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The histologic definition of peripheral pulmonary lesion (PPL) is critical for a correct diagnosis and appropriate therapy. Non-invasive techniques for PPL biopsy are imaging-guided, using endobronchial ultrasound (EBUS), computed tomography (CT), and electromagnetic navigation bronchoscopy (ENB). To assess the diagnostic accuracy of PPL biopsy and provide a framework for reporting data for accuracy studies of PPL biopsy. A systematic review was conducted on PubMed, Scopus, and Web of Science to identify all the articles assessing the accuracy of EBUS, CT, and ENB between January 2000 and June 2023 basing search queries on keywords emerging from PICO question. Only studies investigating biopsy of PPL and reporting accuracy or necessary data to calculate it independently were included. Risk of bias was based on QUADAS-2 tool. In total, 81 studies were included. Median accuracy was 0.78 (range=0.51–0.94) in the EBUS group, 0.91 (range=0.73–0.97) in the CT group, 0.72 (range=0.59–0.97) in the ENB group, and 0.77 (range=0.61–0.92) in the combined group. Sensitivity and NPV ranges were 0.35–0.94 and 0.26–0.88 in the EBUS group, 0.71–0.97 and 0.46–1.00 in the CT group, 0.55–0.96 and 0.32–0.90 in the ENB group, and 0.70–0.90 and 0.28–0.79 in the combined group. Specificity and PPV were 1.00 in almost all studies. Overall complication rate was 3%, 30%, 8%, and 5% in the EBUS, CT, ENB, and combined groups. CT-guided biopsy was the most accurate technique, although with the highest complication rate. When calculating accuracy, indeterminate results must be considered false negatives according to the "intention-to-diagnose" principle. [ABSTRACT FROM AUTHOR]

Purpose: The diagnosis of tuberculosis located in the peripheral zone remains challenging and requires ultrasound bronchoscopy-guided maneuvers. We assessed the precision of CapitalBioTMMycobacterium nucleic acid detection test (CapitalBio MTB test) and Mycobacterium tuberculosis isothermal RNA amplification test (MTB-RNA) using endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary tuberculosis (PTB) and compared it with those of acid-fast bacilli (AFB) smear and MTB culture tests. Patients and Methods: This retrospective analysis included 287 patients suspected of peripheral pulmonary tuberculosis who underwent EBUS-GS examinations, medical examination results of AFB smears, MTB culture, CapitalBio MTB test, and MTB-RNA were analyzed. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC), and its diagnostic accuracy for peripheral PTB was evaluated in comparison with the final clinical diagnosis. Results: The overall sensitivity, specificity, PPV, NPV, and AUC of CapitalBio MTB test were 44.83%, 100.00%, 100.00%, 54.07%, and 0.72, respectively; those of MTB-RNA were 22.99%, 100.00%, 100.00%, 45.75%, and 0.61, respectively, and those for parallel test (CapitalBio MTB test or MTB-RNA) were 46.55%, 100.00%, 100.00%, 54.85%, and 0.73, respectively. These values for AFB smear were 9.2%, 97.35%, 84.21%, 41.04%, and 0.53, respectively, and those of MTB culture were 31.03%, 100.00%, 100.00%, 48.50%, and 0.69, respectively. Conclusion: The CapitalBio MTB test showed the best diagnostic performance compared with AFB smear, MTB culture, and MTB-RNA assays and was similar to the parallel test (CapitalBio MTB test or MTB-RNA). The CapitalBio MTB test combined with EBUS-GS had satisfactory diagnostic accuracy for diagnosing peripheral PTB. [ABSTRACT FROM AUTHOR]

Lihong Zhou,1 Yan Yong,1 Hao Li,2 Qin Hu1 1Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2Tuberculosis Laboratory, Zhejiang Chinese and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Qin Hu, Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-13968146922, Fax +86-571-56109821, Email qinhu19832023@163.comPurpose: The diagnosis of tuberculosis located in the peripheral zone remains challenging and requires ultrasound bronchoscopy-guided maneuvers. We assessed the precision of CapitalBioTM Mycobacterium nucleic acid detection test (CapitalBio MTB test) and Mycobacterium tuberculosis isothermal RNA amplification test (MTB-RNA) using endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary tuberculosis (PTB) and compared it with those of acid-fast bacilli (AFB) smear and MTB culture tests.Patients and Methods: This retrospective analysis included 287 patients suspected of peripheral pulmonary tuberculosis who underwent EBUS-GS examinations, medical examination results of AFB smears, MTB culture, CapitalBio MTB test, and MTB-RNA were analyzed. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC), and its diagnostic accuracy for peripheral PTB was evaluated in comparison with the final clinical diagnosis.Results: The overall sensitivity, specificity, PPV, NPV, and AUC of CapitalBio MTB test were 44.83%, 100.00%, 100.00%, 54.07%, and 0.72, respectively; those of MTB-RNA were 22.99%, 100.00%, 100.00%, 45.75%, and 0.61, respectively, and those for parallel test (CapitalBio MTB test or MTB-RNA) were 46.55%, 100.00%, 100.00%, 54.85%, and 0.73, respectively. These values for AFB smear were 9.2%, 97.35%, 84.21%, 41.04%, and 0.53, respectively, and those of MTB culture were 31.03%, 100.00%, 100.00%, 48.50%, and 0.69, respectively.Conclusion: The CapitalBio MTB test showed the best diagnostic performance compared with AFB smear, MTB culture, and MTB-RNA assays and was similar to the parallel test (CapitalBio MTB test or MTB-RNA). The CapitalBio MTB test combined with EBUS-GS had satisfactory diagnostic accuracy for diagnosing peripheral PTB.Keywords: sensitivity, specificity, receiver operating characteristic curve, endobronchial ultrasonography, polymerase chain reaction, nucleic acid molecular testing

Abstract Background Remimazolam is safe and effective for moderate sedation during flexible bronchoscopy, but its safety and efficacy during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains undetermined. The REST trial (NCT06275594) will be a prospective randomized study of remimazolam in patients undergoing EBUS-TBNA with conscious sedation. The primary aim is to evaluate whether remimazolam is safe and effective for moderate sedation during EBUS-TBNA compared to real-world midazolam and on-label midazolam. Methods The REST trial will recruit 330 patients from four university hospitals with mediastinal lesions suspected of being lung cancer who are eligible for EBUS-TBNA under moderate sedation. The participants will be randomized into groups using remimazolam, real-world midazolam, and on-label midazolam (US prescribing information dosage) to perform EBUS-TBNA for procedural sedation. The primary endpoint will be procedural success using composite measures. Discussion The REST trial will prospectively evaluate the efficacy and safety of remimazolam during EBUS-TBNA under moderate sedation. It will provide information for optimizing sedation modalities and contribute to practical benefits in patients undergoing EBUS-TBNA. Trial registration ClinicalTrials.gov (NCT06275594). Prospectively registered on 15 February 2024.

