Transbronchoscopic Biopsy Research Articles

Flexible Biopsy Robot with Force Sensing for Deep Lung Examination

Lung disease has become a leading cause of disease‐related death, making it one of the most serious health problems in the world. Due to the advantages of fast postoperative recovery and small trauma, transbronchoscopic biopsy has become the main method for the diagnosis of lung diseases. However, limited by the large outer diameter of the bronchoscope, insufficient flexibility of the biopsy needle, and lack of force sensing, traditional biopsy operation is simple and rough, and it is difficult to enter the deep narrow areas of the lung for examination. In this article, a flexible biopsy robot with force‐sensing ability is proposed. The robot is composed of a tendon‐actuated catheter and an inner sliding flexible needle as well as their driving systems. The experimental results demonstrate that the robot has good positioning accuracy of 0.72 mm and high flexibility and repeatability. With the cooperation of the commercial bronchoscope, the robot can reach various narrow areas of the lung to perform biopsy operations. The proposed robot has the potential to improve the diagnosis rate of lung diseases and reduce related deaths.

Metastatic lung tumor from hepatocellular carcinoma with tumor thrombus invasion in the pulmonary vein: a case report

BackgroundMetastatic lung tumor with a tumor thrombus in the peripheral pulmonary vein is very rare. We present a case of a metastatic lung tumor from hepatocellular carcinoma (HCC) with tumor thrombus invasion in the pulmonary vein that was diagnosed preoperatively and underwent complete resection by segmentectomy.Case presentationA 77-year-old man underwent laparoscopic lateral segment hepatectomy for HCC eight years ago. Protein induced by vitamin K absence or antagonist-II remained elevated from two years ago. Contrast-enhanced chest computed-tomography (CT) showed a 27 mm nodule in the right apical segment (S1). He was pathologically diagnosed with a metastatic lung tumor from HCC via transbronchoscopic biopsy. We planned to perform right S1 segmentectomy. Before surgery, contrast-enhanced CT in the pulmonary vessels phase for three-dimensional reconstruction showed that the tumor extended into the adjusting peripheral pulmonary vein, and we diagnosed tumor thrombus invasion in V1a. The surgery was conducted under 3-port video-assisted thoracic surgery. First, V1 was ligated and cut. A1 and B1 were cut. The intersegmental plane was cut with mechanical staplers. Pathological examination revealed moderately-differentiated metastatic HCC with tumor thrombus invasions in many pulmonary veins, including V1a. No additional postoperative treatments were performed.ConclusionsAs malignant tumors tend to develop a tumor thrombus in the primary tumor, it might be necessary to perform contrast-enhanced CT in the pulmonary vessel phase to check for a tumor thrombus before the operation for metastatic lung tumors.

Transbronchoscopic patient biopsy-derived xenografts as a preclinical model to explore chemorefractory-associated pathways and biomarkers for small-cell lung cancer

Insufficient tumor tissue is a major barrier for cancer biology research in small-cell lung cancer (SCLC) and has driven the development of patient-derived xenografts (PDXs) from biopsy tumor tissues. Here, we utilized transbronchoscopic biopsy specimens from SCLC tumors to establish PDXs and evaluated the genomic profile using next-generation sequencing and an RNA sequencing platform. The PDX establishment rate was 54.1% (40/74). PDXs largely recapitulated the major characteristics of their corresponding primary tumors, such as histopathology, genetic profile, and chemo-responsiveness. Compared with chemosensitive (chemo-S) PDXs, chemorefractory (chemo-R) PDXs demonstrated significant gene aberrances in the mitogen-activated protein kinase (MAPK) pathway and a higher frequency of receptor tyrosine kinase (RTK)-related genes. Phosphorylated ERK (pERK) was associated with chemo-R status. Patients with positive pERK expression demonstrated significantly inferior progression-free survival after first-line chemotherapy compared with that of patients who were negative for pERK (p < 0.001). Collectively, transbronchoscopic biopsy SCLC PDXs can serve as a model for genomic profiling and identifying biomarkers predictive of chemo-R status. Using PDXs, RTK-related gene aberrances and pERK expression were found to be associated with chemo-R SCLC.

Eosinophilic tracheobronchitis and airway cough hypersensitivity in chronic non-productive cough.

