White Light Bronchoscopy Research Articles

Utility of auto fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions

BackgroundBronchoscopy is currently the most common technique for lung cancer diagnosis. Patients suspected of malignancy often undergo bronchoscopic examination, and biopsy is routinely used in patients with visible bronchial lesions. However, it is difficult to differentially diagnose lung cancer in patients with bronchial mucosal lesions. Thus, this study was conducted to investigate the utility of fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions. MethodsWe conducted a retrospective study in a single screening center to assess the sensitivity and specificity of fluorescence-guided biopsy compared with white light bronchoscopy (WLB) in patients with bronchial mucosal lesions. ResultsA total of 301 patients with bronchial mucosal lesions were enrolled in this study. The sensitivity for patients with fluorescence-guided biopsy was 60.3 % (95 % confidence interval [CI]: 53.1 %–67.1 %), which was higher than that of patients with WLB alone (45.2 %, 95 % CI: 38.2–52.4 %) (P = 0.0026). Additionally, compared with the WLB group, the fluorescence -guided biopsy group was found to have a significantly higher specificity (100 %, 95 % CI: 95.5–100 % versus 69.6 %, 95 % CI: 59.6–78.1 %), positive predictive value (100 %, 95 % CI: 96.1–100 % versus 74.3 %, 95 % CI: 65.5–81.7 %) and negative predictive value (56.3 %, 95 % CI: 48.8–63.6 % versus 39.4 %, 95 % CI: 32.3–47.0 %). ConclusionFluorescence-guided biopsy can serve as an important adjunct to WLB for the differential diagnosis of lung cancer in patients with bronchial mucosal lesions.

Utility of Narrow-band Imaging Bronchoscopy in the Diagnosis of Endobronchial Sarcoidosis.

There are few reports on the utility of bronchoscopic narrow-band imaging (NBI) for visualizing endobronchial abnormalities in sarcoidosis. Our primary objective was to compare the sensitivity of finding endobronchial abnormality using NBI versus white light bronchoscopy (WLB) in patients with sarcoidosis. The secondary aim was to evaluate the sensitivity of NBI in diagnosing endobronchial sarcoidosis against a reference standard of positive endobronchial biopsy (EBB). We retrospectively included subjects with sarcoidosis, where we sequentially recorded WLB and NBI videos to visualize the endobronchial mucosa. We collected data on the demographic findings, sarcoidosis stage, and the histopathological findings of transbronchial needle aspiration, EBB, and transbronchial lung biopsy. Three experienced bronchoscopists viewed the video recordings and noted the abnormalities of the airway mucosa separately on WLB and NBI. We included 28 subjects (mean age, 42.9y; 53.6% men; 14 each, stages 1 and 2) with a final diagnosis of sarcoidosis. Granulomas were detected on EBB in 11 (39.3%) subjects. We identified endobronchial nodules in 10 and 15 subjects on WLB and NBI. The sensitivity of finding endobronchial abnormality using WLB and NBI was 35.7% (10/28) and 53.6% (15/28), respectively (χ2=1.77, df=1, P=0.18). The sensitivity of NBI in diagnosing endobronchial sarcoidosis against a positive EBB was 63.6% (7/11 subjects). There was excellent agreement (Κ=0.86) for detecting nodules on NBI among the 3 observers. NBI might allow the identification of additional abnormalities not detected on WLB in sarcoidosis. Larger studies are required to confirm our observations.

Prevalence, molecular markers, and outcome of bronchial squamous carcinoma in situ in high-risksubjects.

