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Noriaki Kurimoto - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Endobronchial Ultrasonography Images and Resected Specimens
Bronchial Branch Tracing, 2020Co-Authors: Noriaki Kurimoto, Katsuhiko MoritaAbstract:The objectives of performing Endobronchial Ultrasonography (EBUS) with a guide sheath (EBUS-GS) to examine pulmonary peripheral lesions can be broadly divided into “confirming the presence of a lesion” and “understanding its internal properties.” Since sampling lesion tissue is essential for pathological diagnosis, concerns have been raised that EBUS tends to be used solely to confirm whether or not a lesion is present.
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Endobronchial Ultrasonography (EBUS) using a radial ultrasound miniature probe for peripheral pulmonary lesions: tips and techniques
Current Pulmonology Reports, 2016Co-Authors: Noriaki Kurimoto, Haruhiko NakamuraAbstract:Background When bronchoscopy is performed for peripheral pulmonary lesions (PPLs), a radial ultrasound mini-probe can be inserted from the working channel of the bronchoscope to reach the PPL. Objectives This paper discussed the technique and advantages of diagnosing PPLs using mini-probe. Mini-probe scanning from within a bronchial lumen provides a short-axis image of a PPL. Results Internal structures within PPLs that can be identified by Endobronchial Ultrasonography (EBUS) include patent blood vessels, patent bronchi, hemorrhage, calcifications, bronchi filled with sputum, necrosis, and small amounts of air in pulmonary alveoli. PPLs are classified as type I if the internal echoes are homogeneous, type III if the internal echoes are heterogeneous, and type II if there are mainly hyperechoic lines and dots near the probe. About 92 % of type I lesions were benign, whereas 99 % of type II and type III lesions were malignant. Conclusion There are several techniques of EBUS using a guide sheath (EBUS-GS) for getting adequate specimens of PPLs.
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histogram based quantitative evaluation of Endobronchial Ultrasonography images of peripheral pulmonary lesion
Respiration, 2015Co-Authors: Kei Morikawa, Noriaki Kurimoto, Takeo Inoue, Masamichi Mineshita, Teruomi MiyazawaAbstract:Background: Endobronchial Ultrasonography using a guide sheath (EBUS-GS) is an increasingly common bronchoscopic technique, but currently, no methods have been established to quantitatively evaluate EBUS images of peripheral pulmonary lesions. Objectives: The purpose of this study was to evaluate whether histogram data collected from EBUS-GS images can contribute to the diagnosis of lung cancer. Methods: Histogram-based analyses focusing on the brightness of EBUS images were retrospectively conducted: 60 patients (38 lung cancer; 22 inflammatory diseases), with clear EBUS images were included. For each patient, a 400-pixel region of interest was selected, typically located at a 3- to 5-mm radius from the probe, from recorded EBUS images during bronchoscopy. Histogram height, width, height/width ratio, standard deviation, kurtosis and skewness were investigated as diagnostic indicators. Results: Median histogram height, width, height/width ratio and standard deviation were significantly different between lung cancer and benign lesions (all p Conclusions: Histogram standard deviation appears to be the most useful characteristic for diagnosing lung cancer using EBUS images.
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Diagnosis of peripheral lung lesions (PPLs) by Endobronchial Ultrasonography, with guide sheath transbronchial biopsy
THE BANGKOK MEDICAL JOURNAL, 2011Co-Authors: Sawang Saenghirunvattana, Surapol Israpaibool, Chana Buakham, Noriaki KurimotoAbstract:OBJECTIVE. To study the effectiveness of Endobronchial Ultrasonography (EBUS) with Guide Sheath (GS) in detecting peripheral lung lesions. MATERIALS AND METHODS. Between January and March 2011, 8 patients gave their informed consent to EBUS with GS being performed. RESULTS. In 7 patients (87.5%) EBUS detected the PPLs. CONCLUSION. EBUS is a useful and accurate tool for diagnosis of PPL.
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Airway measurements in tracheobronchial stenosis using Endobronchial Ultrasonography during stenting
European Respiratory Journal, 2011Co-Authors: Seiichi Nobuyama, Noriaki Kurimoto, Naoki Furuya, Hiroshi Handa, Hiroki Nishine, Teruomi MiyazawaAbstract:Purpose: To assess airway measurements, Endobronchial Ultrasonography (EBUS) and multi-detector low computed tomography (MDCT) images are compared in patients with tracheal stenosis. Methods: Airway stenting was performed on 31 patients, 25 malignant and 6 benign. EBUS and MDCT images were compared before intervention to assess the narrowing airway at 212 sites. Of these, 130 sites were considered normal and 82 abnormal. For malignant stenosis, airway measurements were taken at 160 sites including 112 normal and 48 abnormal. For benign stenosis, airway measurements were taken at 52 sites including 18 normal and 34 abnormal. This technique enables the EBUS probe to measure the distal end to proximal end of the stenosis whereby the inflated balloon size changes according to the degree of stenosis. Results: The diameter and length of stenotic sites measured by EBUS and MDCT were near equal in all patients. Significant correlation was seen at all 212 sites (r=0.805, p Conclusions: This EBUS technique was successful in establishing accurate airway measurements for suitable airway stent sizes in interventional procedures, especially in cases with tracheobrochial malacia.