Background: Remimazolam is safe and effective for moderate sedation during flexible bronchoscopy, but its safety and efficacy during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains undetermined. The REST trial (NCT06275594) will be a prospective randomized study of remimazolam in patients undergoing EBUS-TBNA with conscious sedation. The primary aim is to evaluate whether remimazolam is safe and effective for moderate sedation during EBUS-TBNA compared to real-world midazolam and on-label midazolam. Methods: The REST trial will recruit 330 patients from four university hospitals with mediastinal lesions suspected of being lung cancer who are eligible for EBUS-TBNA under moderate sedation. The participants will be randomized into groups using remimazolam, real-world midazolam, and on-label midazolam (US prescribing information dosage) to perform EBUS-TBNA for procedural sedation. The primary endpoint will be procedural success using composite measures. Discussion: The REST trial will prospectively evaluate the efficacy and safety of remimazolam during EBUS-TBNA under moderate sedation. It will provide information for optimizing sedation modalities and contribute to practical benefits in patients undergoing EBUS-TBNA. Trial registration: ClinicalTrials.gov (NCT06275594). Prospectively registered on 15 February 2024. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer-associated death globally. Staging provides classification of the anatomic extent of cancer that is used consistently worldwide. Lung cancer staging is necessary for prognostication, to inform treatment options, and to allow accurate representation in clinical trials. Staging also separates operable from inoperable disease. Since its introduction in the 1970s, the Tumor, Node and Metastasis (TNM) Staging System has undergone significant revisions, with the latest version, the eighth edition, being effective internationally since 2017. Advances in bronchoscopic and thoracoscopic technologies have expanded procedures to diagnose lung cancer and accurately define the anatomic stage. Understanding the advantages and disadvantages of available methods for staging lung cancer is critical to clinician decision making. In patients with lung cancer without distant metastases, the staging of mediastinal lymph nodes determines treatment options. To minimize the risk and cost, the most appropriate method of staging should identify the highest disease stage while carrying acceptable risk. Minimally invasive endoscopic needle techniques to stage the mediastinum are the first choice to assess for metastases in accessible lymph node stations. Surgical techniques are generally reserved for specific clinical situations, including following negative endoscopic needle techniques when suspicion for nodal involvement is high and to assess endoscopically inaccessible lymph nodes. This review provides a concise account of TNM staging of non-small cell lung cancer (NSCLC) and overview of procedures available for the staging of lung cancer.

Background: Oxidized regenerated cellulose (ORC) is commonly used to control small intraoperative bleedings in lung cancer surgery. However, difficulties in its absorption may lead to complications that can mimic malignancy recurrence in the affected areas, and may require further examination. Methods: Between 2015 and 2022, patients who underwent malignant tumour resection and lymph node dissection and were subsequently evaluated for suspected lymph node recurrence and underwent EBUS-guided needle biopsy were included in the study. Pathology reports of these patients showed an ORC-related foreign body type granulomatous reaction. Such reactions, caused by delayed absorption of ORC, can mimic malignancy recurrence and result in unnecessary biopsies. Results: In a total of 13 patients (10 males), pathology was observed in 18 lymph node areas after malignant resection and lymph node dissection, and ORC was detected in subcarinal and inferior paratracheal lymph node areas in all patients. The average age of the patients was calculated as 63.1 years (range 51–74). The mean SUVmax value observed in these lymph node areas on PET/CT was 5.22 (range 0–14.36). Although the SUVmax value decreased as the time between surgery and EBUS increased, no statistically significant difference was observed (p = 0.100). Conclusion: The study suggests that in cases of suspected unexpected lymph node recurrence in postoperative follow-up of lung cancer, it is important for clinicians to communicate with the surgeon and re-evaluate the use of ORC by reviewing the operative notes. This may help in determining an appropriate further investigation strategy. [ABSTRACT FROM AUTHOR]

Mediastinal masses present a diagnostic challenge due to their similar imaging characteristics, making distinguishing between noninfectious and infectious processes or malignancies difficult. A mediastinal abscess can result in severe life-threatening infections if left untreated. Traditional treatment approaches involve surgical debridement and drainage; however, emerging endobronchial techniques, such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), offer a less-invasive means of diagnosing and managing abscesses. Herein, we describe a case of a young male patient who exhibited nonspecific symptoms, including pleuritic chest pain, shortness of breath, and fever. Imaging revealed a mediastinal mass with granuloma formation. EBUS-TBNA successfully drained the abscess, and microbiology analysis confirmed the growth of Streptococcus intermedius. Subsequently, his symptoms resolved, and follow-up imaging demonstrated the resolution of the mass and associated calcifications. Further research is warranted to assess the role of EBUS-TBNA in benign mediastinal masses with granuloma formation. [ABSTRACT FROM AUTHOR]

Abstract Background Transbronchial biopsy (TBB) with endobronchial ultrasonography and a guide sheath (EBUS‐GS) is an effective examination tool for the diagnosis of lung cancer. Factors related to making the diagnosis are still not fully understood. Methods A total of 367 patients who underwent EBUS‐GS and were diagnosed with lung cancer in Saga University Hospital were investigated retrospectively. Clinical characteristics were compared between 244 patients who were diagnosed with lung cancer and 123 patients who were not diagnosed by TBB with EBUS‐GS but were diagnosed by other examinations. Results Size of target lesion, rate of patients with target lesion size ≥20 mm, presence of the bronchus sign, and detection by EBUS imaging were significantly associated with making the diagnosis (all p

Background/aim: Endobronchial ultrasonography (EBUS) is a minimally invasive diagnostic tool in the diagnosis of mediastinal lymph nodes (LNs) and has sonographic features. We aimed to investigate the diagnostic accuracy of EBUS elastography, which evaluates tissue compressibility integrated into EBUS, on malignant vs. benign mediastinal-hilar LNs. Materials and methods: A single-center, prospective study was conducted at the University of Health Sciences Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital between 01/10/2019 and 15/11/2019. The features of 219 LNs evaluated by thoracic computed tomography (CT), positron emission tomography (PET)/CT, EBUS sonography and EBUS elastography were recorded. The LNs sampled by EBUS-guided fine needle aspiration were classified according to EBUS elastography color distribution findings as follows: type 1, predominantly nonblue (green, yellow, and red); type 2, part blue, part nonblue; type 3, predominantly blue. The strain ratio (SR) was calculated based on normal tissue with the relevant region. Results: The average age of 131 patients included in the study was 55.86 ± 13 years, 76 (58%) were male. Two hundred and nineteen lymph nodes were sampled from different stations. Pathological diagnosis of 75 (34.2%) LNs was malignant, the rest was benign. When EBUS B-mode findings and pathological results were compared, sensitivity was 65.33%, specificity 63.19%, positive predictive value (PPV) 48%, negative predictive value (NPV) 77.8%, and diagnostic yield (DY) 64%. When the pathological diagnoses and EBUS elastography findings were compared, while type 1 LNs were considered to be benign and type 3 LNs malignant, sensitivity 94.12%, specificity 86.54%, PPV 82.1%, NPV 95.7%, and DY 89.5%. SR of malignant LNs was significantly higher than benign LNs (p < 0.001). When the classification according to color scale and SR were compared, no difference was found in DY (p = 0.155). Conclusion: The diagnostic accuracy of EBUS elastography is high enough to distinguish malignant LN from benign ones with the SR option. When compared with EBUS-B mode sonographic findings, it was found to have a higher diagnostic yield. [ABSTRACT FROM AUTHOR]