Bronchial squamous carcinoma in situ (CIS) is a preinvasive lesion that is thought to precede invasive carcinoma. We conducted prospective autofluorescence and white light bronchoscopy trials between 1992 and 2016 to assess the prevalence, molecular markers, and outcome of individuals with CIS and other preneoplastic bronchial lesions. Biopsies were evaluated at multiple levels and selected biopsies were tested for aneuploidy and DNA sequenced for TP53 mutation. Thirty-one individuals with CIS were identified. Twenty-two cases of CIS occurred in association with concurrent invasive carcinomas. Seven of the invasive tumors were radiographically occult. In two cases, CIS spread from the focus of invasive carcinoma into contralateral lung lobes, forming secondary invasive tumors. In nine cases, CIS occurred as isolated lesions and one progressed to invasive squamous carcinoma at the same site 40 months after discovery. In a second case, CIS was a precursor of carcinoma at a separate site in a different lobe. In seven cases CIS regressed to a lower grade or disappeared. High level chromosomal aneusomy was often associated with TP53 mutation and with invasive carcinoma. CIS most often occurs in association with invasive squamous carcinoma and may extend along the airways into distant lobes. In rare cases, CIS may be observed to directly transform into invasive carcinoma. CIS may be indicative of invasive tumor at a separate distant site. Isolated CIS may regress. Molecular changes parallel histological changes in CIS and may be used to map clonal expansion in the airways.

Robotic-assisted bronchoscopy for peripheral pulmonary lesions: A single-center experience of the Ion platform

Rationale: The diagnostic yield of electromagnetic navigational bronchoscopy to access lung lesions remains low. The multicenter NAVIGATE study showed the diagnostic yield to be 71% for lesions up to 3 cm and 67% for lesions up to 2 cm. The introduction of robotic-assisted navigational platforms may overcome some of the traditional barriers encountered with previous approaches. We aim to assess the navigational and diagnostic yield of the Ion™ endoluminal system (Intuitive Surgical, Inc., Sunnyvale, California) regarding pulmonary lesions that could not previously be biopsied using conventional white light bronchoscopy. Methods: We retrospectively reviewed and analyzed data from our first 76 consecutive robotic-assisted navigational bronchoscopy (RAB) cases performed by a single proceduralist at our single center between March 11, 2020, to November 25, 2020. Secondary endpoints included the safety of the platform, such as incidences of pneumothoraces and significant bleeding events. Results: The ability to localize the lesion using the shape sensing technology was 100% (n=76). Navigational success, as determined by lesion visualization using radial endobronchial ultrasound confirmation, was 76% (n=58) of the nodules. The additional use of 2D-fluoroscopy for needle-in-lesion guidance and Rapid Onsite Evaluation to assess for adequate tissue sampling resulted in a diagnostic yield of 92% (n=70). There was a 0% complication rate for pneumothorax and significant bleeding events in the postoperative phase. Conclusions: Our study supports the current literature regarding the safety and efficacy of the Ion™ RAB for use in obtaining biopsy of peripheral lung lesions. Depending on the definition of navigational success, based on our results, the Ion™ RAB is comparable to or better than flexible bronchoscopy. The diagnostic yield is comparable to or better than flexible bronchoscopy but slightly lower than the gold standard computed tomography-guided transthoracic biopsy (CTTB) for peripheral lung lesions. However, in contrast to CTTB, the Ion™ RAB has lower complication rates for pneumothoraces and major bleeding. Further studies are needed to directly compare the current two robotic systems with a third system, Galaxy System™ by Noah Medical that is pending FDA approval.

