The Experts below are selected from a list of 3915 Experts worldwide ranked by ideXlab platform
Yiju Tsai - One of the best experts on this subject based on the ideXlab platform.
-
the value of repeat radial probe endobronchial ultrasound guided Transbronchial Biopsy after initial non diagnostic results in patients with peripheral pulmonary lesions
BMC Pulmonary Medicine, 2017Co-Authors: Chunta Huang, Yiju TsaiAbstract:Radial-probe endobronchial ultrasound (rEBUS)-guided Transbronchial Biopsy (TBB) is invaluable in the diagnosis of peripheral pulmonary lesions (PPLs); however, in certain instances, the procedure has to be repeated because of initial non-diagnostic procedure(s). Little if any literature has been published on this issue. Therefore, the aim of this study was to investigate the utility of repeat rEBUS-guided TBB in achieving a definitive diagnosis of PPLs. All patients who underwent rEBUS-guided TBB of PPLs at National Taiwan University Hospital between 2011 and 2015 and had a repeat procedure after non-diagnostic initial procedures were identified as the study subjects. The primary outcome of interest was the diagnostic yield of repeat rEBUS-guided TBB for PPLs. Also, we sought to discover features associated with the yield of repeat procedures. Forty-three (11%) out of 384 patients with initial non-diagnostic TBB were included for analysis. A diagnosis of PPLs was able to be confirmed with repeat TBB in 23(53%) patients. The pathology of the first TBB was significantly associated with the yield of repeat procedures (P = 0.011). Further, patients with normal lung tissue in initial pathology rarely (2/12, 17%) had a definite diagnosis on repeat TBB. Yet, patients with pathology showing atypical cells and other non-specific findings were more likely (21/31, 68%) to obtain a confirmed diagnosis. The diagnostic yield of repeat procedures was not affected by the size, location or CT appearance of the lesions, or position of the rEBUS probe. No death or other serious adverse events occurred with the repeat rEBUS-guided procedures. If clinically indicated, it is reasonable to repeat rEBUS-guided TBB after an initial non-diagnostic procedure as the diagnostic yield will be at least 50% and the side effect profile is favorable.
-
experience improves the performance of endobronchial ultrasound guided Transbronchial Biopsy for peripheral pulmonary lesions a learning curve at a medical centre
PLOS ONE, 2017Co-Authors: Chunta Huang, Shengyuan Ruan, Yiju TsaiAbstract:Background Endobronchial ultrasound(EBUS)-guided Transbronchial Biopsy(TBB) is the preferred diagnostic tool for peripheral pulmonary lesions(PPLs) and mastering this procedure is an important task in the training of chest physicians. Little has been published about the learning experience of physicians with this technique, particularly at an institutional level. We aimed to establish a learning curve for EBUS-guided TBB for PPLs at a medical center. Methods Between 2008 and 2015, consecutive patients with PPLs referred for EBUS-guided TBB at National Taiwan University Hospital were enrolled. To build the learning curve, the diagnostic yield of TBB (plus brushings and washings) was calculated and compared. Meanwhile, lesion characteristics, and procedure-related features and complications were obtained to analyze associations with TBB yield and safety profile. Results A total of 2144 patients were included and EBUS-guided TBB was diagnostic for 1547(72%). The TBB yield was 64% in 2008 and reached a plateau of 72% after 2010. It took approximately 400 EBUS-guided procedures to achieve stable proficiency. Further analysis showed that improvement in diagnostic yield over time was mainly observed in PPLs, in cases in which the diameter was ≤2 cm or the EBUS probe could not be positioned within. Complication rates were low, with 1.8% and 0.5% for pneumothorax and hemorrhage, respectively. Conclusions Even though EBUS-guided TBB is an easy-to-learn technique, it takes 3 years or around 400 procedures for a medical center to achieve a better and stable performance. In particular, the diagnostic yield for lesions without the probe within or those sized ≤2 cm could improve with time.
