonary Metastasis: A Real Aspect of our Country

Objective: To evaluate the diagnostic performance of different bronchoscopic sampling techniques in patients with suspected lung cancer and/or pulmonary metastasis at the General Hospital of Mexico, a center without access to endobronchial ultrasound (EBUS).

Diagnostic performance of rapid on‐site evaluation during bronchoscopy for lung cancer: A comprehensive meta‐analysis

AbstractBackgroundLung cancer is the leading cause of cancer‐related mortality worldwide. Screening high‐risk populations for lung cancer with low‐dose computed tomography (LDCT) reduces lung cancer mortality. Bronchoscopy is a diagnostic procedure used to monitor patients suspected of having lung cancer after LDCT. Rapid on‐site evaluation (ROSE) can improve the diagnostic accuracy of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS‐TBNA), although its diagnostic value remains unclear. In this meta‐analysis, the authors evaluated the diagnostic accuracy of ROSE during bronchoscopy.MethodsThe PubMed, Embase, and Cochrane Library databases were searched for studies evaluating the diagnostic accuracy of ROSE for lung cancer during bronchoscopy. Studies evaluating the performance of ROSE and articles providing sufficient data for constructing a 2 × 2 table on a per‐lesion basis were included. A meta‐analysis was conducted using a bivariate random‐effects model.ResultsIn total, 32 studies involving 8243 lung lesions were included with a pooled sensitivity of 91.8% and a pooled specificity of 94.9%. Subgroup analysis of 12 studies involving 2929 specimens from patients who underwent computed tomography revealed a pooled sensitivity of 93.8% and a pooled specificity of 96%. Further subgroup analysis of seven studies on the diagnostic outcomes of ROSE for intrathoracic or mediastinal lymph nodes through EBUS‐TBNA for lung cancer staging revealed a pooled sensitivity of 90.1% and a pooled specificity of 96.9%.ConclusionsROSE exhibited high sensitivity and specificity for diagnosing lung cancer during bronchoscopy. It also exhibited high sensitivity in detecting lung cancer in patients undergoing LDCT and higher specificity for nodal staging with EBUS‐TBNA.

Understanding the Landscape of Bronchoscopy in Lung Cancer: Insights From Lesion Location, Gender, and Diagnostic Efficacy.

Lung cancer constitutes a critical global health concern. According to the International Agency for Research on Cancer's (IARC) GLOBOCAN 2020 estimates, lung canceris the leading cause of death in cancer patients. In areas where tuberculosis is prevalent, misdiagnosis and mistreatment frequently result from overlap, creating significant difficulties that delay diagnosis and treatment. Amid this complication, bronchoscopic techniques emerge as critical diagnostic tools, though their efficacy varies between studies. Our retrospective study, conducted from July 2021 to December 2022at the Department of Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, examined 156 participants withmalignancies. Our focus encompassed diverse lesions within the bronchial landscape, revealing intriguing findings. Bronchoscopic examinations unravelled prevalent abnormalities: 52 (33.3%) manifested as intraluminal growth, 48 (31.6%) as mucosal irregularities, and a less frequent (16, 10.3%) as an intraluminal bulge. Transbronchial needle aspiration stood out with a 10/11 (91%) positivity rate, biopsy came in second at 38/46 (83%), and bronchoalveolar lavage showed a 44/152 (29%) positivity rate.It was interesting to see how the lesions were spread out among the different types of histology. For example, squamous cell carcinoma showed 17/37 (46%) intraluminal growth, while adenocarcinoma showed 22/60 (36.7%) intraluminal growth and 4/60 (6.7%) intraluminal bulge. Moreover, a significant absence of abnormalities was observed in various lesions, underlining the intricacies of characterising bronchial lesions. Our study shows that direct tissue sampling is better and that new bronchoscopic technologies are important for diagnosing lesions that were hard to get to in the past. However, limitations in patient selection biases and the single-centre focus caution against generalised interpretations. Our research illuminates the pivotal role of bronchoscopic methods in diagnosing lung lesions, emphasising the necessity for continued advancements to enhance diagnostic accuracy and treatment efficacy in lung cancer subtypes.

ERS International Congress 2023: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly.