872: UNCOMMON PRESENTATION OF A RARE NEOPLASM: AN ENDOBRONCHIAL PAPILLOMA PRESENTING AS SEPSIS

Introduction: Endobronchial papilloma’s (EBP) are rare neoplasms associated with nicotine use and Human Papilloma Virus (HPV). We present a case of a non-smoking, HPV negative male who presented to the hospital with obstructive pneumonia and sepsis due to a lower respiratory tract EBP. Description: A 75-year-old male presented to his primary care doctor with two weeks of dyspnea and productive cough. He was a non-smoker and presented with a medical history of end stage renal disease on hemodialysis, and atrial fibrillation (AF). At his primary care doctor’s office, he was found to be hypoxic and sent to the Emergency Department for further evaluation. Computed tomography-pulmonary angiogram revealed complete atelectasis of his left upper lobe, with consolidation present of the left lower lung. This raised suspicion for an intra-bronchial lesion and pneumonia. Ceftriaxone and azithromycin were initiated, and the patient underwent video fiberoptic white light bronchoscopy. Findings were notable for a lesion completely obstructing the anterior, apical, and posterior segments of the left upper lobe. The lesion was excised, and multiple biopsies were obtained. Pathology revealed glandular papilloma with chronic inflammation. HPV serotyping for 16, 18, 31, 33, and 51 were negative. The patient was kept on a ventilator post-operatively due to hypercapnia and uncontrolled AF. He was extubated less than 24 hours later. He was discharged home with oral cefdinir for 14 days, and 2 L/min of oxygen. He followed up with his pulmonologist one week later in clinic, recovering well, and without complication. Discussion: EBP are benign neoplasms, which represent less than 1% of all lung tumors. Due to their slow growing nature, they primarily present with chronic respiratory symptoms such as exertional dyspnea or cough. This case represents an uncommon presentation of EBP, specifically sepsis. Our patient did not have classic risk factors such as HPV or smoking history. Although rare, clinicians should keep EBP in mind when patients present with sepsis if endobronchial lesions are suspected.

The investigation of construction and clinical application of image recognition technology assisted bronchoscopy diagnostic model of lung cancer.

The incidence and mortality of lung cancer ranks first in China. Bronchoscopy is one of the most common diagnostic methods for lung cancer. In recent years, image recognition technology(IRT) has been more and more widely studied and applied in the medical field. We developed a diagnostic model of lung cancer under bronchoscopy based on deep learning method and tried to classify pathological types. A total of 2238 lesion images were collected retrospectively from 666 cases of lung cancer diagnosed by pathology in the bronchoscopy center of the Third Xiangya Hospital from Oct.01 2017 to Dec.31 2020 and 152 benign cases from Jun.01 2015 to Dec.31 2020. The benign and malignant images were divided into training, verification and test set according to 7:1:2 respectively. The model was trained and tested based on deep learning method. We also tried to classify different pathological types of lung cancer using the model. Furthermore, 9 clinicians with different experience were invited to diagnose the same test images and the results were compared with the model. The diagnostic model took a total of 30s to diagnose 467 test images. The overall accuracy, sensitivity, specificity and area under curve (AUC) of the model to differentiate benign and malignant lesions were 0.951, 0.978, 0.833 and 0.940, which were equivalent to the judgment results of 2 doctors in the senior group and higher than those of other doctors. In the classification of squamous cell carcinoma (SCC) and adenocarcinoma (AC), the overall accuracy was 0.745, including 0.790 for SCC, 0.667 for AC and AUC was 0.728. The performance of our diagnostic model to distinguish benign and malignant lesions in bronchoscopy is roughly the same as that of experienced clinicians and the efficiency is much higher than manually. Our study verifies the possibility of applying IRT in diagnosis of lung cancer during white light bronchoscopy.

Novel image features of optical coherence tomography for pathological classification of lung cancer: Results from a prospective clinical trial.

This study aimed to explore the characteristics of optical coherence tomography (OCT) imaging for differentiating between benign and malignant lesions and different pathological types of lung cancer in bronchial lesions and to preliminarily evaluate the clinical value of OCT. Patients who underwent bronchoscopy biopsy and OCT between February 2019 and December 2019 at the Chinese PLA General Hospital were enrolled in this study. White-light bronchoscopy (WLB), auto-fluorescence bronchoscopy (AFB), and OCT were performed at the lesion location. The main characteristics of OCT imaging for the differentiation between benign and malignant lesions and the prediction of the pathological classification of lung cancer in bronchial lesions were identified, and their clinical value was evaluated. A total of 135 patients were included in this study. The accuracy of OCT imaging for differentiating between benign and malignant bronchial lesions was 94.1%, which was significantly higher than that of AFB (67.4%). For the OCT imaging of SCC, adenocarcinoma, and small-cell lung cancer, the accuracies were 95.6, 94.3, and 92%, respectively. The accuracy, sensitivity, and specificity of OCT were higher than those of WLB. In addition, these main OCT image characteristics are independent influencing factors for predicting the corresponding diseases through logistic regression analysis between the main OCT image characteristics in the study and the general clinical features of patients (p<0.05). As a non-biopsy technique, OCT can be used to improve the diagnosis rate of lung cancer and promote the development of non-invasive histological biopsy.