Masaharu Nishimura - One of the best experts on this subject based on the ideXlab platform.
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Usefulness of Endobronchial Ultrasonography With a Guide Sheath and Virtual Bronchoscopic Navigation for Ground-Glass Opacity Lesions
The Annals of thoracic surgery, 2016Co-Authors: Yasuyuki Ikezawa, Noriaki Sukoh, Naofumi Shinagawa, Megumi Morimoto, Hajime Kikuchi, Masahiro Watanabe, Kosuke Nakano, Satoshi Oizumi, Masaharu NishimuraAbstract:Background Endobronchial Ultrasonography with guide sheath (EBUS-GS) could be useful for diagnosing ground-glass opacity (GGO) predominant-type lesions in the peripheral lung. Furthermore, several studies have reported that transbronchial biopsy using EBUS-GS and virtual bronchoscopic navigation (VBN) was safe and effective for diagnosing small peripheral lung lesions. Our objectives were to diagnose solitary peripheral GGO predominant-type lesions by transbronchial biopsy using EBUS-GS and VBN under radiographic fluoroscopic guidance, and to evaluate the clinical factors associated with diagnostic yield. Methods The medical records of 169 patients with GGO predominant-type lesions who underwent transbronchial biopsy using EBUS-GS and VBN under radiographic fluoroscopic guidance were retrospectively reviewed. Results Endobronchial Ultrasonography images could be obtained for 156 (92%) of 169 GGO predominant-type lesions, and 116 (69%) were successfully diagnosed by this method (20 of 31 pure GGO lesions [65%]; 96 of 138 mixed GGO predominant-type lesions [70%]). The mean size of diagnosed lesions was significantly larger than that of nondiagnosed lesions (22 mm versus 18 mm, p p Conclusions The addition of VBN to EBUS-GS could be useful in clinical practice for diagnosing GGO predominant-type lesions in the peripheral lung.
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Endobronchial Ultrasonography With a Guide Sheath in the Diagnosis of Benign Peripheral Diseases
The Annals of thoracic surgery, 2012Co-Authors: Naofumi Shinagawa, Eiki Kikuchi, Hajime Asahina, Kosuke Nakano, Satoshi Oizumi, Tomoo Ito, Yoshihiro Matsuno, Yasuyuki Nasuhara, Masaharu NishimuraAbstract:Background For appropriate treatment, such as the selection of antibiotics or initiation of steroid therapy, correctly diagnosing benign pulmonary diseases located at the periphery is vital. This study assessed the usefulness of bronchoscopy using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) in the diagnosis of benign pulmonary diseases, especially those presenting peripheral nodular lesions. Methods We retrospectively reviewed 159 patients with 171 peripheral pulmonary lesions (PPLs) that were subsequently diagnosed as benign diseases. To examine the role of bronchoscopy with EBUS-GS, the contribution of bronchoscopy was classified into 4 categories. We also retrospectively reviewed 24 patients with 25 PPLs that were subsequently diagnosed as benign diseases by bronchoscopy without EBUS-GS (historical control). Results The ultimate diagnosis of 171 PPLs included 45 cases of mycobacteriosis, 45 cases of bronchiolitis obliterans organizing pneumonia/chronic organized pneumonia (BOOP), 23 cases of bacterial pneumonia, 13 abscesses, 11 cases of sarcoidosis, and 34 other benign diseases. Among them, a definitive diagnosis was obtained by bronchoscopy with EBUS-GS in 99 lesions (58%). Lesions in which the probe was positioned within the lesion had a higher diagnostic yield (64%) than did lesions in which the probe was positioned adjacent to the lesion (52%) or outside the lesion (20%; P = 0.01). The diagnostic yield of bronchoscopy with EBUS-GS was higher compared with that of the historical control (58% versus 28%; P = 0.04). Conclusions Bronchoscopy using EBUS-GS is a reasonable option as a diagnostic procedure for PPLs, even if they are suspected to be benign in nature.