Abstract Background The safety and efficacy of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in patients aged 70 years and older has been established. However, few studies have evaluated the safety, usefulness, and significance of EBUS‐TBNA in patients aged 80 years and older. Methods We retrospectively investigated patients aged 80 years and older who underwent EBUS‐TBNA under local anesthesia. The study period was 10 years; from November 1, 2010 to October 31, 2020. The primary endpoint was the safety of EBUS‐TBNA, which was measured as the incidence of complications associated with the procedure. The secondary endpoints were the overall diagnostic rate, malignant disease diagnosis rate, and malignant disease treatment rate. Results A total of 111 patients were enrolled in the study, and the median age was 82 years (range: 80–89 years). The incidence of complications (the primary endpoint) was 5% (5/111) and comprised oversedation in one case, chest pain in one case, hypoxemia in two cases, and arrhythmia in one case. Regarding the secondary endpoints, the diagnostic rate for all patients was 75% (83/111), and the diagnostic rate of malignant disease was 89% (75/84). Of the 75 patients with malignant disease diagnosed with EBUS‐TBNA, 61 (81%) received tumor‐specific therapy in accordance with their diagnoses. Conclusion EBUS‐TBNA can be considered safe and effective even in patients aged 80 years and older.

Accurate staging for non-small cell lung cancer (NSCLC) is essential to guide therapy. While computed tomography (CT) and positron emission tomography (PET) scan can indicate whether mediastinal lymphadenopathy is present, histologic confirmation is required to complete the staging evaluation. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique associated with similar diagnostic yield and improved postoperative pain and complication rates compared to mediastinoscopy. We share the surgical technique for EBUS-TBNA based on our experience. An 81-year-old man underwent EBUS-TBNA for concurrent tissue diagnosis and mediastinal staging of a hypermetabolic left lower lobe mass and subcarinal lymph node. Our patient had no perioperative complications and was discharged home on the same day. Histologic evaluation demonstrated squamous cell carcinoma in the left lower lobe and subcarinal lymph node. EBUS-TBNA provides histologic confirmation of suspicious mediastinal lymph nodes seen on imaging. Clinicians should consider EBUS-TBNA as a mediastinal staging modality for patients with NSCLC.

Purpose: The diagnosis of tuberculosis located in the peripheral zone remains challenging and requires ultrasound bronchoscopy-guided maneuvers. We assessed the precision of CapitalBio TM Mycobacterium isothermal RNA amplification test (MTB-RNA) using endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary tuberculosis (PTB) and compared it with those of acid-fast bacilli (AFB) smear and MTB culture tests.Mycobacterium tuberculosis isothermal RNA amplification test (MTB-RNA) using endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary tuberculosis (PTB) and compared it with those of acid-fast bacilli (AFB) smear and MTB culture tests., Patients and Methods: This retrospective analysis included 287 patients suspected of peripheral pulmonary tuberculosis who underwent EBUS-GS examinations, medical examination results of AFB smears, MTB culture, CapitalBio MTB test, and MTB-RNA were analyzed. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC), and its diagnostic accuracy for peripheral PTB was evaluated in comparison with the final clinical diagnosis., Results: The overall sensitivity, specificity, PPV, NPV, and AUC of CapitalBio MTB test were 44.83%, 100.00%, 100.00%, 54.07%, and 0.72, respectively; those of MTB-RNA were 22.99%, 100.00%, 100.00%, 45.75%, and 0.61, respectively, and those for parallel test (CapitalBio MTB test or MTB-RNA) were 46.55%, 100.00%, 100.00%, 54.85%, and 0.73, respectively. These values for AFB smear were 9.2%, 97.35%, 84.21%, 41.04%, and 0.53, respectively, and those of MTB culture were 31.03%, 100.00%, 100.00%, 48.50%, and 0.69, respectively., Conclusion: The CapitalBio MTB test showed the best diagnostic performance compared with AFB smear, MTB culture, and MTB-RNA assays and was similar to the parallel test (CapitalBio MTB test or MTB-RNA). The CapitalBio MTB test combined with EBUS-GS had satisfactory diagnostic accuracy for diagnosing peripheral PTB., Competing Interests: All authors declare no conflicts of interest in this work., (© 2024 Zhou et al.)

Abstract Background Pneumothorax is one complication of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS-TBB). We sought to clarify the risk factors for pneumothorax after EBUS-GS-TBB under fluoroscopic guidance. Methods We retrospectively reviewed data from 916 patients who underwent EBUS-GS-TBB at Fujita Health University Hospital. We evaluated the following risk factors for pneumothorax after EBUS-GS-TBB: patient characteristics (sex, age, and pulmonary comorbidities); lesion data (location, size, existence of ground-glass opacities [GGOs], pleural involvement, computed tomography [CT] bronchus sign, visibility on fluoroscopy, and EBUS findings); final diagnosis; years of bronchoscopist experience; and guide sheath size. Univariate and multivariate logistic regression analyses were performed. Results Among the 916 patients, 30 (3.28%) presented with pneumothorax. With a univariate analysis, factors that independently predisposed to pneumothorax included lesions containing GGOs, lesions in sagittal lung segments on fluoroscopy, lesions that were not visible on fluoroscopy, and infectious lesions. A univariate analysis also showed that lesions in the right upper lobe or left upper division, as well as malignant lesions, were less likely to lead to pneumothorax. Age, underlying pulmonary disease, CT bronchus sign, EBUS findings, bronchoscopist experience, and guide sheath size did not influence the incidence of pneumothorax. A multivariate analysis revealed that only lesions containing GGOs (odds ratio [OR] 6.47; 95% confidence interval [CI] 2.13–19.6, P = 0.001) and lesions in lung segments with a sagittal orientation on fluoroscopy (OR 2.47; 95% CI 1.09–5.58, P = 0.029) were significant risk factors for EBUS-GS-TBB-related pneumothorax. Conclusions EBUS-GS-TBB of lesions containing GGOs or lesions located in sagittal lung segments on fluoroscopy correlate with a higher pneumothorax risk.

