Endobronchial Needle Aspiration Research Articles

Squamous cell carcinoma of lung presenting as “Sunray sign” in chest radiograph

Lung cancer is usually diagnosed at a late stage due to a lack of awareness of symptoms to the patient, absence of screening trends by performing chest imaging, and lack of sensitization to the most common radiological signs of lung malignancy to family physicians. Radiological signs will help in suspecting lung cancer earliest and important role in guiding for a protocolized workup to rule out underlying malignancy. “Sunray sign” in chest radiograph is the first time described in the literature and constitutes hilar mass or radiopacity with inhomogeneous linear opacities spreading toward peripheries like sunrays which is the marker of interstitial lymphatic involvement due to the malignant spread of disease. “Sunray sign” is an indicator of underlying lung malignancy with central airway or mainstem bronchus involvement with lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year male presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-ray documented round opacity occupying left hilum with linear opacities emerging toward peripheries in lung parenchyma showing typical “Sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the left mainstem bronchus causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and forceps-guided histopathology suggestive of “squamous cell” type of lung malignancy for “Sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy and Bronchoscopy is a “gold standard” test in cases with Sunray signs to confirm the diagnosis.

Role of fiberoptic bronchoscopy-guided needle aspiration cytology (EBNA) in diagnosing lung cancer in endobronchial lesions: A single-center experience

Objectives: Globally, lung cancer is the leading cause of new cancer diagnosis and deaths. In spite of advancement in diagnostic modalities, lung cancer diagnosis is often delayed due to lack of bronchoscopy facility and techniques. In the present study, we have analyzed role of bronchoscopy in diagnosis of lung cancer with special emphasis on endobronchial needle aspiration (EBNA) cytology in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW) and forcep biopsy (FB). Material and Methods: Prospective and observational study screened 1496 cases with suspected lung malignancy on clinical and radiological basis. Bronchoscopy guided techniques such as EBNA, BW, and FB are used in exophytic endobronchial lesions (EEL) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BW and FB. Rapid on-site evaluation analysis of all EBNA samples done in pathology laboratory allied center. Finally, histopathology proven 893 lung malignancy cases are included in study. Statistical analysis is done using Chi-square test. Results: In the present study, 893 diagnosed lung cancer patients between 29 and 85 age groups; male is 60.02% (536/893) and females are 39.97% (357/893). Commoner radiological presenting features are mass lesion in 48.60% (434/893) cases, Hilar opacity in 33.37% (298/893) cases, and collapse segmental/lobar in 12.54% (112/893) cases. During bronchoscopy, anatomical location is documented on the right side of tracheobronchial in 57.33% (512/893) cases as compared to the left side of tracheobronchial wall 23.96% (214/893) and growth at carina documented in 18.70% cases (167/893) cases. Upper lobe bronchi are commoner site on both the sides as compared to other segmental bronchi. In the present study, yield of FB and FB plus BW in EEL is 84.65% (756/893) and 88.35% (789/893), respectively. Yield of EBNA, EBNA plus BW, and EBNA plus FB in EEL is 70.99% (634/893), 73.48% (656/893), and 99.66% (890/893), respectively. Overall, yield of all bronchoscopy guided techniques (EBNA + FB + BW) in our study in EEL is 100%. Additional yield of EBNA in EEL over other CDTs (CDTs such as FB plus BW) is 11.65%. Sensitivity of FB and EBNA in diagnosing lung malignancy in EEL is 84.65% and 70.99%, respectively. FB is more sensitive technique than EBNA in EEL (P < 0.00001). Sensitivity of FB plus BW in EEL is 88.35% (789/893). Sensitivity of EBNA plus BW in EEL is 73.48% (656/893). Sensitivity of EBNA plus FB in EEL is 99.66% (890/893) (P < 0.00001). Conclusion: EBNA has documented very crucial role in diagnosing lung cancer in comparison to other CDTs. Although FB is more sensitive test then EBNA in EEL in diagnosing disease, we have documented that EBNA has significant additive yield in proportionate number of cases. EBNA is safe, sensitive and cytology samples can give comparable results to histopathology.