We have shown that some patients presenting with chronic bronchodilator-resistant non-productive cough have global atopic tendency and airway cough hypersensitivity without non-specific bronchial hyperresponsiveness, abbreviated as atopic cough. The cough is successfully treated with histamine H1-antagonists and/or glucocorticoids. This prospective study was conducted to elucidate the histological feature of atopic cough. Tracheal and bronchial mucosa obtained by transbronchoscopic biopsy and bronchoalveolar lavage (BAL) cell component were studied with special emphasis on eosinophils in eight non-smokers diagnosed with atopic cough, all of whom had increased sensitivity of cough response to inhaled capsaicin, normal lung function and bronchial responsiveness to methacholine and normal chest roentgenogram. Their cough completely resolved on histamine H1-antagonists and/or glucocorticoids. Transbronchoscopic tracheal and bronchial biopsy and BAL were also performed in healthy non-smokers as a control. A small number of eosinophils was detected in subepithelium of trachea in six of seven patients and in subepithelium of bronchi in seven of eight cough patients. The numbers of eosinophils in subepithelium of trachea and bronchi were significantly increased in the patients compared with control subjects. There was no BAL eosinophilia in any patients. It is concluded that eosinophilic tracheobronchitis and cough hypersensitivity are pathological and physiological characteristics of atopic cough.

A CASE OF PAPILLARY THYROID CARCINOMA ASSOCIATED WITH SO-CALLED METASTASIZING LEIOMYOMA

So-called metastasizing leiomyoma that was first advocated by Steiner in 1939 is a tumor in both primary and metastasized lesions consisting of smooth muscle cells and areolar tissues to exhibit a benign tissue profile. It is extremely rare to be reported in Japan. In this case, we had difficulty in determining operative method, because left goiter and multiple shadow in the both lung indicated a possible metastasized thyroid carcinoma to the lung, however, preoperative transbronchoscopic biopsy of the lung provided no definite diagnosis. The lung biopsy under open-chest condition performed immediately before operation of thyroid carcinoma revealed the case of thyroid cacinoma associated with metastasizing leiomyoma. This case is interesting in inconsistency that it shows a benign morphology histologically while exhibits metastasizing lesion clinically. Excepting to the lung, the metastasis to the peritoneum, retroperitoneum, oophoron, spine, or cava has been reported, however, no report of the metastasis to the thyroid has been found as possible as we could review.

Computed-tomographic-guided minithoracotomy. A preliminary report of a new approach to open lung biopsy.

The authors describe a simple computed-tomographic method, using precise surface localization, to locate small subpleural nodules or pulmonary lesions. This permits a guided minithoracotomy for chest lesions which are not visible on plain radiographs or are considered inaccessible by percutaneous or transbronchoscopic biopsy.

Papillomas of the Tracheobronchial Tree with Malignant Degeneration

Papillomas are rare tumors of the respiratory tract, which are usually considered benign. We studied a male patient with adult onset of squamous papillomatosis involving both the trachea and the bronchi, with malignant degeneration. When we obtained specimens bronchoscopically, only the bronchial lesions showed carcinomatous changes. Thoracotomy demonstrated carcinoma in the tracheal lesion as well. We conclude that transbronchoscopic biopsy may be inadequate in the evaluation of papillomatosis. Papillomas are rare tumors of the respiratory tract, which are usually considered benign. We studied a male patient with adult onset of squamous papillomatosis involving both the trachea and the bronchi, with malignant degeneration. When we obtained specimens bronchoscopically, only the bronchial lesions showed carcinomatous changes. Thoracotomy demonstrated carcinoma in the tracheal lesion as well. We conclude that transbronchoscopic biopsy may be inadequate in the evaluation of papillomatosis.

Transbronchoscopic Lung Biopsy for Diffuse Pulmonary Diseases: Technique and Results in 450 Cases

We have described a technique of transbronchoscopic biopsy of the lung and the use of this technique in patients with diffuse diseases of the lungs. Satisfactory pulmonary tissue was obtained in 378 of 450 cases (84 percent). Pneumothorax was noted in 14 percent of the patients, and mediastinal emphysema and significant bleeding each were encountered in about 1 percent. There was one death. We have found that transbronchoscopic lung biopsy has been helpful in the diagnosis of diffuse pulmonary disease. We have described a technique of transbronchoscopic biopsy of the lung and the use of this technique in patients with diffuse diseases of the lungs. Satisfactory pulmonary tissue was obtained in 378 of 450 cases (84 percent). Pneumothorax was noted in 14 percent of the patients, and mediastinal emphysema and significant bleeding each were encountered in about 1 percent. There was one death. We have found that transbronchoscopic lung biopsy has been helpful in the diagnosis of diffuse pulmonary disease.