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Combining transbronchial biopsy using Endobronchial Ultrasonography with a guide sheath and positron emission tomography for the diagnosis of small peripheral pulmonary lesions
Lung cancer (Amsterdam Netherlands), 2010Co-Authors: Hidenori Mizugaki, Eiki Kikuchi, Hajime Asahina, Naofumi Shinagawa, Satoshi Oizumi, Noriyuki Yamada, Kakuko Kanegae, Nagara Tamaki, Masaharu NishimuraAbstract:Abstract To evaluate the combination of transbronchial biopsy (TBB) using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) and positron emission tomography with fluorodeoxyglucose (FDG-PET) for the diagnosis of small peripheral pulmonary lesions (PPLs) ≤30 mm in mean diameter. A total of 74 PPLs (69.2%) were diagnosed by TBB using EBUS-GS with X-ray fluoroscopy. Diagnostic yield by FDG-PET was 78.5% for the 107 PPLs examined. Diagnostic yield with the combination of TBB using EBUS-GS and FDG-PET (90.7%) was significantly higher compared with that for each procedure alone. A significant increment in diagnostic yield with this combination was seen for PPLs >20 mm and ≤30 mm and for malignant lesions. Combination of TBB using EBUS-GS and FDG-PET is useful for the diagnosis of small PPLs.
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factors related to diagnostic yield of transbronchial biopsy using Endobronchial Ultrasonography with a guide sheath in small peripheral pulmonary lesions
Chest, 2007Co-Authors: Noriyuki Yamada, Noriaki Kurimoto, Koichi Yamazaki, Eiki Kikuchi, Hajime Asahina, Naofumi Shinagawa, Satoshi Oizumi, Masaharu NishimuraAbstract:Study objectives To evaluate factors predicting the diagnostic yield of transbronchial biopsy (TBB) using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) in small peripheral pulmonary lesions (PPLs) ≤ 30 mm in mean diameter. Design Retrospective analysis. Patients and methods One hundred fifty-five consecutive patients with 158 small PPLs underwent TBB using EBUS-GS. Results A definitive diagnosis was established by TBB using EBUS-GS in 106 PPLs (67%). The diagnostic yield of PPLs ≤ 15 mm in mean diameter (40%) was significantly lower than that of PPLs > 15 mm and ≤ 30 mm in mean diameter (76%; p Conclusions The position of the probe ( ie , within or adjacent to the PPL) is a significant factor in predicting the diagnostic yield of TBB using EBUS-GS for small PPLs; the optimum number of biopsy specimens is at least five.
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diagnostic value of Endobronchial Ultrasonography with a guide sheath for peripheral pulmonary lesions without x ray fluoroscopy
Chest, 2007Co-Authors: Motoko Yoshikawa, Noriaki Sukoh, Koichi Yamazaki, Shinichi Fukumoto, Masao Harada, Eiki Kikuchi, Kenya Kanazawa, Mitsuru Munakata, Masaharu Nishimura, Hiroshi IsobeAbstract:Study objectives We evaluated the feasibility and efficacy of transbronchial biopsy (TBB) and bronchial brushing by Endobronchial Ultrasonography (EBUS) with a guide sheath (GS) as a guide for diagnosing peripheral pulmonary lesions (PPLs) without radiographic fluoroscopy. Patients One hundred twenty-one patients with 123 PPLs (mean diameter, 31.0 mm) whose bronchoscopic findings were normal. Methods An EBUS-GS was inserted and advanced to the PPL without fluoroscopy. Once we obtained the EBUS image, the probe was withdrawn and the GS was left in place. TBB and/or bronchial brushing were performed via the GS. When an EBUS image could not be obtained, we changed to the bronchoscopic examination under fluoroscopy. Results Seventy-six of 123 PPLs (61.8%) were diagnosed by EBUS-GS guidance without fluoroscopy. The diagnostic yield for PPLs > 20 mm in diameter (75.6%) was significantly higher than that for those ≤ 20 mm in diameter (29.7%; p Conclusions EBUS-GS–guided bronchoscopy without the use of radiographic fluoroscopy is effective for diagnosing PPLs. The diameter, location, and CT scan appearance of the PPLs, and the identification of the bronchus leading to the PPLs were valuable as factors related to a higher diagnostic sensitivity with this procedure.
Teruomi Miyazawa - One of the best experts on this subject based on the ideXlab platform.