Background: The safety and efficacy of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in patients aged 70 years and older has been established. However, few studies have evaluated the safety, usefulness, and significance of EBUS‐TBNA in patients aged 80 years and older. Methods: We retrospectively investigated patients aged 80 years and older who underwent EBUS‐TBNA under local anesthesia. The study period was 10 years; from November 1, 2010 to October 31, 2020. The primary endpoint was the safety of EBUS‐TBNA, which was measured as the incidence of complications associated with the procedure. The secondary endpoints were the overall diagnostic rate, malignant disease diagnosis rate, and malignant disease treatment rate. Results: A total of 111 patients were enrolled in the study, and the median age was 82 years (range: 80–89 years). The incidence of complications (the primary endpoint) was 5% (5/111) and comprised oversedation in one case, chest pain in one case, hypoxemia in two cases, and arrhythmia in one case. Regarding the secondary endpoints, the diagnostic rate for all patients was 75% (83/111), and the diagnostic rate of malignant disease was 89% (75/84). Of the 75 patients with malignant disease diagnosed with EBUS‐TBNA, 61 (81%) received tumor‐specific therapy in accordance with their diagnoses. Conclusion: EBUS‐TBNA can be considered safe and effective even in patients aged 80 years and older. [ABSTRACT FROM AUTHOR]

Objectives: : The main objective of this study was to evaluate the procedure characteristics and complication rates of ultrasound-guided endobronchial transbronchial needle aspiration (EBUS-TBNA) performed under conscious sedation (CS) versus general anesthesia (GA). The airway devices used for GA were being evaluated as a secondary aim. Methods: Patients who had EBUS-TBNA at our tertiary hospital’s between January 2017 and December 2021 were retrospectively studied. The study included all participants who were 18 years or older and had no missing medical data. The patients were divided into two groups: Those who had CS and those who had GA. Age, gender, ASA physical status, EBUS-TBNA mean number of lymph node (LN) per patient, and complications during the procedure were compared between groups. Results: There were 454 patients (58.7%) in the CS group and 319 patients (41.3%) in the GA group in our sample of 773 patients. Classical laryngeal mask airway (LMA) (92.1%) was the most common in the GA group, whereas number 4 LMA (71.7%) was the most preferred in LMA. In EBUS-TBNA, the average number of aspirated LN procedures per patient was greater in the GA group than in the CS group (1.63 vs.1.32). Complications were more common in the CS group than in the GA group (9.7% vs. 4.4%). Conclusion: The GA approach in EBUS-TBNA was shown to be more successful and safer than the CS approach in terms of number of LNs per patient and complication rates. We also determined that the classic LMA is an appropriate airway device in EBUS-TBNA. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately. Materials and Methods: Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol. Results: Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%). Conclusion: EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert.

Pulmonary manifestations of rheumatic diseases are common and lead to significant morbidity. Rheumatic diseases can affect the lung parenchyma, the interstitium, airways, pleura as well as the mediastinum. The pulmonary manifestation can be a part of the active disease, or be because of infectious complications, drug-induced changes, or pulmonary manifestations of other organ failure. It is hence important to diagnose early and appropriately, and treat aggressively. Interventional Pulmonology, a subspecialty of pulmonary medicine helps in diagnosis of these pulmonary manifestations. Interventional pulmonology procedures also help to treat central airway obstruction. Various modalities like bronchoscopy, endobronchial ultrasonography and thoracoscopy are now available. This article focuses on these modalities, the procedures which can be performed (bronchoalveolar lavage, endobronchial biopsy, forceps and cryo transbronchial lung biopsies, transbronchial needle aspiration) and the indications for the same.

Hong-Yan Ren,1 Xiao-Ju Zhang,1 Kun Zhang,2 Tian-Xiao Li,2 Bu-Lang Gao,2 Zheng-Xian Chen3 1Department of Respiratory and Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China; 2Department of Interventional Therapy, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China; 3Department of Respiratory Medicine, Zhongshan University Sixth Affiliated Hospital, Guangzhou, Guangdong, People’s Republic of ChinaCorrespondence: Tian-Xiao Li Tel +8615981836911Email syylitianxiao@126.comIntroduction: This study was to develop a simple model for predicting malignancy of peripheral pulmonary lesions (PPLs) based on endobronchial ultrasonography (EBUS) and clinical findings.Methods: Patients who had EBUS for PPLs were analyzed and compared on the EBUS imaging characteristics and clinical data. The malignancy prediction model was established by the logistic equation of probability of malignant PPL based on the data of 135 patients. The model was tested on an additional 50 patients for efficiency.Results: Among 135 prospectively enrolled patients, 77 (57%) patients had malignant and 58 (43%) had benign lesions with the size of 36.5± 19.9 mm. Univariate analysis demonstrated a significant (P< 0.05) difference in the serum CEA (borderline 15 μg/mL) and smoking history between malignant and benign lesions but a non-significant (P> 0.05) difference in age (50 years as the cutoff value) and history of extra-thoracic malignancies. Logistic analysis of multiple factors showed that smoking history, serum CEA, borderline, air bronchogram, heterogeneous echo, and anechoic areas were significant (P< 0.02) risk factors for malignant lesions. The malignancy prediction model was established by the logistic equation of probability of malignant PPL (P) = l/[l+e–Z], where Z=− 2.986+1.993X1+2.293X2+l.552X3+1.616X4– 2.011X5+1.718X6, e is the base of the natural logarithm, X1 is the smoking history, X2 is the serum CEA, X3 is the borderline, X4 is the heterogenicity, X5 is the air bronchogram, and X6 is the anechoic area. The receiver operating characteristic curve had an area under the curve (AUC) of 0.926 (95% confidence interval: 0.883– 0.969). The sensitivity, specificity, and accuracy were 88.2% (30/34), 75.0% (12/16), and 92.0% (46/50), respectively, for the logistic equation to predict the malignancy.Conclusion: Endobronchial ultrasonography is a safe and practical method, and the model combining EBUS and clinical data can accurately predict the malignancy of peripheral pulmonary lesions.Keywords: endobronchial ultrasonography, peripheral pulmonary lesions, malignancy, benign, prediction model

Introduction: Transbronchial needle aspiration guided by endobronchial ultrasonography (EBUSTBNA) has the disadvantage of sometimes offering samples of an unsuitable size for an accurate histo-molecular diagnosis. Transbronchial mediastinal cryobiopsy (CRYOEBUS) is a very novel and additional technique to EBUS-TBNA that allows us to obtain larger and quality samples, improving diagnostic performance., Material and Methods: Descriptive study of 110 patients with lesions and/or mediastinal lymphadenopathy who underwent EBUS-TBNA and CRYO-EBUS in a single procedure. Our objective was to analyze the diagnostic profitability and safety of the technique., Results: CRYO-EBUS obtained samples of 0.42cm on average compared to 0.14cm obtained by EBUS-TBNA. The overall diagnostic performance of the techniques was 60% for EBUS-TBNA and 94.5% for CRYO-EBUS. Furthermore, the latter was more sensitive for the diagnosis of both malignant and benign diseases. With a very high security profile., Conclusions: The CRYO-EBUS technique is cost-effective and safe, and is superior to EBUS-TBNA. Future studies may confirm our findings., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Pulmonary manifestations of rheumatic diseases are common and lead to significant morbidity. Rheumatic diseases can affect the lung parenchyma, the interstitium, airways, pleura as well as the mediastinum. The pulmonary manifestation can be a part of the active disease, or be because of infectious complications, drug-induced changes, or pulmonary manifestations of other organ failure. It is hence important to diagnose early and appropriately, and treat aggressively. Interventional Pulmonology, a subspecialty of pulmonary medicine helps in diagnosis of these pulmonary manifestations. Interventional pulmonology procedures also help to treat central airway obstruction. Various modalities like bronchoscopy, endobronchial ultrasonography and thoracoscopy are now available. This article focuses on these modalities, the procedures which can be performed (bronchoalveolar lavage, endobronchial biopsy, forceps and cryo transbronchial lung biopsies, transbronchial needle aspiration) and the indications for the same. [ABSTRACT FROM AUTHOR]