“Bulging fissure sign” on chest radiograph: Strong predictor of central airway malignancy

A bulging fissure sign in a chest radiograph is usually associated with right upper lobe lung collapse with horizontal fissural effusion or collection. Etiology and pathophysiology traced to infective and noninfective causes. Commonly bulging fissure sign is described with lung malignancy in old age. Infective etiologies are infective types in children and adults with comorbid conditions. In this case report, we have reported a 54-year-old male presented with cough and hemoptysis with progressive worsening of shortness of breath. Clinically tubular breath sounds in the right infraclavicular region with egophony were heard. Chest X-ray documented right lung consolidation or mass lesion with bulging fissures. Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right mainstem bronchus causing near-complete occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and forceps-guided (forcep biopsy) histopathology suggestive of “squamous cell” type of lung malignancy for bulging fissure sign in our case. A high index of suspicion is must to rule out underlying malignancy and bronchoscopy is “gold-standard” test in cases with bulging fissure sign to confirm a diagnosis.

Role of endobronchial needle aspiration during bronchoscopy in exophytic endobronchial lesions: A single-center experience of 810 cases in tertiary care setting

Role of endobronchial needle aspiration during bronchoscopy in exophytic endobronchial lesions: A single-center experience of 810 cases in tertiary care setting

Retraction: Role of endobronchial needle aspiration during bronchoscopy in exophytic endobronchial lesions: A single-center experience of 810 cases in tertiary care setting

Retraction: Role of endobronchial needle aspiration during bronchoscopy in exophytic endobronchial lesions: A single-center experience of 810 cases in tertiary care setting

Case report: Small cell lung cancer presenting as the “sunray sign” in the chest radiograph and recurrent hemoptysis

Lung cancer prognosis has not changed in the last few decades due to diagnosis at an advanced stage. The majority of cases with early disease are asymptomatic, and whenever clinical presentations with cough, dyspnea, hemoptysis, or chest pain occur, when these cases have progressed to an advanced stage. Lung cancer tops the list of all causes of cancer-related deaths globally and is ahead of digestive tract malignancies. Small-cell lung cancer (SCLC) has the worst outcome, with survival rates in the range of weeks to months from diagnosis. SCLC is usually manifested as an extensive disease due to its delayed presentation, early metastasis, systemic nature, and poor response to available treatment options. “sunray sign” in chest radiographs is first described in literature and constitutes a hilar mass or radiopacity with inhomogeneous linear opacities spreading toward the periphery like sunrays, which is a marker of interstitial lymphatic involvement due to malignant spread of disease. The “sunray sign” is an indicator of underlying lung malignancy with central airway or main stem bronchus involvement and lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year-old male who presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-rays documented round opacities occupying the right hilum with linear opacities emerging toward the periphery in lung parenchyma, showing the typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right main stem bronchus, causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration (EBNA) cytology and forceps-guided (FB) histopathology are suggestive of “small cell histological type” lung malignancy for the “sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy, and bronchoscopy is the “gold standard” test in cases with the sunray sign to confirm the diagnosis.

Role of Endobronchial Needle Aspiration Cytology in Diagnosing Lung Cancer in Bronchoscopically Visible Tumors

Introduction: Bronchoscopy is an important diagnostic tool for the diagnosis of lung cancer, and various techniques have documented increase in diagnostic sensitivity. In this study, we have analyzed the role of bronchoscopy in diagnosis of lung cancer with special emphasis on endobronchial needle aspiration cytology (EBNA) in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW) and forcep biopsy (FB). Materials and Methods: Prospective, observational study screened 1564 cases with suspected lung malignancy on clinical and radiological basis. Bronchoscopy-guided techniques such as EBNA, BW, and FB are used in exophytic endobronchial lesions (EELs) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BW and FB. Rapid onsite evaluation (ROSE) analysis of all EBNA samples done in pathology lab allied center. Finally, histopathology proven 917 lung malignancy cases are included in this study. Statistical analysis is done by using chi-test. Results: In this study, 917 diagnosed lung cancer patients between 29 and 85 age group predominant 61.83% (567/917) and smokers by addiction in 52.12% (478/917) cases. Presented with cough in 80.80% (741/917), clubbing in 55.83% (512/917) cases, and mass lesion in chest radiograph in 53.10% (487/917) cases. Anatomical location is documented on the right side of tracheobronchial in 58.66% (538/917) cases during bronchoscopy. Yield of FB and FB plus BW in EEL is 86.69% (795/917) and 90.94% (834/917), respectively. Yield of EBNA, EBNA plus BW, and EBNA plus FB in EEL is 70.22% (644/917), 75.13% (689/917), and 97.16% (891/917), respectively. Overall yield of all bronchoscopy-guided techniques (EBNA + FB + BW) in our study in EEL is 100%. Additional yield of EBNA in EEL over other CDTs (FB plus BW) is 9.06%. Sensitivity of FB and EBNA in diagnosing lung malignancy in EEL is 86.69% and 70.22%, respectively. FB is more sensitive technique than EBNA in EEL (P < 0.00001). Sensitivity of FB plus BW in EEL is 90.94% (834/917). Sensitivity of EBNA plus BW in EEL is 75.13% (689/917). Sensitivity of EBNA plus FB in EEL is 97.16% (891/917) (P < 0.00001). Conclusion: EBNA is underutilized bronchoscopic technique in visible endobronchial lesions (exophytic endobronchial type) in spite of satisfactory diagnostic yield as compared with other CDTs. Although FB is most commonly preferred technique in bronchoscopically visible tumors, the addition of EBNA has improved overall diagnostic yield of bronchoscopy and decreased need for repeat bronchoscopy procedure.