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histogram based quantitative evaluation of Endobronchial Ultrasonography images of peripheral pulmonary lesion
Respiration, 2015Co-Authors: Kei Morikawa, Noriaki Kurimoto, Takeo Inoue, Masamichi Mineshita, Teruomi MiyazawaAbstract:Background: Endobronchial Ultrasonography using a guide sheath (EBUS-GS) is an increasingly common bronchoscopic technique, but currently, no methods have been established to quantitatively evaluate EBUS images of peripheral pulmonary lesions. Objectives: The purpose of this study was to evaluate whether histogram data collected from EBUS-GS images can contribute to the diagnosis of lung cancer. Methods: Histogram-based analyses focusing on the brightness of EBUS images were retrospectively conducted: 60 patients (38 lung cancer; 22 inflammatory diseases), with clear EBUS images were included. For each patient, a 400-pixel region of interest was selected, typically located at a 3- to 5-mm radius from the probe, from recorded EBUS images during bronchoscopy. Histogram height, width, height/width ratio, standard deviation, kurtosis and skewness were investigated as diagnostic indicators. Results: Median histogram height, width, height/width ratio and standard deviation were significantly different between lung cancer and benign lesions (all p Conclusions: Histogram standard deviation appears to be the most useful characteristic for diagnosing lung cancer using EBUS images.
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Airway measurements in tracheobronchial stenosis using Endobronchial Ultrasonography during stenting
European Respiratory Journal, 2011Co-Authors: Seiichi Nobuyama, Noriaki Kurimoto, Naoki Furuya, Hiroshi Handa, Hiroki Nishine, Teruomi MiyazawaAbstract:Purpose: To assess airway measurements, Endobronchial Ultrasonography (EBUS) and multi-detector low computed tomography (MDCT) images are compared in patients with tracheal stenosis. Methods: Airway stenting was performed on 31 patients, 25 malignant and 6 benign. EBUS and MDCT images were compared before intervention to assess the narrowing airway at 212 sites. Of these, 130 sites were considered normal and 82 abnormal. For malignant stenosis, airway measurements were taken at 160 sites including 112 normal and 48 abnormal. For benign stenosis, airway measurements were taken at 52 sites including 18 normal and 34 abnormal. This technique enables the EBUS probe to measure the distal end to proximal end of the stenosis whereby the inflated balloon size changes according to the degree of stenosis. Results: The diameter and length of stenotic sites measured by EBUS and MDCT were near equal in all patients. Significant correlation was seen at all 212 sites (r=0.805, p Conclusions: This EBUS technique was successful in establishing accurate airway measurements for suitable airway stent sizes in interventional procedures, especially in cases with tracheobrochial malacia.
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Introduction of Endobronchial Ultrasonography (EBUS) in Bronchoscopy Clearly Reduces Fluoroscopy Time: Comparison of 147 Cases in Groups Before and After EBUS Introduction
Japanese journal of clinical oncology, 2011Co-Authors: Yoshitsugu Fujita, Noriaki Kurimoto, Teruomi Miyazawa, Nobuhiko Seki, Ken Inoue, Tadashi Abe, Kenji EguchiAbstract:Background: Endobronchial Ultrasonography (EBUS) has been used in diagnosing peripheral lung cancer and has allowed for higher rates of peripheral lung cancer diagnosis. However, no studies have reported that fluoroscopy time is shortened by the use of Endobronchial Ultrasonography. We aimed to investigate whether fluoroscopy time is shortened using Endobronchial Ultrasonography. Methods: We retrospectively researched fluoroscopy time in terms of the rate of diagnosis, lesion size, age, gender, histologic type and lesion site in 147 cases of malignant lesions from January 2006 to September 2007 at the Tokai University Hospital. The location of the bronchial brush or biopsy forceps was confirmed by fluoroscopy without Endobronchial Ultrasonography with guide-sheath group in 96 of the 147 cases, while fluoroscopy with Endobronchial Ultrasonography guide sheath group was confirmed in 51 cases. Results: The result was that fluoroscopy time was significantly shortened in the Endobronchial Ultrasonography guide-sheath group (4.08+3.27 min) compared with the nonEndobronchial Ultrasonography guide-sheath group (7.06+3.99 min), but there was no significant difference between either groups in terms of bronchoscopic diagnosis, lesion size, age, gender, histologic type and lesion site. Conclusion: The use of Endobronchial Ultrasonography guide sheath allows a reduction in fluoroscopy time and may reduce the adverse effects of radiation exposure on patients and staff.
