Search

Durch die steigende Anzahl an durchgefuhrten Thorax-Computertomographie(CT)-Untersuchungen in den letzten Jahren nimmt die Rate an zufallig entdeckten peripheren Lungenherden zu. Die fruhe Diagnosestellung geht bei Lungenkarzinomen einher mit einer Verbesserung der Prognose dieser meist todlich verlaufenden Erkrankung. Die diagnostische Sicherheit der Bronchoskopie mit konventionellen bioptischen Moglichkeiten (transbronchiale Zangenbiopsie unter Rontgendurchleuchtung) ist niedrig. Ein operatives Vorgehen sollte angestrebt werden, wenn kein begrundeter Zweifel an der Malignitat besteht und keine relevanten Komorbiditaten vorliegen. Bildgebende Verfahren, wie die 18F-Fluordeoxyglukose-Positronenemissionstomographie/Computertomographie (FDG-PET/CT) konnen die Dignitat eines Herds nicht sicher klaren und sind in dieser Situation wenig hilfreich. Die Verbesserung der diagnostischen Sicherheit durch eine histologische Sicherung, meist durch bronchoskopische Probeentnahme, sollte in dieser Situation gepruft werden. In den letzten Jahren wurden mehrere bronchoskopische Verfahren entwickelt, welche die diagnostische Sicherheit von peripheren Lungenherden deutlich erhohen. Durch die verbesserte Erreichbarkeit der Herde kommt zukunftig die Moglichkeit einer bronchoskopischen Lokaltherapie in Betracht.

Background: The need to determine the aetiology of solitary pulmonary nodules (SPN) is high. The ArchimedesTM System combines virtual bronchoscopy navigation (VBN) with fused fluoroscopy (FF) in order to improve the guidance. Objective: To analyze the feasibility of ArchimedesTM interventions for the diagnosis of SPN. Methods: From 01-05/2020 16 patients with SPN were examined. Based on a specific CT scan the access way to the SPN was calculated and adjusted as needed. Interventions were done in general anesthesia with chest tube. Results: 16 Patients (43,8% female, 56,3% male) aged 64 years (±8,3) were included with a malignancy risk for the SPN (calculated with the Brock Model) of 40,6% (±19,3). SPN measured 14,9mm (±7,1). Localization were 43,8% left upper lobe, 25% right lower lobe, 25% right upper lobe, 6,3% middle lobe. The distance from the last reconstructed bronchus to the lesion was 21,5mm (± 12,7), the distance between target and pleura 20,1mm (± 16,8). Time for calculation 21 minutes (± 10,4), time to location of the SPN 14 minutes (±15,5). Bronchoscope with 4,2mm (93,8%) and 3mm (6,3%) outside diameter were used. The lesion could be seen in radial EBUS in 87,5% (50% adjacent, 25% central, 12,5% stop phenomenon). There were no major complications (25% mild bleeding managed by suction, no pneumothoraxes). Sensitivity was calculated 71,4%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 33,3% and accuracy 75%. Conclusion: A high diagnostic yield for small peripheral SPN can be achieved with ArchimedesTM interventions even if the distance from the last reconstructed bronchus to the target is over 20mm.

Introduction: Endobronchial ultrasound bronchoscopes (EBUS-scopes) actually represent the gold-standard to investigate mediastinal lymph nodes and centrally located lesions in patients affected by lung cancer. The commonly used EBUS-scope (Olympus BF-UC180F), however, does not allow a complete exploration of the segmental bronchi, just reaching the lobar bronchi or, sometimes, lower lobes segmental bronchi. The new EBUS-scope (Olympus BF-UC190F) has a smaller diameter and greater flexibility, and promises to provide a better access to more peripheral lesions. The aim of this study is to compare the two different generations of EBUS-scopes, to assess if peripheral access is improved by using the new one. Materials and Methods: We subsequently submitted 4 patients to an EBUS procedure with both EBUS-scopes (BF-UC180F and BF-UC190F), intending to introduce them into the segmental bronchi 1-6 on both sides. For a more careful evaluation of the results we created a numeric score, based on which part of the instrument was able to enter each of the bronchi. The statistical analysis was performed with the Student´s T test. Results: Despite the fact that our statistical analysis could be affected by the limited number of patients involved, we highlighted a statistically significative difference between the two generations of EBUS-scopes. Particularly, we were already able to prove that the new EBUS instrument allows a better exploration regarding LB 1+2 (p Conclusions: in our experience, the new EBUS-scope (BF-UC190F) allows a deeper access into segmental bronchi, therefore improving the diagnosis of peripheral lesions.