Objective: The accuracy of rapid on-site evaluation (ROSE) during endobronchial ultrasonography with guide sheath (EBUS-GS) was reported to be approximately 90% for diagnosing small peripheral pulmonary lesions (PPLs). When ROSE during EBUS-GS for diagnosing small peripheral lung cancer is carried out and does not include malignant cells in a position whereby the probe was located within or adjacent to the lesion, the best technique for overcoming the lower diagnostic yield remains unknown. This study aimed to evaluate factors affecting positive results of ROSE during EBUS-GS in such a probe position. Moreover, when the results of ROSE were consistently negative, we evaluated the effectiveness of conventional transbronchial biopsy (TBB) in addition to EBUS-GS alone. Methods: We performed a retrospective analysis of consecutive patients who underwent EBUS-GS combined with ROSE for diagnosing small peripheral lung cancer (≤30 mm). We classified the results of ROSE into two groups based on the presence of malignant cells: the ROSE positive group (included malignant cells) and the ROSE negative group (did not include malignant cells). The significant predictors of positive ROSE results during EBUS-GS were analyzed using multivariate logistic regression analyses. Results: We identified 67 lesions (43 lesions in the ROSE positive group and 24 lesions in the ROSE negative group, respectively). Multivariate logistic analysis revealed that the significant factor affecting positive ROSE results was lesion size (>15 mm) (OR = 9.901). The diagnostic yield of additional conventional TBB to EBUS-GS was significantly higher than that of EBUS-GS alone (75.0% vs 33.3%, P =.041). Conclusion: The positive results of ROSE during EBUS-GS were significantly influenced by lesion size (>15 mm). When the results of ROSE during EBUS-GS were consistently negative in a position whereby the probe was located within or adjacent to the lesion, additional conventional TBB was effective to improve the diagnostic yield compared with EBUS-GS alone. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe procedure with high diagnostic yield. However, complications related to EBUS-TBNA procedures are increasingly being reported. Common complications of EBUSTBNA include infectious complications, pneumothorax, bleeding, and pneumomediastinum. Although the frequency of complications varies among studies, complication rates are quite rare (0.15 - 1.44%). One of the rare complications of EBUS-TBNA is the appearance of nodular lesions at the tracheobronchial puncture sites following EBUS-TBNA, namely "tracheobronchial puncture site nodular reaction" (TPNR). Here, we present three cases of TPNR, two of which were diagnosed with granulation tissue and one with malignancy. A biopsy must be taken in cases presenting with nodular lesion after EBUS. [ABSTRACT FROM AUTHOR]

INTRODUCTION[|]The aim of this study was to investigate the diagnostic value of endobronchial ultrasonography (EBUS) and factors associated with diagnosis in patients with lung sarcoidosis. [¤]METHODS[|]In this prospective study, EBUS transbronchial needle aspiration (TBNA) was performed for patients with a clinical and radiological suspicion of pulmonary sarcoidosis with enlarged hilar/mediastinal lymph nodes detected on a computerized tomography scan of the chest between January 2014 and September 2015. [¤]RESULTS[|]During the study period, 107 patients underwent EBUS-TBNA and 1 patient underwent transesophageal endoscopic ultrasonography with fine needle aspiration (EUS-FNA). Four cases determined to be non-sarcoidosis (tuberculosis) were excluded from the study. Of the 104 cases definitively diagnosed as sarcoidosis, 28.8% were male patients and 71.2% were female, with a mean age of 44.3+-13.1 years. A total of 92.3% of the patients (n=96) were diagnosed with EBUS-TBNA and 1% (n=1) was diagnosed based on EUS-FNA results. EBUS was nondiagnostic in 7 patients and sarcoidosis was diagnosed by mediastinoscopy in 6 patients and by right supraclavicular lymph node biopsy in 1 patient. The sensitivity of EBUS-TBNA was 92.3%, with a specificity of 100%. [¤]DISCUSSION AND CONCLUSION[|]EBUS-TBNA has a high sensitivity and specificity for demonstrating granulomatous inflammation in cases of suspected sarcoidosis. Given the high diagnostic rate of EBUS-TBNA, additional invasive procedures may be unnecessary.[¤]

Abstract A 28‐year‐old man had a cavitary lesion in the upper right lobe with a tree‐in‐bud appearance on chest computed tomography (CT). Diagnostic bronchoscopy was performed. An ultrathin bronchoscope in the right B2aiiβxyy reached the cavity. We filled the cavity with saline under direct bronchoscopic visualization. We suspected a blood vessel was present in the cavity wall based on narrow‐band imaging. Bronchial lavage of the cavity was performed. Next, endobronchial ultrasonography (EBUS) using a guide sheath was performed with a thin bronchoscope. EBUS showed a pulsating blood vessel in the cavity wall. Bronchial lavage collected with ultrathin and thin bronchoscopy revealed Mycobacterium kansasii. Observation of vessels in the wall of a cavitary lesion with ultrathin bronchoscopy and EBUS may be useful for avoiding severe bleeding associated with biopsy of a cavitary lesion.

Abstract Invasive mucinous adenocarcinoma (IMA), which is a relatively rare lung adenocarcinoma, is considered a high‐grade subtype and is associated with a poor prognosis. IMA is difficult to diagnose by computed tomography because it requires differentiation from inflammatory diseases, such as atelectasis, infectious pneumonia, and organizing pneumonia. Thus far, no reports of radial endobronchial ultrasonography (EBUS) findings in IMA have been published. This article presents a case of IMA with a characteristic shadow, snowball‐like appearance on radial EBUS in a 67‐year‐old Japanese man.