Is there any contribution of bronchial washing to biopsy in the diagnosis of patients with endobronchial pathology in the era of personalized medicine?

Bronchoscopic biopsies and bronchial washings (BW) are commonly used together for the diagnosis of centrally located tumors. This study aimed to investigate the clinical relevance of routinely collecting BWs in patients who simultaneously had biopsies for visible endobronchial lesions in the current molecular analysis-driven personalized medicine era. We retrospectively reviewed the patients who underwent fiberoptic bronchoscopy (FOB) between October 2011 and December 2016. Patients who had both BW and biopsy specimens (EBB: endobronchial forceps biopsy and/or EBNA: endobronchial needle aspiration biopsy) for visible endobronchial lesions were included in this study. Demographic and clinical data, macroscopic findings during FOB, pathology results, and final diagnoses were collected from the hospital database. The study included 269 patients (220 males/49 females) with a mean age of 61.6 ± 10.6 years. While the overall diagnostic yield of FOB was 71.4%, the diagnostic yields of bronchoscopic procedures were 68.2% for EBB, 83.3% for EBNA, and 19.7% for BW. Only three patients (1.1%) with undiagnostic biopsies had positive BW cytology revealing merely malignant epithelial cells. BW provided a negligible diagnostic contribution in 1.1% (n= 3) of the patients. These three patients had undergone further diagnostic procedures for making a proper therapeutic management plan. In the era of personalized therapy, it is logical to obtain more biopsy in the time spent for BWs.

Case of Endobronchial Needle Aspiration in A Patient With A False COPD Diagnosis

Respiratory foreign body aspiration is a critical condition. Foreign body aspirations can be fatal or can rarely be silent. Our case, a 44-year-old female patient diagnosed as COPD at another clinic due to complaints cough and shortness of breath, applied to our service with cough, sputum and shortness of breath. The chest X-ray showed a homogeneous opacity in the lower right section. The foreign body taken out by flexible bronchoscopy and forceps was a needle. It should be noted that foreign body aspiration in adult patients may mimic diseases which cause airway obstruction.

Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series

BackgroundSignificant bleeding may occur following endobronchial forceps biopsy or brushing of necrotic or hypervascular tumors in the airways. In some cases, methods such as endobronchial instillation of iced saline lavage and epinephrine may fail to control bleeding. The present study evaluated the efficacy and safety of a new bronchoscopic technique using intratumoral injection of tranexamic acid (IIT) for control of bleeding during forceps biopsy in patients with endobronchial tumors with a high risk of bleeding.MethodsThe study was a prospective case series carried out in a single center. Bronchoscopic IIT was performed in those patients who had endoscopically visible tumoral lesions with persistent active bleeding following the first attempt at bronchoscopic sampling. Tranexamic acid (TEA) was injected through a 22-gauge Wang cytology needle into the lesion in nominal doses of 250–500 mg. After 2–3 minutes, multiple forceps biopsy specimens were obtained from the lesion.ResultsOf the 57 consecutive patients included in the study, 20 patients (35.1%) underwent bronchoscopic IIT. The first attempt in 18 patients was endobronchial forceps biopsy (EBB), and because of a high risk of bleeding, the first attempt for the remaining two patients, who were on continuous dual antiplatelet therapy (aspirin and clopidogrel), employed endobronchial needle aspiration (EBNA) as a precautionary measure. Following IIT, subsequent specimens were obtained using EBB in all patients. Multiple forceps biopsy specimens (3–10) were obtained from the lesions (8 necrotic and 12 hypervascular) without incurring active bleeding. The following histopathologic diagnoses were made: squamous cell carcinoma (n = 14), adenocarcinoma (n = 2), small-cell lung cancer (n = 3), and malignant mesenchymal tumor (n = 1). No side effects of TEA were observed.ConclusionsBronchoscopic IIT is a useful and safe technique for controlling significant bleeding from a forceps biopsy procedure and can be considered as a pre-biopsy injection for lesions with a high risk of bleeding.Trial registrationISRCTN23323895