Introduction: Central Airway Obstruction (CAO) is life threatening condition and caused by various benign and malignant conditions. Airway Stents (AS) are used to alleviate symptoms by providing patency to airway lumen. AS have gone timely modifications over the years and the reasons for their use have varied. We present a retrospective analysis of 40 patients, who underwent AS placement at our center Methods: 40 patients, who underwent stent placement for CAO were included in this retrospective analysis. The stenotic segment was identified, and AS were introduced using rigid bronchoscopy under general anesthesia. Self-expanding Metal-Stents (SEMS) used were Ultraflex (7), Leufen Aerstent (8), Hanaro (4) Nitinol (2), others (2), polymer-stents used were Dumon (12), Vergnon (2) Polyflex (1) and Biodegradable Stents (4). Results: 26 M and 14 F with mean age of 65±13 yrs were included in this study. The underlying pathology was benign in 16 and malignant in 24 patients. Length of CAO was ≤ 4 cm in 29 and >4 cm in 6 patients. 5 cases presented with a fistula. Complications included granulation tissue formation (3), migration (8) and mucostasis (1). The location, type and complications of AS are summarized in Table 1. Discussion: Our analysis gives an overview about the choice and possible complications of AS. Migration occurred mostly in polymer AS (5/8) and those introduced in intermediate Bronchus (3/6). Though the AS are relatively safe, but complications such as migration need to be timely anticipated and sent securing procedure may be considered in such situations.

Background. Pneumothorax is a common side effect in interventional pulmonology. The ideal moment for detection with chest X-ray or ultrasound has not yet been defined. Earlier studies demonstrated the utility of performing these tests with a certain delay, which always results in a potentially dangerous gap. Methods. We prospectively enrolled patients with pulmonary interventions at increased risk of pneumothorax. Thoracic ultrasound was performed immediately after the intervention and at the moment of chest X-ray with a delay up to two hours. Results: Overall, we detected four pneumothoraxes in 115 procedures. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 75%, 100%, 100%, 99%, 99% for ultrasound and 75%, 90%, 21%, 99% und 89% for chest X-ray respectively. All pneumothoraces requiring chest tube were sufficiently detected by both methods. Conclusion. Thoracic ultrasound when performed immediately can more accurately exclude pneumothorax after interventional bronchoscopy when compared to chest X-ray. Further ultrasound examinations are unnecessary.

Background: Several novel methods have been proposed to improve the diagnostic yield of transbronchial biopsy for peripheral pulmonary lesions (PPL). LungPoint® virtual bronchoscopic navigation (VBN) uses virtual 3-dimensional reconstruction of the bronchial tree to guide a bronchoscope visually to the lesion. Objective: To analyse the advantages and limitations of VBN for the diagnosis of PPL. Methods: Nineteen consecutive patients with PPL smaller than 35mm were referred to bronchoscopy with VBN. The distance from the last reconstructed bronchus to the lesion was calculated by the VBN system prior to the procedure. A total of 12 cases with a calculated distance less than 15 mm were included in the analysis. In eight patients radial endobronchial ultrasound (R-EBUS) was used to confirm the location of the lesion following virtual navigation. In all cases a definite diagnosis was achieved either by the bronchoscopic procedure or surgery. Results: The mean lesion diameter was 20 mm. Ten of the lesions were located in the right upper, one in the right middle, two in the right lower, five in the left upper, and one in the left lower lobe. The diagnostic yield of the VBN bronchoscopy was 66,7% (5 benign, 3 malignant lesions). In 5 (41,6%) cases the lesion could be visualized by R-EBUS. In all these cases a conclusive histopathologic diagnosis could be established by the bronchoscopy, leading to a diagnostic yield of 100%. Conclusions: A high diagnostic yield can be achieved with the virtual bronchoscopic navigation if the calculated distance from the last reconstructed bronchus to the lesion is less than 15 mm and the lesion site can be confirmed by R-EBUS.

In order to identify single-nucleotide polymorphisms (SNPs) and analyze their characteristics in a set of 111 genes, we resequenced exons and flanking regions in an average of 170 chromosomes from individuals of European origin. Genetic variability was decreased in noncoding regions highly conserved between human and rodents, indicating functional relevance of these regions. Furthermore, diversity of coding nonsynonymous SNPs was found lower in regions encoding a known protein sequence motif. SNPs predicted to be of functional significance were more common amongst rare variants. Despite the significant recent growth of SNP numbers in public SNP databases, only a small fraction of these rare variants is represented. This may be relevant in the investigation of the genetic causes of severe side effects, for which rare variants are plausible candidates. Estimation of htSNPs reduces the genotyping effort required in capturing common haplotypes, for certain genes, however, this accounts for only a small fraction of haplotype diversity.