The value of narrow-band imaging bronchoscopy in diagnosing central lung cancer.

AimsThis research aimed to study the value of narrow-band imaging(NBI) in the diagnosis of central lung cancer.Materials and methodsThis study included 916 patients with clinical suspected of central lung cancer or follow-up of patients after curative lung cancer surgery. All of the patients were examined by Olympus Evis Lucera electronic bronchoscope system, any sites that were abnormal when viewed by white-light bronchoscopy (WLB) or NBI were biopsied, four to six biopsies were taken at each site of the abnormal region visualized as lesions, we record the endoscopic features of NBI and compared with histopathology results, to evaluate the diagnostic value of NBI for central lung cancer and the relationship between vascular patterns of NBI and histological types of lung cancer, and try to establish a multinomial logistic regression model for predicting the histological types of lung cancer. The biopsy specimens were examined by CD34 antibody through immunohistochemistry (IHC) method, CD34 marked microvessel density(MVD), compared the number of microvessels between benign and malignant diseases and the number between different histological types of lung cancer, to verify the results of NBI.ResultsNBI provided high sensitivity (91.7%), specificity (84.9%), positive predictive value (97.6%), negative predictive value (61.5%), and agreement rate (90.7%). The predominant vascular patterns in the well-defined histological types of lung cancer were dotted blood vessels (121 patients), tortuous blood vessels (248 patients), and abrupt-ending blood vessels (227 patients). Logistic regression analysis of the results showed that smoking status of the patient, combined with vascular patterns under NBI, and age partly affect the histological types of lung cancer.ConclusionsNBI is highly accurate for the diagnosis of central lung cancer.

Vascular patterns on narrow band imaging (NBI) video bronchoscopy of lung cancer patients and its relationship with histology: an analytical cross-sectional study.

Narrow band imaging (NBI) video bronchoscopy provides better visualisation of submucosal vascular patterns in malignant airway lesions compared to white light bronchoscopy. This analytical cross-sectional study was aimed to look for any relationship between these NBI vascular patterns and the histologic type of lung cancer. After screening 78 patients with suspected lung cancer, 53 subjects underwent video bronchoscopy. Thirty-two patients showing abnormal bronchial mucosa or endobronchial growth with any of the NBI vascular patterns on bronchoscopy were enrolled in the study. These abnormal areas were then biopsied and sent for histologic examination. NBI bronchoscopy revealed a dilated tortuous vascular pattern in 54.8% of the patients, a non-specific pattern in 32%, a dotted pattern in 9.7% and an abrupt ending vessels pattern in 3.2% of the patients. We did not find any statistically significant relationship between a dilated tortuous pattern and squamous-cell carcinoma (p = 0.48), adenocarcinoma (p = 0.667) or small-cell carcinoma (p = 1); between a dotted pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 0.54) or small-cell carcinoma (p = 1), and between an abrupt ending capillary pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 1) or small-cell carcinoma (p =1). No relationship exists between NBI vascular patterns and the histology of lung cancer. Endobronchial lesions showing any vascular pattern on NBI needs to be adequately sampled for proper histologic and molecular studies in lung cancer patients.

Usefulness of autofluorescence bronchoscopy in early diagnosis of airway complications after lung transplantation