• Endobronchial Ultrasonography (EBUS) and mediastinoscopy are used for mediastinal lymph node staging in patients with suspected non-small cell lung carcinoma (NSCLC). • This study provides insight in EBUS and mediastinoscopy performances in patients with proven NSCLC from January 2007 until January 2019. • The past nine years, none of confirmatory mediastinoscopies was tumor positive after negative EBUS results. • In our institute, confirmatory mediastinoscopy has no added value after tumor negative EBUS procedures, and has been abandoned as standard procedure. Endobronchial Ultrasonography (EBUS) and mediastinoscopy are used for mediastinal lymph node staging in patients with suspected non-small cell lung carcinoma (NSCLC). In our hospital, confirmatory mediastinoscopy has been largely abandoned, which may reduce the number of surgical interventions and health care costs. This study provides insight into EBUS and mediastinoscopy performance in patients with proven NSCLC from January 2007 until January 2019. This is a single-centre, retrospective study, evaluating unforeseen N2 rates, negative predictive value and survival, providing insight into the diagnostic yield of EBUS and mediastinoscopy. Surgical lung resection with lymph node dissection was used as reference. A total of 418 patients with proven NSCLC after lung resection (mean age: 66 years; 61 % male) and 118 patients who underwent mediastinoscopy, have been included in the study. The overall prevalence of N2 metastases after lung resection was 10.5 %. The percentage of unforeseen N2 cases after negative EBUS was 14.5 %, and 14.3 % after negative mediastinoscopy. Over the past nine years, none of the confirmatory mediastinoscopies were tumor positive after negative EBUS results. The median survival in patients with surgically confirmed N2 metastases was 33 months, compared to 23 months in patients with EBUS/mediastinoscopy-proven N2 metastases. Despite optimisation of mediastinal staging procedures, it remains difficult to identify all patients with N2 metastases in the workup of NSCLC. In our institute, confirmatory mediastinoscopy has no added value after tumor-negative EBUS procedures, and has been abandoned as standard procedure. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax is one complication of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS-TBB). We sought to clarify the risk factors for pneumothorax after EBUS-GS-TBB under fluoroscopic guidance.Methods: We retrospectively reviewed data from 916 patients who underwent EBUS-GS-TBB at Fujita Health University Hospital. We evaluated the following risk factors for pneumothorax after EBUS-GS-TBB: patient characteristics (sex, age, and pulmonary comorbidities); lesion data (location, size, existence of ground-glass opacities [GGOs], pleural involvement, computed tomography [CT] bronchus sign, visibility on fluoroscopy, and EBUS findings); final diagnosis; years of bronchoscopist experience; and guide sheath size. Univariate and multivariate logistic regression analyses were performed.Results: Among the 916 patients, 30 (3.28%) presented with pneumothorax. With a univariate analysis, factors that independently predisposed to pneumothorax included lesions containing GGOs, lesions in sagittal lung segments on fluoroscopy, lesions that were not visible on fluoroscopy, and infectious lesions. A univariate analysis also showed that lesions in the right upper lobe or left upper division, as well as malignant lesions, were less likely to lead to pneumothorax. Age, underlying pulmonary disease, CT bronchus sign, EBUS findings, bronchoscopist experience, and guide sheath size did not influence the incidence of pneumothorax. A multivariate analysis revealed that only lesions containing GGOs (odds ratio [OR] 6.47; 95% confidence interval [CI] 2.13-19.6, P = 0.001) and lesions in lung segments with a sagittal orientation on fluoroscopy (OR 2.47; 95% CI 1.09-5.58, P = 0.029) were significant risk factors for EBUS-GS-TBB-related pneumothorax.Conclusions: EBUS-GS-TBB of lesions containing GGOs or lesions located in sagittal lung segments on fluoroscopy correlate with a higher pneumothorax risk. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately. Materials and Methods: Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol. Results: Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%). Conclusion: EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert. [ABSTRACT FROM AUTHOR]

Background/aim: The aim of this study is to evaluate the effects of preemptive oral pregabalin on hemodynamic response, anxiety, sedation, and recovery in patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under sedation with intravenous ketamine-propofol combination. Materials and methods: Sixty patients were included in this study, and patients were randomly divided into two equal groups to receive the placebo (Group 1) versus pregabalin 150 mg (Group 2) one hour prior to EBUS- TBNA procedure. Patients received 0.25 mg kg-1 ketamine and 0.25 mg kg-1 propofol mixture (ketofol) for sedation. Timing of the parameters was defined as follows; T0: in hospital ward before pregabalin or placebo administration, T1: premedication, T2: in operating room, T3: before the procedure, T4: initiation, T5: 3 min after induction, T6: 6 min after induction, T7: 9 min after induction, and T8: 12 min after induction. Hemodynamic parameters, severity of coughing, sedation and anxiety scores, and complications were recorded. The level of satisfaction of the bronchoscopist and the patients were evaluated at the end of the procedure. Results: The heart rate and mean arterial pressure were significantly higher in Group 1 (P = 0.008, P = 0.04). Total doses of anesthetics, recovery time, and desaturation rate were significantly higher in Group 1 (P = 0.014, P = 0.001, P = 0.045). In Group 2, SpO2 level was significantly higher at various time periods (T1; P = 0.025, T4; P =0.043, T6; P = 0.001, T7; P = 0.003, T8; P < 0.001). The severity of coughing was found significantly lower in Group 2 (T4; P = 0.011, T5; P = 0.01, T6; P = 0.02, T7; P = 0.03, T8; P < 0.01). Anxiety scores were significantly lower in Group 2 (P < 0.001). Conclusion: Preemptive oral pregabalin, in addition to sedation with ketamine-propofol combination, was effective in providing limited hemodynamic response, restricted coughing reflex, and lower anxiety during EBUS-TBNA. Besides, with pregabalin usage, decreased anesthetics consumption, lower complication rate, and shorter recovery time might have contributed to safety of the procedure and comfort of the bronchoscopist. [ABSTRACT FROM AUTHOR]

Background: Whether the indications and diagnostic yield of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) vary according to the socioeconomic status of the patient, remains unknown. Herein, we evaluate this aspect in participants who underwent EBUS-TBNA. Materials and Methods: This is a retrospective analysis of all participants who underwent EBUS-TBNA for the evaluation of intrathoracic lymphadenopathy. We evaluated the indications and outcome of EBUS-TBNA in participants with and without economic disadvantage (issuance of a below poverty line card by the government). Results: Of the EUBUS procedures performed on 1582 participants (mean [standard deviation] age, 46.1 [15.7] years; 593 [37.5%] women) performed during the study, 61 (3.9%) were done in the economically disadvantaged (ED) group. Individuals in the ED group were younger (median age, 40 vs. 46 years; P = 0.002) and more likely to have tuberculosis (42.6% vs. 26.2%, P = 0.005) or malignancy (39.3% vs. 26.9%, P = 0.032) as a presumptive diagnosis. The overall diagnostic yield of EBUS was 63% and was significantly lower in the ED group (49.2% vs. 63.5%, P = 0.023). Previously used EBUS-TBNA needles were more commonly employed in the ED participants (62.7% vs. 20.1%, P < 0.001). On multivariate logistic regression analysis, younger age, larger size, and number of nodes sampled, and the use of new (versus reused) needles were independent predictors of higher diagnostic yield. There was no difference in the complication rate between the two groups. Conclusion: The diagnostic yield of EBUS was significantly lower in the ED participants, which is due to the differences in the clinical and procedural characteristics.

The COVID-19 pandemic is the first and most challenging health condition in the 21st century. The number of patients confirmed with COVID-19 disease worldwide is now above one million, and the number of deaths is increasing day by day. Bronchoscopy is a procedure used for the diagnosis and treatment of various conditions, but it can also transmit disease if appropriate precautions are not followed. In this short review, the limited scientific knowledge about bronchoscopy in COVID-19 pneumonia and the precautions which should be performed are summarized. [ABSTRACT FROM AUTHOR]

Photodynamic therapy has been considered as the first choice of treatment for central-type early-stage lung cancer. Recent advances in the comprehensive diagnosis of central-type early-stage lung cancer and the selection of a good indication for photodynamic therapy have been anticipated to improve the therapeutic outcome of this type of early-stage lung cancer. In terms of enrollment, evaluation of the tumor area on the bronchial surface and the depth of invasion in the bronchial wall is important. Autofluorescence bronchoscopy and endobronchial ultrasonography have shown considerable impact on diagnostic bronchoscopy for this type of lung cancer. In terms of size, central-type early-stage lung cancer of < 1 cm diameter has shown a favorable cure rate by photodynamic therapy. The development of photodynamic therapy with a new photosensitizer is expected to further expand its indications to encompass even large tumors of > 1.0 cm diameter owing to its stronger effect. We postulate that the indication of photodynamic therapy will expand to larger central tumors together with a possible therapeutic option for peripheral early cancer. [ABSTRACT FROM AUTHOR]

