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Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt. Objective This study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience. Patients and methods This cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018. Results The overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor non-life-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA. Conclusion Implementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

SETTING In high-risk areas (sputum collection room in a tuberculosis [TB] clinic, patient rooms in a TB ward, the emergency department and the bronchoscopy unit) in seven health care facilities located in central Thailand. OBJECTIVE To detect airborne Mycobacterium tuberculosis complex and other environmental parameters using the liquid impinger and real-time quantitative polymerase chain reaction (real-time qPCR) technique in high-risk areas. DESIGN Cross-sectional study. RESULTS M. tuberculosis was detected in 3 of 99 (3.0%, 95%CI 0.6-8.6) areas: one sputum collection room and one TB in-patient room in one facility and one sputum collection room in another facility. In these three areas, the M. tuberculosis copy number/m³ ranged from 9.6 to 1671. Lower air change rate ( 65%), and contact with coughing patient(s) were more common in airborne M. tuberculosis-positive areas than in M. tuberculosis-negative areas. CONCLUSIONS Air sampling using a liquid impinger followed by real-time qPCR is effective for quantitative detection of airborne M. tuberculosis in high-risk areas. Our findings indicate TB risk among health care workers, and suggest that improved ventilation, enhanced appropriate cough etiquette and respiratory protection are needed to mitigate M. tuberculosis transmission. .

Introduction: We hypothesise that management of tracheal stenosis (TS) following intubation due to cardiogenic shock is particularly difficult. Methods: Retrospective study of patients with TS and history of intubation submitted to bronchoscopic procedures in a Bronchoscopy Unit, from 2014 to 2018. Patients were divided in 2 groups: I – intubation due to cardiogenic shock; II – intubation due to other causes. Clinical data was reviewed. Results: From a total of 55 patients with benign TS, 48 (87.3%) had history of intubation. Three were excluded due to missing cause of intubation. Out of 45 included patients (27 men, median age 58 years, 18 with smoking history), 13 (28.9%) matched group I and 32 (71.1%) group II. Patients’ characteristics and procedures are shown in Table 1. Group I was submitted to significantly more rigid bronchoscopies (6 vs 2, p 0.031) and mechanical dilations (5 vs 2, p 0.031) compared to group II. Discussion: Almost 30% of patients with TS were intubated due to cardiogenic shock. These patients required a higher number of endoscopic procedures, reflecting a more complex management. It would be important to identify risk factors and implement preventive strategies of tracheal injury in these at risk patients. Data: median (IQR), no. of patients (%) or no. of procedures

Objective To assess the incidence of bacteremia following bronchoscopy to determine whether the use of prophylactic antibiotics is warranted in patients at risk of endocarditis. Design Prospective nonrandomized clinical study. Settings Bronchoscopy Unit of Chest Department and Thoracic Surgery Department, and Microbiology Laboratory of Ain Shams University Hospitals, Cairo, Egypt. Patients Forty-five patients undergoing diagnostic and therapeutic bronchoscopy. Interventions Blood samples for culture were obtained before and immediately after the procedure. Results There were no documented cases of bacterial growth in blood. Two culture bottles yielded contaminant. Conclusion Bronchoscopy is a low-risk procedure for the development of bacteremia. This may bear on present practice regarding perioperative antibiotic prophylaxis for endocarditis in the high-risk groups.

Background: The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. Methods: We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Results: Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. Conclusions: EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

ObjectiveForceps biopsy is the standard method to obtain specimens in endoscopically visible lesions. It is common to combine forceps biopsy with cytology methods to increase the diagnostic yield. Although the flexible cryoprobe has been established for bronchoscopic interventions in malignant stenosis, the obtained biopsies, called “cryobiopsies,” have not been investigated in a large cohort of patients. The aim of this feasibility study was to prospectively evaluate the diagnostic yield and safety of cryobiopsy and forceps biopsy.MethodsDuring a 6-year period, 296 patients with visible endoluminal tumor lesions were included in the study at the bronchoscopy unit of a university hospital. In the first consecutively conducted 55 cases, both techniques, forceps biopsy and cryobiopsy, were applied simultaneously. Pathologic and quantitative image analyses were performed to evaluate the size and quality of the obtained specimens. We evaluated the safety and diagnostic yield to describe the feasibility of cryobiopsy.ResultsComparative analysis of the first conducted and randomly assigned 55 cases revealed a significantly higher diagnostic yield for cryobiopsy compared with forceps biopsy (89.1% vs 65.5%, P < .05). In this cohort, quantitative image analysis showed significantly larger biopsies regarding size and artifact-free tissue sections for cryobiopsy compared with forceps biopsy (P < .0001). The overall diagnostic yield of cryobiopsy was 89.5%. Mild bleeding occurred in 11 cases (3.7%), moderate bleeding occurred in 3 cases (1.0%), and severe bleeding occurred in 1 case (0.3%).ConclusionCryobiopsy is safe and increases the diagnostic yield in endobronchial tumor lesions. The method also is feasible under routine conditions.