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airway measurements in tracheobronchial stenosis using Endobronchial Ultrasonography during stenting
Journal of bronchology & interventional pulmonology, 2011Co-Authors: Seiichi Nobuyama, Noriaki Kurimoto, Takeo Inoue, Masamichi Mineshita, Shin Matsuoka, Taeko Shirakawa, Teruomi MiyazawaAbstract:PURPOSE: To assess airway measurements, Endobronchial Ultrasonography (EBUS) and multidetector, row computed tomography (MDCT) images were compared in patients with tracheal stenosis. METHODS: Airway stenting was performed on 31 patients, 25 malignant and 6 benign. EBUS and MDCT images were compared before intervention to assess the degree of airway narrowing at 212 sites. Of these, 130 sites were considered normal and 82 abnormal. For malignant stenosis, airway measurements were taken at 160 sites including 112 normal and 48 abnormal. For benign stenosis, airway measurements were taken at 52 sites including 18 normal and 34 abnormal. This technique enables the EBUS probe to measure the distal end to the proximal end of the stenosis whereby the inflated balloon size changes according to the degree of stenosis. RESULTS: The diameter and length of the stenotic sites measured by EBUS and MDCT were nearly equal in all patients. Significant correlation was seen at all 212 sites (r=0.805, P<0.0001), 130 normal (r=0.758, P<0.0001) and 82 abnormal (r=0.654, P<0.0001). For malignant cases, there was significant correlation in a total of 160 sites (r=0.810, P<0.0001), 112 normal (r=0.782, P<0.0001) and 48 abnormal (r=0.564, P<0.0001). Benign cases showed significant correlations in total 52 sites (r=0.780, P<0.0001), 18 normal (r=0.778, P<0.0001) and 34 abnormal (r=0.731, P<0.0001). CONCLUSION: This EBUS technique was successful in establishing accurate airway measurements for suitable airway stent sizes in interventional procedures, especially in cases with tracheobronchial malacia.
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Endobronchial Ultrasonography and magnetic resonance imaging in tracheobronchial stenosis from ulcerative colitis.
Journal of bronchology & interventional pulmonology, 2011Co-Authors: Miho Nakamura, Noriaki Kurimoto, Takeo Inoue, Atsuko Ishida, Yuka Miyazu, Teruomi MiyazawaAbstract:A 49-year-old woman presented with continuous cough, progressive dyspnea on exertion, and hoarseness. She had a total colectomy for ulcerative colitis 17 years earlier. Bronchoscopy showed circumferential mucosal erythema. The surface of the tracheal mucosa was irregular and bled easily on contact. Endobronchial Ultrasonography and magnetic resonance imaging (MRI) showed characteristic findings that suggested that the lesion was located within the tracheal mucosa and submucosa. Endobronchial Ultrasonography images showed circumferential thickening of the mucosa, but tracheobronchial cartilage was preserved intact. Moreover, the comparison between tracheal tissues from tracheostomy and colon tissues resected 17 years earlier showed similarities in pathologic findings. These findings suggested that inflammatory bowel disease can cause the tracheobronchial stenosis.
Shinji Sasada - One of the best experts on this subject based on the ideXlab platform.
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The dose and risk factors for radiation exposure to medical staff during Endobronchial Ultrasonography with a guide sheath for peripheral pulmonary lesions under x-ray fluoroscopy
European Respiratory Journal, 2014Co-Authors: Masahiro Katsurada, Takehiro Izumo, Christine Chavez, Mayumi Kitagawa, Jun Torii, Takumi Iwase, Tomohiko Aso, Yuichi Nagai, Takaaki Tsuchida, Shinji SasadaAbstract:Introduction: Therapy for lung cancer has recently evolved to include molecular targeted therapy and adequate amounts of lung cancer tissue are needed to identify particular phenotypes. For this purpose, quite a number of investigations on diagnostic bronchoscopy have been undertaken. Corollary to the increasing number of transbronchial biopsies for peripheral pulmonary nodules is the increased chances of radiation exposure during fluoroscopy, but there are few study about radiation exposure dose during transbronchial biopsies. Aim and Objectives: Determine the dose and risk factors of radiation exposure to medical staff. Methods: Endobronchial Ultrasonography with a guide sheath under X-ray fluoroscopy was performed on 132 cases of peripheral pulmonary lesions. The radiation exposure dose to medical staff (operator physicians, assistant physicians, nurses and radiological technologists) was measured. Results: The median radiation exposure dose to operator physicians was 12 microSv/exam (range 1–99), while that of the other medical staff was lower. In a multivariate analysis, patients9 body mass index and the location of the radial ultrasound probe had significantly higher odds ratios. Conclusions: The risk factors for an increased radiation exposure dose were patients9 BMI and the location of the radial ultrasound probe. But even then, the radiation exposure dose to medical staff during Endobronchial Ultrasonography with a guide sheath was very low, especially for nurses and radiological technologists in whom the exposure dose was negligible.