Abstract Background Transbronchial biopsy for peripheral pulmonary lesions is generally performed under X-ray fluoroscopy. Virtual bronchoscopic navigation (VBN) is a method in which virtual images of the bronchial route to the lesion are produced based on CT images obtained before VBN, and the bronchoscope is guided using these virtual images, improving the diagnostic yield of peripheral pulmonary lesions. VBN has the possibility of eliminating the need for X-ray fluoroscopy in the bronchoscopic diagnosis of peripheral lesions. To determine whether VBN can be a substitute for X-ray fluoroscopy, a randomized multicenter trial (non-inferiority trial) was performed in VBN and X-ray fluoroscopy (XRF) -assisted groups. Methods The non-inferiority margin in the VBN-assisted group compared with the XRF-assisted group was set at 15%. The subjects consisted of 140 patients with peripheral pulmonary lesions with a mean diameter > 3 cm. In the VBN-assisted group, the bronchoscope was guided to the lesion using a VBN system without X-ray fluoroscopy. In the XRF-assisted group, the same bronchoscope was guided to the lesion under X-ray fluoroscopy. Subsequently, in both groups, the lesion was visualized using endobronchial ultrasonography with a guide sheath (EBUS/GS), and biopsy was performed. In this serial procedure, X-ray fluoroscopy was not used in the VBNA group. Results The subjects of analysis consisted of 129 patients. The diagnostic yield was 76.9% (50/65) in the VBN-assisted group and 85.9% (55/64) in the XRF-assisted group. The difference in the diagnostic yield between the two groups was -9.0% (95% confidence interval: -22.3% ~ 4.3%). The non-inferiority of the VBN-assisted group could not be confirmed. The rate of visualizing lesions by EBUS was 95.4% (62/65) in the VBN-assisted group and 96.9% (62/64) in the XRF-assisted group, being high in both groups. Conclusions On EBUS/GS, a bronchoscope and biopsy instruments may be guided to the lesions using VBN without X-ray fluoroscopy, but X-ray fluoroscopy is necessary to improve the accuracy of sample collection from lesions. During transbronchial biopsy for peripheral pulmonary lesions, VBN cannot be a substitute for X-ray fluoroscopy. Trial registration UMIN-CTR (UMIN000001710); registered 16 February 2009.

We evaluated the usefulness of endobronchial ultrasonography with guide sheath (EBUS-GS) for the diagnosis of peripheral pulmonary lesions (PPLs) in Japan. We searched the PubMed/Medline database using the keywords "EBUS guide sheath" for Japanese studies on EBUS-GS published between January 2004 and August 2023. We included 32 original articles that evaluated the diagnostic yield of EBUS-GS for PPLs. Case reports and conference abstracts were excluded due to limited information available for quality assessment. The diagnostic yield of EBUS-GS was 73.6% for 2996 malignant lesions, 65.4% for 752 ground-glass nodules, 59.4% for 414 benign lesions, 61.3% for 1114 lesions of size ≤2 cm, and 75.6% for 1246 lesions of size >2 cm; it was 69.4% for lesions located in the upper lobe (n=793), 71.9% for the middle lobe/lingula (n=121), and 62.5% for the lower lobe (n=334). None of the patients experienced severe complications. In this review, EBUS-GS is effective for the diagnosis of malignant and benign PPLs. A multimodality approach is needed to further enhance its diagnostic performance., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Minami et al.)

Objective: The aim of this study was to investigate the diagnostic value of endobronchial ultrasonography (EBUS) and factors associated with diagnosis in patients with lung sarcoidosis. Methods: In this prospective study, EBUS transbronchial needle aspiration (TBNA) was performed for patients with a clinical and radiological suspicion of pulmonary sarcoidosis with enlarged hilar/mediastinal lymph nodes detected on a computerized tomography scan of the chest between January 2014 and September 2015. Results: During the study period, 107 patients underwent EBUS-TBNA and 1 patient underwent transesophageal endoscopic ultrasonography with fine needle aspiration (EUS-FNA). Four cases determined to be non-sarcoidosis (tuberculosis) were excluded from the study. Of the 104 cases definitively diagnosed as sarcoidosis, 28.8% were male patients and 71.2% were female, with a mean age of 44.3±13.1 years. A total of 92.3% of the patients (n=96) were diagnosed with EBUS-TBNA and 1% (n=1) was diagnosed based on EUS-FNA results. EBUS was nondiagnostic in 7 patients and sarcoidosis was diagnosed by mediastinoscopy in 6 patients and by right supraclavicular lymph node biopsy in 1 patient. The sensitivity of EBUS-TBNA was 92.3%, with a specificity of 100%. Conclusion: EBUS-TBNA has a high sensitivity and specificity for demonstrating granulomatous inflammation in cases of suspected sarcoidosis. Given the high diagnostic rate of EBUS-TBNA, additional invasive procedures may be unnecessary. [ABSTRACT FROM AUTHOR]

A 28‐year‐old man had a cavitary lesion in the upper right lobe with a tree‐in‐bud appearance on chest computed tomography (CT). Diagnostic bronchoscopy was performed. An ultrathin bronchoscope in the right B2aiiβxyy reached the cavity. We filled the cavity with saline under direct bronchoscopic visualization. We suspected a blood vessel was present in the cavity wall based on narrow‐band imaging. Bronchial lavage of the cavity was performed. Next, endobronchial ultrasonography (EBUS) using a guide sheath was performed with a thin bronchoscope. EBUS showed a pulsating blood vessel in the cavity wall. Bronchial lavage collected with ultrathin and thin bronchoscopy revealed Mycobacterium kansasii. Observation of vessels in the wall of a cavitary lesion with ultrathin bronchoscopy and EBUS may be useful for avoiding severe bleeding associated with biopsy of a cavitary lesion. [ABSTRACT FROM AUTHOR]

Invasive mucinous adenocarcinoma (IMA), which is a relatively rare lung adenocarcinoma, is considered a high‐grade subtype and is associated with a poor prognosis. IMA is difficult to diagnose by computed tomography because it requires differentiation from inflammatory diseases, such as atelectasis, infectious pneumonia, and organizing pneumonia. Thus far, no reports of radial endobronchial ultrasonography (EBUS) findings in IMA have been published. This article presents a case of IMA with a characteristic shadow, snowball‐like appearance on radial EBUS in a 67‐year‐old Japanese man. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer-related mortality worldwide. A low cure rate of lung cancer is not only attributed to intrinsic aggressive biological behavior, but also little attention to lung cancer screening. With lung screening methods continuous progress, peripheral pulmonary lesions detection rate gradually increased. Currently, a transbronchial approach using a bronchoscope or computed tompgraphy (CT) guided transthoracic needle aspiration/biopsy have been the most generally accepted methods for diagnosing peripheral pulmonary lesions. However, conventional bronchoscopy has a poor diagnostic yield and CT-guided approach has high rates of pneumothorax for such peripheral pulmonary lesions. Therefore, clinicians will be challenged with the task of providing the means to provide a safe and minimally invasive method of obtaining accurate tissue diagnostics for the pulmonary peripheral lesions. New bronchoscopic interventional diagnosis technologies have recommended in clinical gradually. They can effectively improve the peripheral pulmonary lesions diagnosis rate, shorten the time of diagnosis, and make the patients get timely and effective treatment. In this paper, we reviewed briefly available technologies to aid clinicians in attempts at minimally invasive techniques.