Background Tranexamic acid (TA) is a synthetic antifibrinolytic substance used for short-term control of bleeding. However, control of pulmonary bleeding with endobronchial administration of TA in more than 2 cases has not been attempted earlier. Objective We tested the feasibility of endobronchial administration of TA for controlling pulmonary bleeding. Methods This was a 2-year prospective observational trial of endobronchial TA in consecutive patients presenting with hemoptysis to our bronchoscopy unit. Patients were initially treated according to the recommendations of the Spanish National Guidelines using ice-cold saline and adrenaline. Endobronchial administration of TA was attempted in patients with uncontrolled hemoptysis before proceeding with further interventions (balloon occlusion or embolization). Results Forty-eight patients (37 male; mean age: 64±13 y) were treated with endobronchial TA. The causes of bleeding were divided into iatrogenic (n=28) and noniatrogenic (n=20). Among patients with noniatrogenic bleeding, malignancies (11 patients) and bronchiectasis (10 patients) were the most frequent causes of hemoptysis. In this patient group, endobronchial TA successfully controlled the bleeding in 11 subjects (39.2%). Nonresponders to endobronchial TA suffered more frequently from bronchiectasis (58.3% vs. 18.8%, P=0.039) and less frequently from malignancies (16.7% vs. 56.3%, P=0.040) as compared with responders. All patients with iatrogenic bleeding were treated successfully with endobronchial TA. No subject in either of the patient groups suffered from thrombotic events or other adverse events related to endobronchial TA administration. Conclusions Patients with acute pulmonary bleeding may benefit from endobronchial instillation of TA. Further double-blinded controlled studies are necessary to confirm our results.

The prevalence of lung cancers with epidermal growth factor receptor (EGFR) mutations in South Africa is not known. In the absence of the routine availability of laboratory assays to test for the presence of EGFR mutations, certain demographic and clinical features might be used to predict a response to treatment with a tyrosine kinase inhibitor in patients with lung cancer. These features include East-Asian ethnicity, female gender, non-smokers, and those with adenocarcinoma.

Study objective: To evaluate the extent to which high-resolution CT (HRCT) can predict the clinical outcome of bronchoscopic treatment with curative intent in patients with intraluminal typical bronchial carcinoid tumors. Design: An observational study. Setting: Bronchoscopy unit and radiology department of a university hospital. Patients and interventions: Eighteen patients with intraluminal typical bronchial carcinoid tumors in the absence of nodal and distant disease were treated with bronchoscopic electrocautery or Nd-YAG laser as an alternative to surgical resection. Prior to treatment, HRCT was performed. Results: In 10 patients, HRCT showed no peribronchial tumor extension, and 9 of these patients were found to be tumor free after bronchoscopic treatment. So far during follow-up, none of these patients has had a recurrence of the tumor. The median duration of follow-up was 33 months (range, 13 to 68 months). In five patients, HRCT showed signs of peribronchial tumor extension. In three of these patients, specimens taken from biopsies performed after bronchoscopic treatment showed residual tumors, and salvage surgery was carried out. In three patients, HRCT was unable to assess peribronchial tumor extension: in two because of insufficient connective tissue contrast between the hilar structures and in one patient because of suboptimal scan technique. Conclusion: HRCT findings were complementary but not conclusive in patients with intraluminal typical bronchial carcinoid tumors treated with bronchoscopic therapy. However, in a category of patients in whom HRCT showed strictly intraluminal tumors, bronchoscopic resection as an alternative for surgical resection seems justified. (CHEST 2000; 117:125‐128)