Despite the promising results achieved so far in long-term survival after lung transplantation (LuTx), airway complications (ACs) still arise in the post-operative period. Early diagnosis and prompt treatment of ACs play a critical role in preventing their onset. Specifically, large bronchi ischemia has been recognized as a triggering factor for ACs. Autofluorescence bronchoscopy, which was first introduced for early cancer diagnosis, displays ischemic mucosae as red spots, while normal vascularized mucosae appear in green. The aim of this study is to investigate whether a significant correlation exists between ACs and the red/green (RG) ratio detected on scheduled autofluorescence bronchoscopy up to 1 year after LuTx. This prospective, observational, single-center cohort study initially considered patients who underwent LuTx between July 2014 and February 2016. All patients underwent concomitant white-light and autofluorescence bronchoscopy at baseline (immediately after LuTx), on POD7, POD14, POD21, POD28, POD45, 3 months, 6 months, and 1 year after LuTx. An autofluorescence image of the first bronchial carina distal to the anastomosis was captured and analyzed using histograms for red and green pixels; the R/G ratio was then recorded. Potential ACs were classified according according to the presence of a white-light following the MDS (macroscopic aspect, diameter and suture) criteria. The authors assessed the association between the R/G ratio and the ACs occurrence using a generalized estimating equations model. Thirty-one patients met the inclusion criteria and were therefore selected. Out of a total of 53 bronchial anastomoses, 8 developed complications (late bronchial stenosis), with an average onset time of 201 days after LuTx. ACs showed a similar baseline covariate value when compared to anastomoses that involved no complication. Generalized estimating equations regression indicated a clear association over time between the R/G ratio and the rise of complications (p = 0.023). The authors observed a significant correlation between post-anastomotic stenosis and the delayed decrease of the R/G ratio. Preliminary outcomes suggest that autofluorescence bronchoscopy may be an effective and manageable diagnostic tool, proving complementary to other instruments for early diagnosis of ACs after LuTx. Further research is needed to confirm and detail preliminary findings.

Role of I-scan technique in screening for lung cancer in smokers with positive sputum cytology

BackgroundLung cancer has a very poor prognosis and high mortality. Positive sputum for malignant and/or atypical cells warrants the need for fibreoptic bronchoscopy. White light bronchoscopy (WLB) is usually unable to detect preinvasive lesions; therefore, autofluorescence bronchoscopy (AFB) was introduced as a gold standard for detecting such lesions. The aim of this work was to investigate the role of I-scan as a screening tool for cancer in smoker patients showing positive sputum cytology.ResultsNew suspicious findings under I-scan occurred in 11 patients (36.7%). The overall sensitivity of WLB alone to diagnose malignancy is 23.3%, in contrast to an added sensitivity of 50% when I-scan was combined with white light (p value < 0.05). The specificity of I-scan could not be assessed in the absence of control cases (true negatives). No major complications or deaths occurred. Haemorrhage and bronchospasm were the commonest minor complications.ConclusionsThe addition of I-scan to the routine white light examination can increase the overall sensitivity of bronchoscopic screening in cases of sputum suspicious for malignancy if put in experienced hand. The suggested increase in procedure duration due to the combined use of I-scan and white light bronchoscopy is not associated with life-threatening complications.

White light bronchoscopy reveals a tear in the membranous wall of the trachea due to mishandling of an EBUS bronchoscope

White light bronchoscopy reveals a tear in the membranous wall of the trachea due to mishandling of an EBUS bronchoscope

Comparison of autofluorescence and white-light bronchoscopies performed with the Evis Lucera Spectrum for the detection of bronchial cancers: a meta-analysis.

BackgroundMany recent studies have reported that autofluorescence bronchoscopy (AFB) has a superior sensitivity and decreased specificity in the diagnosis of bronchial cancers when compared with white-light bronchoscopy (WLB). We specifically analyzed the diagnostic performances of autofluorescence imaging video bronchoscopy (AFI) performed with the Evis Lucera Spectrum from Olympus, which is a relatively novel approach in detecting and delineating bronchial cancers, and compared it to the older WLB method.MethodsWe searched the PubMed, Embase, Web of Science, and CNKI databases from inception to July 12th, 2018 for trials in which patients were diagnosed with lung cancer via concurrent or combined use of AFI and WLB. The included studies were required to have a histologic diagnosis as the gold standard comparison, and a sufficient amount of data was extracted to assess the diagnostic capacity. A 2×2 table was constructed, and the area under the receiver-operating characteristic curve (AUC) of AFI and WLB was estimated by using a stochastic model for diagnostic meta-analysis using STATA software.ResultsA total of 10 articles were eligible for the meta analysis, comprising 1,830 patients with complete data included in the analysis. AFI showed a superior sensitivity of 0.92 (95% CI, 0.88–0.95) over WLB’s 0.70 (95% CI, 0.58–0.80) with P<0.01, and a comparable specificity of 0.67 (95% CI, 0.51–0.80) compared with WLB’s 0.78 (95% CI, 0.68–0.86) with P=0.056. Egger’s test P value (0.225) demonstrated that there was no publication bias.ConclusionsOur research showed that in the evaluation of bronchial cancers, AFI was superior to conventional WLB. With its higher sensitivity, AFI could be valuable for avoiding misdiagnosis.