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Transbronchial needle aspiration through a guide sheath with Endobronchial Ultrasonography for peripheral pulmonary lesions
European Respiratory Journal, 2014Co-Authors: Motohisa Takai, Takehiro Izumo, Christine Chavez, Takaaki Tsuchida, Shinji SasadaAbstract:Purpose : Although Endobronchial Ultrasonography with a guide sheath is becoming a common procedure for the diagnosis of peripheral pulmonary lesions, there remain to be some inaccuracies in cases wherein the probe is located outside the lesion. We tested whether adding transbronchial needle aspiration through a guide sheath to the conventional technique increases efficacy for diagnosing peripheral pulmonary lesions. Methods : We performed transbronchial needle aspiration through a guide sheath for 37 subjects with peripheral pulmonary lesions between September 2012 and April 2013. The devices used were as follows (all Olympus Ltd.): bronchoscope with wide working channel (1T-260 or LF-TP), guide sheath measured 2.2 mm in diameter (K203 kit) and 13 mm length 21-G needle without side hole set through a metallic sheath (NA-1C-1)., The guide sheath was customized by cutting 30 mm from the proximal end to fit well with the needle. Results : The Endobronchial ultrasound probe was located within the lesion in 21 cases (56.8%) and outside in 16 cases (43.2%). Overall accuracy was 86.5 percent; 90.5% in “within” cases compared to 81.3% in “outside” cases with no significant difference (P = 0.42). Pneumothorax occurred in 2 cases and pneumonia in 1 case. Conclusion : Transbronchial needle aspiration through a guide sheath is an effective and safe diagnostic procedure for peripheral pulmonary lesions, especially when the guide sheath is outside the lesion.
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Molecular analysis of liquid cytological samples collected by bronchoscopy with radial Endobronchial Ultrasonography and guide sheath.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2014Co-Authors: Naomi Iwabu, Takehiro Izumo, Christine Chavez, Yukiko Nakamura, Takaaki Tsuchida, Shinji SasadaAbstract:A 64-year-old man who underwent sigmoid resection for Stage 4 colon cancer had a growing nodule on the left upper lobe during follow-up. Surgical resection revealed primary pulmonary adenocarcinoma. Subsequently, a new nodule appeared in the contralateral S(1)b, for which Endobronchial Ultrasonography with a guide sheath (EBUS-GS) was performed for diagnosis. However, histopathologic examinations were inconclusive. Gene analysis of the liquid samples from this lesion revealed KRAS mutation, which on hindsight was not detected in the metachronous left upper lobe cancer but was detected in the resected sigmoid colon. Hence, the right upper lobe nodule was diagnosed by bronchoscopy as colon cancer metastasis, confirmed after wedge resection. For specimen obtained by EBUS-GS, search for gene mutation in the liquid specimen is useful as an ancillary test especially when histological diagnosis is equivocal. Thus, developments on diagnostic tools using liquid samples are highly expected in the future.
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The Dose and Risk Factors for Radiation Exposure to Medical Staff during Endobronchial Ultrasonography with a Guide Sheath for Peripheral Pulmonary Lesions under X-ray Fluoroscopy
Japanese journal of clinical oncology, 2014Co-Authors: Masahiro Katsurada, Takehiro Izumo, Christine Chavez, Mayumi Kitagawa, Jun Torii, Takumi Iwase, Tomohiko Aso, Yuichi Nagai, Takaaki Tsuchida, Shinji SasadaAbstract:Objective Therapy for lung cancer has recently evolved to include molecular targeted therapy and adequate amounts of lung cancer tissue are needed to identify particular phenotypes. For this purpose, quite a number of investigations on diagnostic bronchoscopy have been undertaken. Corollary to the increasing number of transbronchial biopsies for peripheral pulmonary nodules is the increased chances of radiation exposure during fluoroscopy. Our aim was to determine the dose and risk factors of radiation exposure to medical staff. Methods Endobronchial Ultrasonography with a guide sheath under X-ray fluoroscopy was performed on 132 cases of peripheral pulmonary lesions. The radiation exposure dose to medical staff (operator physicians, assistant physicians, nurses and radiological technologists) was measured. Results The median time of fluoroscopy was 7.6 min (range 1.5-23.9). The median radiation exposure dose to operator physicians was 12 μSv/exam (range 1-99), while that of the other medical staff was lower. In a multivariate analysis, body mass index and the location of the radial ultrasound probe had significantly higher odds ratios. Conclusions The risk factors for an increased radiation exposure dose were patients' BMI and the location of the radial ultrasound probe. But even then, the radiation exposure dose to medical staff during Endobronchial Ultrasonography with a guide sheath was very low, especially for nurses and radiological technologists in whom the exposure dose was negligible.