The Clinical Techniques, Imaging and Endoscopy Assembly is involved in the diagnosis and treatment of several pulmonary diseases, as demonstrated at the 2023 European Respiratory Society (ERS) International Congress in Milan, Italy. From interventional pulmonology, the congress included several exciting results for the use of bronchoscopy in lung cancer, including augmented fluoroscopy, robotic-assisted bronchoscopy and cryobiopsies. In obstructive lung disease, the latest results on bronchoscopic treatment of emphysema with hyperinflation and chronic bronchitis were presented. Research on using cryobiopsies to diagnose interstitial lung disease was further explored, with the aims of elevating diagnostic yield and minimising risk. For imaging, the latest updates in using artificial intelligence to overcome the increased workload of radiologists were of great interest. Novel imaging in sarcoidosis explored the use of magnetic resonance imaging, photon-counting computed tomography and positron emission tomography/computed tomography in the diagnostic work-up. Lung cancer screening is still a hot topic and new results were presented regarding incorporation of biomarkers, identifying knowledge gaps and improving screening programmes. The use of ultrasound in respiratory medicine is an expanding field, which was demonstrated by the large variety in studies presented at the 2023 ERS Congress. Ultrasound of the diaphragm in patients with amyotrophic lateral sclerosis and myasthenia gravis was used to assess movements and predict respiratory fatigue. Furthermore, studies using ultrasound to diagnose or monitor pulmonary disease were presented. The congress also included studies regarding the training and assessment of competencies as an important part of implementing ultrasound in clinical practice.

PCDHGA12 methylation biomarker in bronchial washing specimens as an adjunctive diagnostic tool to bronchoscopy in lung cancer.

The use of bronchoscopy is central to the diagnosis of lung cancer. However, the sensitivity of bronchoscopy is low. In addition, bronchial washing cytology, which is a routine adjunctive test, does not significantly improve the performance of bronchoscopy owing to its low sensitivity. To enhance the diagnostic performance of bronchoscopy, the protocadherin GA12 (PCDHGA12) methylation biomarker in bronchial washings was introduced as a novel adjunctive diagnostic test. A total of 98 patients who underwent bronchoscopy owing to suspicion of lung cancer were analyzed. Cytological examination and PCDHGA12 methylation biomarker testing of the bronchial washing fluid were performed. The performance of the tests was analyzed. The final diagnosis in 60 patients was lung cancer and in 38 patients was benign disease. The PCDHGA12 methylation biomarker had a sensitivity of 75.0%, a specificity of 78.9% and a positive predictive value (PPV) of 84.9%, whereas cytological assessment had a sensitivity of 45.0%, a specificity of 92.1% and a PPV of 90%. Patients with positive PCDHGA12 methylation test had an odds ratio for lung cancer of 11.25 (confidence interval, 4.25-29.8) compared with negative subjects. The combination of the two tests exhibited an increased sensitivity (83.3%), a specificity of 71.1% and a PPV of 82.0%. Furthermore, considering the non-diagnostic bronchoscopy group alone, the test demonstrated a sensitivity of 61.9% and a specificity of 78.9%. The results of the present study demonstrated that PCDHGA12 methylation, as a lung cancer biomarker in bronchial washings, may be a used as an adjunctive test to bronchoscopy.

Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer?

PURPOSE:The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure.METHODS:Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann–Whitney U-test. In all tests, P < 0.05 was considered significant.FINDINGS:A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016).CONCLUSION:We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion.

Prognostic Factors Associated With Interventional Bronchoscopy in Lung Cancer

Interventional bronchoscopy is an effective procedure for malignant central airway obstruction, although its indications are poorly defined and its benefits difficult to predict. The purpose of the study was to identify the patients' or the disease's characteristics that are correlated with survival to enable clinicians to identify the best indications. We retrospectively studied the data from 204 patients treated between 2004 and 2010. We analyzed survival times according to the patients' or disease's characteristics, and identified homogeneous risks using classification and regression trees. Reduced survival was associated with a high American Society of Anesthesiologists score (13, 5.9, and 2.9 months for scores of 2, 3, and 4, respectively; p = 0.0005), nonsquamous cell histology (median survival, 6.3 months; p = 0.007), metastatic tumors (9.2 and 6.2 months for stage IIIA and IIIB, respectively, versus 3 months for stage IV; p = 0.0002), and for patients who had not received a specific treatment (median survival, 8.6 versus 3.2 months for untreated patients; p < 0.0001). Classification and regression trees segmentation identified five distinct groups of patients. Patients receiving a specific treatment for squamous cell carcinoma derived the best survival (median, 13 months; p < 0.0001), whereas patients with an American Society of Anesthesiologists score of 4 treated for large cell cancer or adenocarcinoma and metastatic patients who did not receive any specific treatment had the worst survival (0.8 months and 2.7 months, respectively; p < 0.0001). Interventional bronchoscopy is a safe and effective procedure that should be integrated into a multimodal therapy for selected patients.