Role of HD i-scan bronchoscopy in the diagnosis of nonendobronchial lung cancer

Introduction Bronchoscopy with i-scan (image-scan) is a new image-enhanced endoscopic technology used for the detection of small intraepithelial and preinvasive lesions. Aim Comparing the diagnostic yield of high definition (HD)+i-scan bronchoscopy vs white light bronchoscopy (WLB) in the detection of vascular abnormalities and preinvasive lesions for early diagnosis of lung cancer. Patients and methods This cross-sectional study enrolled 40 patients with suspected lung cancer admitted to the Chest Department, Mansoura University, Egypt, 2016–2018. Patients with suspected lung cancer were included while patients unfit for bronchoscopy or with endobronchial mass were excluded. All patients after clinical, laboratory, and radiological assessment were screened by bronchoscopy using: WLB, HD-bronchoscopy, i-scan1, i-scan2, and i-scan3. When suspicious sites were detected, they were graded, counted, and categorized, afterwards cryobiopsies were taken to correlate between bronchoscopic and pathological findings followed by calculation of sensitivity and accuracy. Results Most of the patients were men, with a mean age of 59.25 years. Few abnormal sites detected by WLB (29) lesions were highly significantly lower than i-scan1, i-scan2, and i-scan3 (P Conclusion HD-bronchoscopy+i-scan which offers real-time image enhancement has a better diagnostic yield than WLB in the diagnosis of lung cancer with nonendobronchial extension.

Role of high-definition bronchoscopy in histopathological diagnosis of bronchogenic carcinoma according to bronchial vascular patterns

Background Owing to technological advances, a novel technique has become available, called high-definition (HD) bronchoscopy, giving substantially higher resolution images than conventional white light bronchoscopy and producing signal images with resolutions ranging from 850 000 pixels to more than 1 million pixels. HD bronchoscopes are designed for image output onto commercial TVs or computer monitors via i-scan video device. Aim The aim of this study was to determine the relation between different vascular patterns and histopathological type of bronchogenic carcinoma by using HD bronchoscopy and i-scan. Patients and methods The study was performed at Chest Department, Ain Shams University Hospital, from January 2015 till January 2016. The study included 30 patients, comprising 24 males and six females, with age ranging from 45 to 73 years. Bronchogenic carcinoma was diagnosed in all patients: 10 patients had squamous cell type, eight patients had adenocarcinoma, seven patients had small cell type, and five cases had large cell type. All patients were subjected to full history taking, complete clinical examination, and radiographic studies including plain chest radiography and computerized tomography of the chest. Laboratory evaluations included complete blood count, liver functions, renal functions, prothrombin time, partial thromboplastin time, international normalized ratio, and spirometry if needed. All cases were prepared and examined by HD PENTAX 3.2 Medical 70K-series (EB-1970TK) video bronchoscope and i-scan Video Processor EPK-i 5000. Results There was a statistically significant association between vascular pattern and pathology of bronchogenic carcinoma. Tortuous vessels were identified in 80% of patients with squamous cell carcinoma, 60% of large cell type, 42.8% of small cell type, and 12.5% of patients of adenocarcinoma. Dotted vessels were identified in 78.5% of adenocarcinoma cases, 42.8% of small cell type, 20% of large cell type, and 10% of squamous cell type. Abrupt-ending vessels were identified in 10% of squamous cell carcinoma cases, 14.4% of small cell type, and 20% of large cell type. Incidence of tortuous vessels in cases with squamous cell carcinoma was significantly greater (7.429 times) than nontortuous vessels. Incidence of dotted vessels in cases with adenocarcinoma was significantly higher (23.80 times) than nondotted vessels. Conclusion Advanced bronchoscopic technologies may enable obtaining an ‘optical biopsy’ of the bronchial tree, providing high-resolution and three-dimensional virtual images. These technologies may fundamentally improve the diagnostic and therapeutic assessment of bronchial tumors.