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transbronchial needle aspiration through a guide sheath with Endobronchial Ultrasonography gs tbna for peripheral pulmonary lesions
Annals of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Motohisa Takai, Takehiro Izumo, Christine Chavez, Takaaki Tsuchida, Shinji SasadaAbstract:PURPOSE: Although, Endobronchial Ultrasonography with a guide sheath is becoming a common procedure for the diagnosis of peripheral pulmonary lesions, there remain to be some inaccuracies in cases wherein the probe is located outside the lesion. We tested whether adding transbronchial needle aspiration through a guide sheath to the conventional technique increases efficacy for diagnosing peripheral pulmonary lesions. METHODS: We performed transbronchial needle aspiration through a guide sheath for 37 subjects with peripheral pulmonary lesions between September 2012 and April 2013. The devices used were as follows (all Olympus Ltd., Tokyo, Japan): 1T-260 or LF-TP bronchoscope, K203 guide sheath kit and NA-1C-1 needle apparatus, customized by cutting the guide sheath 30 mm from the proximal end to fit well with the needle. RESULTS: The Endobronchial ultrasound probe was located within the lesion in 21 cases (56.8%) and outside in 16 cases (43.2%). Overall accuracy was 86.5 percent; 90.5% in "within" cases compared to 81.3% in "outside" cases with no significant difference (P = 0.42). Pneumothorax occurred in 2 cases and pneumonia in 1 case. CONCLUSION: Transbronchial needle aspiration through a guide sheath is an effective and safe diagnostic procedure for peripheral pulmonary lesions, especially when the guide sheath is outside the lesion.
Hajime Asahina - One of the best experts on this subject based on the ideXlab platform.
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Endobronchial Ultrasonography With a Guide Sheath in the Diagnosis of Benign Peripheral Diseases
The Annals of thoracic surgery, 2012Co-Authors: Naofumi Shinagawa, Eiki Kikuchi, Hajime Asahina, Kosuke Nakano, Satoshi Oizumi, Tomoo Ito, Yoshihiro Matsuno, Yasuyuki Nasuhara, Masaharu NishimuraAbstract:Background For appropriate treatment, such as the selection of antibiotics or initiation of steroid therapy, correctly diagnosing benign pulmonary diseases located at the periphery is vital. This study assessed the usefulness of bronchoscopy using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) in the diagnosis of benign pulmonary diseases, especially those presenting peripheral nodular lesions. Methods We retrospectively reviewed 159 patients with 171 peripheral pulmonary lesions (PPLs) that were subsequently diagnosed as benign diseases. To examine the role of bronchoscopy with EBUS-GS, the contribution of bronchoscopy was classified into 4 categories. We also retrospectively reviewed 24 patients with 25 PPLs that were subsequently diagnosed as benign diseases by bronchoscopy without EBUS-GS (historical control). Results The ultimate diagnosis of 171 PPLs included 45 cases of mycobacteriosis, 45 cases of bronchiolitis obliterans organizing pneumonia/chronic organized pneumonia (BOOP), 23 cases of bacterial pneumonia, 13 abscesses, 11 cases of sarcoidosis, and 34 other benign diseases. Among them, a definitive diagnosis was obtained by bronchoscopy with EBUS-GS in 99 lesions (58%). Lesions in which the probe was positioned within the lesion had a higher diagnostic yield (64%) than did lesions in which the probe was positioned adjacent to the lesion (52%) or outside the lesion (20%; P = 0.01). The diagnostic yield of bronchoscopy with EBUS-GS was higher compared with that of the historical control (58% versus 28%; P = 0.04). Conclusions Bronchoscopy using EBUS-GS is a reasonable option as a diagnostic procedure for PPLs, even if they are suspected to be benign in nature.
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Usefulness of Endobronchial Ultrasonography with a guide sheath for diagnosing ground glass opacity lesions
European Respiratory Journal, 2011Co-Authors: Yasuyuki Ikezawa, Hajime Asahina, Naofumi Shinagawa, Taichi Takashina, Kenichiro Ito, Iki Ogura, Yutaka Takeuchi, Noriyuki Yamada, Jun Sakakibara-konishi, Satoshi OizumiAbstract:Background and purpose: It is often hard to diagnose ground glass opacity (GGO) lesions by transbronchial biopsy (TBB), because of difficulty in detecting the site of the lesions under X-ray fluoroscopy. We have reported the usefulness of TBB using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) for small peripheral pulmonary lesions (PPLs). EBUS-GS has an advantage to detect the location of PPLs. In this study, we retrospectively analyzed the diagnostic yield of GGO lesions by EBUS-GS and examined of lesions which might influence the diagnostic yield. Patients and methods: Between August 2003 and December 2007, we performed EBUS-GS for a total of 67 GGO lesions in Hokkaido University Hospital and Hokkaido Cancer Center. Results: Of the 67 lesions (11 pure GGO lesions and 56 mixed GGO lesions, which consist of GGO components more than 50%), 43 (64%) were not visible by conventional X-ray fluoroscopy. Thirty-eight lesions were diagnosed by TBB with EBUS-GS (36 adenocarcinoma, 1 lymphoma and 1 inflammation). The average size of lesions with diagnosis was significantly larger than that of lesions without definitive diagnosis. (23.9mm vs. 16.7mm; P