Rapid On-Site Evaluation Improves Needle Aspiration Sensitivity in the Diagnosis of Central Lung Cancers: A Randomized Trial

Background: Few prospective studies have evaluated the role of endobronchial needle aspiration in diagnosing central airways neoplasms. Rapid on-site evaluation has long been used in transbronchial needle aspiration of adenopathies and peripheral lesions, but its role in sampling central malignancies has not been substantiated yet. Objectives: In this study we evaluated if endobronchial needle aspiration may increase the sensitivity of bronchoscopy for diagnosing central airways neoplasms when added to conventional diagnostic methods (forceps biopsy, brushing and bronchial washing), and if rapid on-site evaluation may be beneficial in patients undergoing endobronchial needle aspiration. Methods: 125 patients (77% males, aged 70 ± 7 years; mean ± SD) with central lung cancers were randomized to undergo bronchoscopy including conventional diagnostic methods and needle aspiration, with or without rapid on-site evaluation, stratifying the patients on the basis of the neoplasm growth pattern (exophytic and submucosal/peribronchial disease). Results: Needle aspiration significantly increased the sensitivity of bronchoscopy when added to conventional methods (from 76 to 91%; p < 0.001), primarily resulting from differences in submucosal/peribronchial diseases (68 vs. 90%; p < 0.001) and independently from the presence of rapid on-site evaluation; needle aspiration guided by rapid on-site evaluation guaranteed a higher improvement in bronchoscopy sensitivity than conventional needle aspiration (98 vs. 84%, respectively; p = 0.004). Needle aspiration guided by rapid on-site evaluation showed a significantly higher sensitivity than the conventional method (97 vs. 76%, respectively; p = 0.001). Conclusions: Needle aspiration increases the sensitivity of bronchoscopy in diagnosing central airways malignancies when added to conventional diagnostic methods, with a further significant improvement when guided by rapid on-site evaluation.

Cost minimization analysis for combinations of sampling techniques in bronchoscopy of endobronchial lesions

The choice of sampling techniques in bronchoscopy with sampling from a visible lesion will depend on the expected diagnostic yields and the costs of the sampling techniques. The aim of this study was to determine the most economical combination of sampling techniques when approaching endobronchial visible lesions. A cost minimization analysis was performed. All bronchoscopies from 2003 and 2004 at Haukeland university hospital, Bergen, Norway, were reviewed retrospectively for diagnostic yields. 162 patients with endobronchial disease were included. Potential sampling techniques used were biopsy, brushing, endobronchial needle aspiration (EBNA) and washings. Costs were estimated based on registration of equipment costs and personnel costs. Sensitivity analyses were performed to determine threshold values. The combination of biopsy, brushing and EBNA was the most economical strategy with an average cost of Euro 893 (95% CI: 657, 1336). The cost of brushing had to be below Euro 83 and it had to increase the diagnostic yield more than 2.2%, for biopsy and brushing to be more economical than biopsy alone. The combination of biopsy, brushing and EBNA was more economical than biopsy and brushing when the cost of EBNA was below Euro 205 and the increase in diagnostic yield was above 5.2%. In the current study setting, biopsy, brushing and EBNA was the most economical combination of sampling techniques for endobronchial visible lesions.

Bronchoscopic needle aspiration biopsy.

Bronchoscopic needle aspiration biopsy, which encompasses transbronchial needle aspiration, transtracheal needle aspiration, and endobronchial needle aspiration, is a minimally invasive technique used to diagnose mediastinal and pulmonary masses and to stage lung cancer patients with mediastinal lymphadenopathy. Since it is safe, accurate, and potentially cost-efficient, its use may increase in the coming years. It is important that pathologists who examine cytology specimens understand this procedure, its limitations, and ways that it may be optimized.

Endobronchial Needle Aspiration in the Diagnosis of Small-Cell Carcinoma

Endobronchial biopsy specimens of small-cell carcinoma often exhibit extensive crush artifact that precludes definitive diagnosis. Occasionally, cytologic study from the brushings and washings is also nondiagnostic, contributing to the frustration of the bronchoscopist. We reviewed our experience with this problem over the past 4 years. We identified five cases in which an endobronchial needle aspirate proved critical in establishing the diagnosis of small-cell carcinoma. We believe endobronchial needle aspiration is a valuable adjunct in the diagnosis of endobronchial small-cell carcinoma.