Sampling Utility of the Convex Probe Endobronchial Ultrasound Visible Intrapulmonary Lesion.

The value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer has been well established. However, data regarding its utility in the diagnosis of intrapulmonary lesions has been sparse. This study assesses the sampling utility of convex probe EBUS-visible intrapulmonary lesions not visualized by the white-light bronchoscopy. A retrospective analysis of EBUS-TBNA of EBUS-visible intrapulmonary lesions was performed between January 2010 and March 2015. Patients with visible endobronchial lesions by white-light bronchoscopy were excluded from analysis. Among 108 procedures, the diagnostic yield of EBUS-TBNA for EBUS-visible intrapulmonary lesions was 87%. Following diagnoses were established: lung cancer (73/67.6%), lung metastases (10/9.2%), infection (5/4.6%), lymphoma (1/<1%), sarcoma/spindle cell sarcoma or neoplasm (3/2.8%), unspecified malignancy (1<1%), and hamartoma (1/<1%). EBUS-TBNA was nondiagnostic in 14 (13%); among these, 9 turned out to have benign disease based on additional bronchoscopy samples or other testing and/or follow-up imaging. Five were ultimately diagnosed with a malignant condition: lymphoma (1), epithelioid hemangioendothelioma (1), and non-small cell lung cancer (3). The sensitivity and the negative predicted value of EBUS-TBNA for differentiating malignancy from benign disease was 94.7% and 75%, respectively, while the accuracy for diagnosing the neoplastic disease was 95.3%. There was one major bleeding requiring bronchial artery embolization and 1 pneumothorax requiring chest tube drainage. EBUS-TBNA is safe and effective in the diagnosis of EBUS-visible intrapulmonary lesions. It should be considered as the diagnostic test of choice in patients with these lesions undergoing EBUS-TBNA for the staging of suspected lung cancer.

Autofluorescence and White Light Bronchoscopy in the Diagnosis of Endobronchial Malignant Lesions

Autofluorescence bronchoscopy (AFB) allows a more sensitive approach to the diagnosis of premalignant and malignant endobronchial lesions than white light bronchoscopy (WLB) can do. To assess the autofluorescence bronchoscopy and white light bronchoscopy in diagnosing malignant endobronchial lesions. The design of the study is a retrospective case-control study. Thirty-two parameters were entered into an Excel file and analysed with SPSS v. 21 for Mac book Pro. Endoscopy findings were graded in 4 options and morphological results - in 9 options according to WHO classification. The results are presented using McNemar's test and sensitivity, specificity and positive and negative predictive values as well. Three hundred and three patients were included in the study. Lung cancer was found in 38.3% of the patients using histology and in 35.6% - using cytology. McNemar's test for AFB finding for suspected and malignant lesions OR was 8.333 (95% CI 3.571-23.784) while for WLB OR was 0.128 (95% CI 0.045-0.299). For cytological results OR was 3.800 (95% CI 2.123-7.227) and 3.471 (95% CI 1.996-6.351), respectively. P value was <0.0001 for all tests. Sensitivity for AFB and WLB was 94.83% but specificity was 52.83% and 55.66% if histology was used. For cytology these numbers were respectively 86.11% and 84.26% for sensitivity, and 63.69% and 62.42% for specificity. AFB has an advantage over WLB in diagnosing endobronchial malignant lesions. Biopsying suspicious, not only visible malignant lesions, increased diagnostic sensitivity.