This report describes a case of guide sheath breakage during endobronchial ultrasonography. While steering the guide sheath in the direction of a peripheral lung nodule using a guiding device/curette, the radiopaque band (RB) attached to the head of the guide sheath dislodged and remained in the peripheral bronchus near the tumour. The band could not be removed endoscopically. As the tumour was diagnosed as a colon cancer metastasis, we performed a partial lung resection to remove the RB and nodule together four months after bronchoscopy. [ABSTRACT FROM AUTHOR]

Background: Radial-probe endobronchial ultrasound (RP-EBUS) is predominantly used clinically for the localisation of peripheral pulmonary lesions prior to biopsy. However, the RP-EBUS image itself contains information that can characterise the aetiology of lesions. Objectives: The aim of this study was to show the utility of RP-EBUS image analysis using unconstrained regions of interest (ROIs) that utilise more image information and eliminate ROI selection bias. Methods: We developed custom software to analyse RP-EBUS images digitally captured during clinical procedures. Unconstrained ROIs were mapped onto lesions. We computed first-order greyscale image statistics of minimum, maximum, mean, standard deviation and range of pixel intensities, and entropy. We also computed second-order greyscale texture features of contrast, correlation, energy and homogeneity. The results of image analysis were compared to gold-standard tissue diagnosis. Features from expert- and non-expert-defined ROIs were also compared. Results: Eighty-five images were analysed (38 benign and 47 malignant). Five greyscale features were significantly different between benign and malignant lesions. Benign lesions had higher mean (p < 0.01) and maximal (p < 0.001) intensity, greater range (p < 0.001) of pixel intensities and greater entropy (p < 0.01). The highest positive predictive values were associated with maximal (87.8%) and range of pixel (83.8%) intensities. There were no significant differences between expert- and non-expert-defined ROIs. Conclusion: RP-EBUS image analysis using unconstrained ROIs eliminates ROI selection bias and can characterise benign and malignant lesions with an accuracy of up to 85%. [ABSTRACT FROM AUTHOR]

Background: Whether the indications and diagnostic yield of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) vary according to the socioeconomic status of the patient, remains unknown. Herein, we evaluate this aspect in participants who underwent EBUS-TBNA. Materials and Methods: This is a retrospective analysis of all participants who underwent EBUS-TBNA for the evaluation of intrathoracic lymphadenopathy. We evaluated the indications and outcome of EBUS-TBNA in participants with and without economic disadvantage (issuance of a below poverty line card by the government). Results: Of the EUBUS procedures performed on 1582 participants (mean [standard deviation] age, 46.1 [15.7] years, 593 [37.5%] women) performed during the study, 61 (3.9%) were done in the economically disadvantaged (ED) group. Individuals in the ED group were younger (median age, 40 vs. 46 years, P = 0.002) and more likely to have tuberculosis (42.6% vs. 26.2%, P = 0.005) or malignancy (39.3% vs. 26.9%, P = 0.032) as a presumptive diagnosis. The overall diagnostic yield of EBUS was 63% and was significantly lower in the ED group (49.2% vs. 63.5%, P = 0.023). Previously used EBUS-TBNA needles were more commonly employed in the ED participants (62.7% vs. 20.1%, P < 0.001). On multivariate logistic regression analysis, younger age, larger size, and number of nodes sampled, and the use of new (versus reused) needles were independent predictors of higher diagnostic yield. There was no difference in the complication rate between the two groups. Conclusion: The diagnostic yield of EBUS was significantly lower in the ED participants, which is due to the differences in the clinical and procedural characteristics. [ABSTRACT FROM AUTHOR]

Background: Sarcoidosis and Mediastinal Tuberculous Lymphadenitis (MTLA) are two granulomatous diseases. Differentiation between these two diseases is dependent on clinical presentation, microbiological investigation, and cytopathological examination. In endemic regions, differential diagnosis of MTLA and sarcoidosis might be difficult. Endobronchial ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is a new diagnostic procedure for the diagnosis of mediastinal lymphadenopathy. EBUS not only enables the sampling of Lymph Nodes (LN), but also visualization of sonographic features of them. We hypothesized that the sonographic features of LN may help to differentiate MTLA from sarcoidosis. Materials and Methods: This is a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent EBUS-TBNA and were finally diagnosed as sarcoidosis or MTLA. Size, shape, margin, echogenicity, and coagulation necrosis were compared between the groups. Results: A total of 257 LNs (215 sarcoidosis, 42 MTLA) were examined in 101 patients. A heterogeneous echotexture of lymph nodes was significantly more common (P <0.0001) in MTLA (69%) than sarcoidosis (36.2%). Also, necrosis was statistically significantly higher in MTLA compared to sarcoidosis (P<0.0001). The vascular pattern was similar in both groups (P=0.9050). Nearly half of the patients had grade 1 vascular pattern in both groups. The odds for diagnosis of MTLA were significantly higher in the presence of heterogeneous echotexture (odds ratio [OR], 7,00) or necrosis sign (OR, 131,2). Conclusion: Vascular patterns of two diseases were similar. Heterogeneous echotexture and necrosis sign in the LNs on EBUS are specific for MTLA. Combination of these findings with a positive tuberculin skin test, favors the diagnosis of MTLA over sarcoidosis. [ABSTRACT FROM AUTHOR]

Objectives: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary method for the diagnosis and staging of lung cancer. The purpose of this study was to assess the yield of EBUS-TBNA in the subtyping and genotyping of lung adenocarcinoma.Methods: Sixty-nine patients at Indiana University Hospital and Sidney and Lois Eskenazi Hospital with possible or confirmed lung adenocarcinoma underwent EBUS-TBNA using a 21-gauge Olympus needle without suction. Samples were sent for molecular testing after rapid onsite specimen evaluation. A total of 6 to 10 passes were placed in a cell block.Results: Sixty-nine samples from patients with non-small-cell lung cancer were sent for molecular testing for epidermal growth factor receptor. Results were obtained in all of the patients. Mutations were found in three patients (4.3%). Fifty-eight samples were sent for V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (100% yield), 10 of which had mutations (17.2%). Fifty-one samples were sent for proto-oncogene tyrosine-protein kinase ROS testing (1 [7.8%] mutant). Tissue samples were inadequate in three patients (94.1% yield). Sixty-three samples were sent for anaplastic lymphoma receptor tyrosine kinase testing (3 [4.8%] mutant, 6 [9.5%] inadequate, 90.5% yield).Conclusions: EBUS-TBNA with a 21-gauge needle is appropriate for the analysis of multiple mutations and the genotyping of lung adenocarcinoma. [ABSTRACT FROM AUTHOR]