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A definitive diagnosis of invasive pulmonary aspergillosis (IPA), which usually occurs in immunocompromised patients, is often difficult. We report two cases of cavitating IPA in a peripheral pulmonary region in patients who were receiving corticosteroids, in whom the cavity was successfully visualized and sampled during ultrathin bronchoscopy. Ultrathin bronchoscopy provides a new option for definitive diagnosis of cavitating IPA.

Objective: Recently, various blood and urine markers of bone metabolism have been developed and applied to the diagnosis of bone metastases. However, the cut-off values for each parameter have not yet been completely defined. In this study, the usefulness of serum pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (I CTP) was assessed for detecting bone metastases from primary lung cancer and the most efficient cut-off value for I CTP based on the receiver operating characteristic curve was calculated. Methodology: Over a 1-year period, serum I CTP and serum alkaline phosphatase (ALP) were assayed for 87 primary lung cancer patients, including 21 bone metastases-positive cases at Nagoya Ekisaikai Hospital, Nagoya, Japan. Results: I CTP was significantly higher in patients with bone metastases than in the group without bone metastases. In contrast, there was no significant difference in serum ALP between the two groups. The most efficient cut-off value for I CTP computed in this study was 6.4 ng/mL. This was higher than the recommended value (4.5 ng/mL) based on the data from the summated values obtained for lung cancer, breast cancer and prostate cancer, as well as the maximum value for healthy controls (4.9 ng/mL). Conclusion: These results suggest that measurement of serum I CTP is a useful test for diagnosing bone metastases from lung cancer. Each type of cancer has a different pattern of bone turnover at the site of bone metastases. Considering that lung cancer mainly metastasizes to bone in an osteolytic pattern, it is proposed to set a higher cut-off value for lung cancer patients than the currently recommended value.

Recently, ultrathin bronchoscopes with a thinner external diameter, greater visual range, improved visibility, and a larger working channel have been developed. The utility of a 2.8-mm diameter ultrathin bronchoscope in diagnosing peripheral pulmonary nodules has been reported by some authors. While the feasibility of approaching peripheral pulmonary lesions is attractive, peculiar complications that have not been experienced with standard bronchoscopy may occur. We report two cases in which pneumothoraces occurred because their visceral pleuras were perforated with an ultrathin bronchoscope during the procedure. The peculiar mechanism of pneumothorax in relation to ultrathin bronchoscopy is discussed.

Pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) is a metabolite of type I collagen representing more than 90% of organic substances in bone and expected to be one of the markers reflecting bone resorption. We measured ICTP to evaluate its clinical usefulness for diagnosis of bone metastasis from primary lung cancer by comparing serum alkaline phosphatase (ALP), a bone formation marker, which was simultaneously measured. In addition, using the receiver operating characteristic (ROC) curve, we calculated the cut-off value of ICTP from which the diagnostic accuracy serves as best. The subjects were 87 patients with primary lung cancer including 21 patients with bone metastasis. ICTP was significantly higher in patients with bone metastasis than in the group without bone metastasis. On the other hand, in the serum ALP there was no significant difference between the two group. The result suggested that measurement of serum ICTP is worthwhile as a diagnosis method of bone metastasis from lung cancer. The calculated cut-off value was 6.4 ng/ml, higher than the 4.5 ng/ml indicated by the appending document which was from patients with lung, breast and prostate cancer. It is possible that the reason for the style of bone metastasis from lung cancer is mainly a osteolytic process.

Background: Transbronchial needle aspiration (TBNA) is used most frequently to assess subcarinal nodes because of its technical ease. Objectives: We conducted a prospective observational clinical study to define the indications for TBNA use for subcarinal nodes (transcarinal needle aspiration, TCNA) related to the nodal size by computed tomography (CT) of the chest. Methods: One hundred and eight consecutive patients with lung cancer underwent TCNA at the time of initial diagnostic bronchoscopy within a 22-month period. Results: TCNA was positive in 21 of the patients. Only 1 of 75 patients (1%) with subcarinal nodes less than 10 mm in short-axis diameter by CT had a positive result. TCNA for enlarged nodes, 10 mm or greater, had a high positive yield of 61% (20/33). The procedure provided the only evidence of unresectable non-small cell lung cancer (stage IIIA-N2 disease) in 3 patients and the sole pathological evidence for malignancy in 5 patients. Conclusions: The high yield of positive TCNA results for enlarged subcarinal nodes contributes to the improvement of the overall diagnostic yield of bronchoscopy. We recommend that TCNA for enlarged subcarinal nodes on CT in patients with presumptive lung cancer should be performed routinely at the time of initial diagnostic bronchoscopy.