Fiberoptic Bronchoscopy in Lung Cancer: Gender, Histologic Type and Localization

Fiberoptic Bronchoscopy in Lung Cancer: Gender, Histologic Type and Localization

Fiberoptic Bronchoscopy in Lung Cancer: Gender, Histologic Type and Localization

Fiberoptic Bronchoscopy in Lung Cancer: Gender, Histologic Type and Localization

Bronchial Airway Gene-Expression Testing Improves the Diagnostic Yield of Bronchoscopy for Lung Cancer: Results of the AEGIS Trial

Bronchial Airway Gene-Expression Testing Improves the Diagnostic Yield of Bronchoscopy for Lung Cancer: Results of the AEGIS Trial

Advances in bronchoscopy for lung cancer

Bronchoscopic techniques have seen significant advances in the last decade. The development and refinement of different types of endobronchial ultrasound and navigation systems have led to improved diagnostic yield and lung cancer staging capabilities. The complication rate of these minimally invasive procedures is extremely low as compared to traditional transthoracic needle biopsy and surgical sampling. These advances augment the safe array of methods utilized in the work up and management algorithms of lung cancer.

Bronchoskopische Therapieverfahren beim Lungenkarzinom

Stenosis of central airways or hemoptysis are classical indications for interventional bronchoscopy in lung cancer. In the case of endoluminal tumor growth cryo-, laser- or brachytherapy are widely used. In the case of airway stenosis due to compression by extraluminal tumor masses balloon-dilatation and/or stenting and - with delayed effect - brachytherapy are first-choice therapies. Carcinoma in situ and early stage tumors can be treated curatively with brachytherapy or photodynamic therapy. Recently introduced bronchoscopic techniques like electro-magnetic navigation may result in new curative options for peripheral lung tumors.

Bronchoscopy for lung cancer: why bin the brush?

Bronchoscopy for lung cancer: why bin the brush?

Role of Bronchoscopy in Lung Cancer

Advancements in technology and experience have pushed forth the bronchoscope's increasing role in the struggle against lung cancer. The bronchoscope is useful in the following situations: diagnosis, staging, treatment of endobronchial lesions for palliation or cure, early detection of lung cancer, and research. In this article, we provide a concise overview of several endoscopic modalities (i.e., transbronchial needle aspiration, laser photoresection, photodynamic therapy, electrocautery, cryotherapy, brachytherapy, stents, autofluorescence bronchoscopy, and gene therapy). Basic principles, technique, indications, outcome data, and associated complications of each modality are discussed.

Routine Culture for Tuberculosis During Bronchoscopy for Lung Cancer is Not Warranted

Routine Culture for Tuberculosis During Bronchoscopy for Lung Cancer is Not Warranted

FUTURE OF FLEXIBLE BRONCHOSCOPY

Despite some potential "threats" (Table 3), the future of bronchoscopy is likely full with ever expanding applications in clinical medicine and research (Tables 1 and 2). The role of bronchoscopy in lung cancer continues to expand and the usefulness of newer techniques needs to be established. The role of FB is also ever expanding in the immuno compromised host and critically ill patients. Future studies, however, should concentrate on patient outcome, especially survival and performance status. Therapeutic bronchoscopy has been extended to many areas and the emphasis of future research will likely continue to be at the molecular level rather than on studies of better instruments for retrieval purposes. The most exciting developments are likely to be in the field of gene therapy, which has made remarkable progress in the past decade. Gene therapy can be a powerful technology, but several hurdles must be overcome to make gene therapy a reality for treating human disease in the future. As the cost of technology continues to challenge health care delivery systems, a major challenge for the future of bronchoscopy is to evaluate new technologies and applications based on their impact on patient outcome, survival, and management of cost.

A phase 1 study, in cystic fibrosis patients, of the safety, toxicity, and biological efficacy of a single administration of a replication deficient, recombinant adenovirus carrying the cDNA of the normal cystic fibrosis transmembrane conductance regulator gene in the lung.

A phase 1 study, in cystic fibrosis patients, of the safety, toxicity, and biological efficacy of a single administration of a replication deficient, recombinant adenovirus carrying the cDNA of the normal cystic fibrosis transmembrane conductance regulator gene in the lung.

The role of bronchoscopy in lung cancer : Arroliga AC, Matthay RA. Pulmonary and Critical Care Section, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510. Clin Chest Med 1993;14:87–98

The role of bronchoscopy in lung cancer : Arroliga AC, Matthay RA. Pulmonary and Critical Care Section, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510. Clin Chest Med 1993;14:87–98