-
risk factors of pneumothorax after endobronchial ultrasound guided Transbronchial Biopsy for peripheral lung lesions
PLOS ONE, 2012Co-Authors: Chunta Huang, Shengyuan Ruan, Weiyu Liao, Yaowen Kuo, Chiying Lin, Yiju TsaiAbstract:Background The risk of endobronchial ultrasound-guided Transbronchial Biopsy-related pneumothorax is a major concern and warrants further studies. The aim of our study was to estimate the risk of pneumothorax after this procedure and identify its risk factors. Methods From 2007 to 2011, 399 patients who underwent endobronchial ultrasound-guided Transbronchial Biopsy for peripheral lung lesions were included in this study. The variables analyzed included patient factors, lesion factors and procedure factors. Multivariate logistic regression analysis was used to identify independent risk factors for pneumothorax. Results The incidence of pneumothorax was 3.3% (13/399). Chest tube placement was required for 31% (4/13) of pneumothoraces. Independent risk factors for pneumothorax included pulmonary emphysema (OR, 55.09; 95% CI, 9.37–324.03; p<0.001) and probe position adjacent to the lesion (OR, 17.01; 95% CI, 2.85–101.64; p = 0.002). The number of Biopsy specimens, age, sex, history of prior lung surgery and lesion size, location and character did not influence the risk of pneumothorax in our analyses. Conclusions The risk of pneumothorax after endobronchial ultrasound-guided Transbronchial Biopsy is low. To further reduce the risk of pneumothorax, every effort should be made to advance the endobronchial ultrasound probe into the bronchus where it is imaged within the target lesion before embarking on Transbronchial Biopsy.
-
endobronchial ultrasound guided Transbronchial Biopsy of peripheral pulmonary lesions how many specimens are necessary
Respiration, 2012Co-Authors: Chunta Huang, Yiju Tsai, Weiyu Liao, Panchyr YangAbstract:Background: Although endobronchial ultrasound (EBUS)-guided Transbronchial Biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of Biopsy specimens required has not been thoroughly investigated. Objectives: We sought to examine whether the number of Biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions. Methods: The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of Biopsy specimens, with the diagnostic yield was analysed. Results: A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p Conclusions: Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of Biopsy specimens should be decided on a case-by-case basis.
-
factors influencing visibility and diagnostic yield of Transbronchial Biopsy using endobronchial ultrasound in peripheral pulmonary lesions
Respirology, 2009Co-Authors: Chunta Huang, Chaochi Ho, Yiju Tsai, Chongjen Yu, Panchyr YangAbstract:Background and objective: Endobronchial ultrasound (EBUS) has increased the diagnostic yield of bronchoscopic Biopsy of peripheral pulmonary lesions (PPL). However, certain lesions cannot be localized by EBUS, and the factors associated with the visibility of PPL by EBUS have not been investigated. This study evaluated the factors predicting the visualization of EBUS in PPL and the diagnostic yield of EBUS-guided Transbronchial Biopsy (TBB). Methods: n 2007, 83 patients with PPL underwent EBUS-guided TBB, and their medical records were reviewed and analysed retrospectively. Results: Of the 83 patients examined, EBUS images could not be obtained in 23 patients (28%). Lesion size was a determining factor for the visibility of PPL, with thevisualizationyieldofEBUSinlesions <20 mmbeing significantly lower than that in lesions 20 mm (P < 0.001). A definitive diagnosis of PPL localized by EBUS was established using EBUS-guided TBB in 73% of patients. There were no significant differences in diagnostic yield related to underlying disease, lobar distribution, CT scan appearance or presence of complications.Multivariate analysis revealed that the location of PPL on CT scans and position of the probe were independentpredictorsofthediagnosticyieldbyEBUSguidedTBB (P < 0.001 and P = 0.001,respectively). Conclusions: Lesion size is a significant factor predicting visualization of EBUS for PPL. The location of PPL on CT scans and position of the probe are significantly related to a higher diagnostic yield with EBUSguided TBB.