Direct comparison of autofluorescence bronchoscopy (AFB) and the combination of autofluorescence bronchoscopy and white light bronchoscopy (AFB + WLB) for detecting airway cancerous and precancerous lesions: a systematic review and meta-analysis

Background: Autofluorescence bronchoscopy (AFB) presents high sensitivity but low specificity for detecting cancerous and precancerous lesions; its specificity and overall diagnostic performance may be improved when combining with white light bronchoscopy (AFB + WLB). Methods: We conducted a systematic review and meta-analysis through searching PubMed and Web of Science from the inception date of each database to 31 Dec 2017. Eligible comparative studies should contain sufficient data of AFB versus AFB + WLB to construct 2×2 tables. In addition, the samples detected by bronchoscopies should be confirmed by histopathology. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC) were estimated by a random-effect model. Results: We included seven comparative studies involving a total of 904 patients and 2,740 biopsy specimens. According to the original reported data, no specificities of AFB + WLB were higher than the specificities of AFB. In our meta-analysis, the sensitivity, specificity, DOR and AUC of AFB were 88% (95% CI: 65–97%), 63% (49–75%), 12 [3–54] and 77% (73–81%), respectively; those of AFB + WLB were 90% (77–96%), 54% (39–68%), 11 [4–34] and 78% (74–81%), respectively. Conclusions: Both AFB and AFB + WLB presented similar diagnostic performance for cancerous and precancerous lesions. In other word, AFB + WLB did not present superiority compared to AFB alone, especially in terms of the specificity.

White light, autofluorescence and narrow-band imaging bronchoscopy for diagnosing airway pre-cancerous and early cancer lesions: a systematic review and meta-analysis.

We aimed to summarize the diagnostic accuracy of white light bronchoscopy (WLB) and advanced techniques for airway pre-cancerous lesions and early cancer, such as autofluorescence bronchoscopy (AFB), AFB combined with WLB (AFB + WLB) and narrow-band imaging (NBI) bronchoscopy. We searched for eligible studies in seven electronic databases from their date of inception to Mar 20, 2015. In eligible studies, detected lesions should be confirmed by histopathology. We extracted and calculated the 2×2 data based on the pathological criteria of lung tumor, including high-grade lesions from moderate dysplasia (MOD) to invasive carcinoma (INV). Random-effect model was used to pool sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC). In 53 eligible studies (39 WLB, 39 AFB, 17 AFB + WLB, 6 NBI), diagnostic performance for high-grade lesions was analyzed based on twelve studies (10 WLB, 7 AFB, 7 AFB + WLB, 1 NBI), involving with totally 2,880 patients and 8,830 biopsy specimens. The sensitivity, specificity, DOR and AUC of WLB were 51% (95% CI, 34-68%), 86% (95% CI, 73-84%), 6 (95% CI, 3-13) and 77% (95% CI, 73-81%). Those of AFB and AFB + WLB were 93% (95% CI, 77-98%) and 86% (95% CI, 75-97%), 52% (95% CI, 37-67%) and 71% (95% CI, 56-87%), 15 (95% CI, 4-57) and 16 (95% CI, 6-41), and 76% (95% CI, 72-79%) and 82% (95% CI, 78-85%), respectively. NBI presented 100% sensitivity and 43% specificity. With higher sensitivity, advanced bronchoscopy could be valuable to avoid missed diagnosis. Combining strategy of AFB and WLB may contribute preferable diagnosis rather than their alone use for high-grade lesions. Studies of NBI warrants further investigation for precancerous lesions.

The Importance of Bronchoscopy in Early Lung Cancer (LC) Diagnosis

Abstract Lung cancer is a leading cause of death worldwide, due to the fact that most patients are diagnosed in a fairly advanced stage. Screening tests such as sputum citology, chest x-rays or CT scans have their limitations and need further histological confirmation of the diagnosis. Therefore, the need forfast and accurate detection and staging of lung cancer has determined the development of advanced medical procedures using bronchoscopic methods such as white light bronchoscopy, narrow-band imaging, auto-fluorescence bronchoscopy, confocal fluorescence microendoscopy or echoendoscopy.