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usefulness of Endobronchial Ultrasonography with a guide sheath for diagnosing ground glass opacity lesions
European Respiratory Journal, 2011Co-Authors: Yasuyuki Ikezawa, Hajime Asahina, Naofumi Shinagawa, Taichi Takashina, Kenichiro Ito, Iki Ogura, Yutaka Takeuchi, Noriyuki Yamada, Jun Sakakibarakonishi, Satoshi OizumiAbstract:Background and purpose: It is often hard to diagnose ground glass opacity (GGO) lesions by transbronchial biopsy (TBB), because of difficulty in detecting the site of the lesions under X-ray fluoroscopy. We have reported the usefulness of TBB using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) for small peripheral pulmonary lesions (PPLs). EBUS-GS has an advantage to detect the location of PPLs. In this study, we retrospectively analyzed the diagnostic yield of GGO lesions by EBUS-GS and examined of lesions which might influence the diagnostic yield. Patients and methods: Between August 2003 and December 2007, we performed EBUS-GS for a total of 67 GGO lesions in Hokkaido University Hospital and Hokkaido Cancer Center. Results: Of the 67 lesions (11 pure GGO lesions and 56 mixed GGO lesions, which consist of GGO components more than 50%), 43 (64%) were not visible by conventional X-ray fluoroscopy. Thirty-eight lesions were diagnosed by TBB with EBUS-GS (36 adenocarcinoma, 1 lymphoma and 1 inflammation). The average size of lesions with diagnosis was significantly larger than that of lesions without definitive diagnosis. (23.9mm vs. 16.7mm; P<0.01) For lesions with bronchus leading directly to the center of the lesions on high-resolution computed tomography images (positive CT sign), the diagnostic yield was significantly higher than lesions with negative CT sign. (31% vs. 66%; P < 0.01) Conclusion: EBUS-GS is a useful method for diagnosing GGO lesions. However, failure of diagnosis is associated with the lesions in smaller size and/or with negative CT sign.
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Combining transbronchial biopsy using Endobronchial Ultrasonography with a guide sheath and positron emission tomography for the diagnosis of small peripheral pulmonary lesions
Lung cancer (Amsterdam Netherlands), 2010Co-Authors: Hidenori Mizugaki, Eiki Kikuchi, Hajime Asahina, Naofumi Shinagawa, Satoshi Oizumi, Noriyuki Yamada, Kakuko Kanegae, Nagara Tamaki, Masaharu NishimuraAbstract:Abstract To evaluate the combination of transbronchial biopsy (TBB) using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) and positron emission tomography with fluorodeoxyglucose (FDG-PET) for the diagnosis of small peripheral pulmonary lesions (PPLs) ≤30 mm in mean diameter. A total of 74 PPLs (69.2%) were diagnosed by TBB using EBUS-GS with X-ray fluoroscopy. Diagnostic yield by FDG-PET was 78.5% for the 107 PPLs examined. Diagnostic yield with the combination of TBB using EBUS-GS and FDG-PET (90.7%) was significantly higher compared with that for each procedure alone. A significant increment in diagnostic yield with this combination was seen for PPLs >20 mm and ≤30 mm and for malignant lesions. Combination of TBB using EBUS-GS and FDG-PET is useful for the diagnosis of small PPLs.
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factors related to diagnostic yield of transbronchial biopsy using Endobronchial Ultrasonography with a guide sheath in small peripheral pulmonary lesions
Chest, 2007Co-Authors: Noriyuki Yamada, Noriaki Kurimoto, Koichi Yamazaki, Eiki Kikuchi, Hajime Asahina, Naofumi Shinagawa, Satoshi Oizumi, Masaharu NishimuraAbstract:Study objectives To evaluate factors predicting the diagnostic yield of transbronchial biopsy (TBB) using Endobronchial Ultrasonography with a guide sheath (EBUS-GS) in small peripheral pulmonary lesions (PPLs) ≤ 30 mm in mean diameter. Design Retrospective analysis. Patients and methods One hundred fifty-five consecutive patients with 158 small PPLs underwent TBB using EBUS-GS. Results A definitive diagnosis was established by TBB using EBUS-GS in 106 PPLs (67%). The diagnostic yield of PPLs ≤ 15 mm in mean diameter (40%) was significantly lower than that of PPLs > 15 mm and ≤ 30 mm in mean diameter (76%; p Conclusions The position of the probe ( ie , within or adjacent to the PPL) is a significant factor in predicting the diagnostic yield of TBB using EBUS-GS for small PPLs; the optimum number of biopsy specimens is at least five.