Masaharu Nishimura - One of the best experts on this subject based on the ideXlab platform.
-
endobronchial ultrasonography with a guide sheath for pure or mixed ground glass opacity lesions
Respiration, 2014Co-Authors: Yasuyuki Ikezawa, Noriaki Sukoh, Naofumi Shinagawa, Satoshi Oizumi, Kosuke Nakano, Masaharu NishimuraAbstract:Background: Ground-glass opacity (GGO) lesions are difficult to diagnose by Transbronchial Biopsy (TBB). Objectives: We atte
-
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.
-
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.
-
Transbronchial Biopsy Using Endobronchial Ultrasonography With a Guide Sheath and Virtual Bronchoscopic Navigation
Chest, 2005Co-Authors: Hajime Asahina, Koichi Yamazaki, Eiki Kikuchi, Yuya Onodera, Naofumi Shinagawa, Fumihiro Asano, Masaharu NishimuraAbstract:Study objectives We evaluated the feasibility, safety, and efficacy of Transbronchial Biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopy (VB) navigation for small peripheral pulmonary lesions ≤ 30 mm in diameter. Design Pilot study. Setting A national university hospital. Patients We performed TBB using EBUS-GS with VB navigation for 29 patients with 30 small peripheral pulmonary lesions (average diameter, 18.6 mm) between January 1, 2004, and August 31, 2004. Interventions VB images were reconstructed from helical CT data. TBB was then performed using EBUS-GS with VB navigation. Results In all patients, TBB was performed safely with no complications. Bronchi seen on VB imaging were highly consistent with the actual structures confirmed using fiberoptic bronchoscopy. Following VB navigation, the endobronchial ultrasonography (EBUS) probe was inserted into third-to sixth-generation bronchi. Twenty-four lesions (80%) were visualized on EBUS images. Average durations of the initial EBUS examination of lesions, first Biopsy, and the total procedure were 9.56 min, 11.99 min, and 25.72 min, respectively. Nineteen lesions (63.3%) were diagnosed from histopathologic or cytologic examination. Diagnostic sensitivities were 44.4% (8 of 18) for lesions Conclusions In summary, TBB using EBUS-GS with VB navigation was safely performed and was effective in diagnosing small peripheral pulmonary lesions.
-
endobronchial ultrasonography with guide sheath for peripheral pulmonary lesions
European Respiratory Journal, 2004Co-Authors: Eiki Kikuchi, Noriaki Kurimoto, Noriaki Sukoh, Koichi Yamazaki, Junko Kikuchi, Hajime Asahina, Mikado Imura, Yuya Onodera, Ichiro Kinoshita, Masaharu NishimuraAbstract:The usefulness of endobronchial ultrasonography (EBUS) with guide-sheath (GS) as a guide for Transbronchial Biopsy (TBB) for diagnosing peripheral pulmonary lesions (PPL)s and for improving diagnostic accuracy was evaluated in this study. EBUS-GS-guided TBB was performed in 24 patients with 24 PPLs of < or =30 mm in diameter (average diameter=18.4 mm). A 20-MHz radial-type ultrasound probe, covered with GS was inserted via a working bronchoscope channel and advanced to the PPL in order to produce an EBUS image. The probe with the GS was confirmed to reach the lesion by EBUS imaging and X-ray fluoroscopy. When the lesion was not identified on the EBUS image, the probe was removed and a curette was used to lead the GS to the lesion. After localising the lesion, the probe was removed, and TBB and bronchial brushing were performed via the GS. Nineteen peripheral lesions (79.2%) were visualised by EBUS. All patients whose PPLs were visible on EBUS images subsequently underwent an EBUS-GS-guided diagnostic procedure. A total of 14 lesions (58.3%) were diagnosed. Even when restricted to PPLs <20 mm in diameter, the diagnostic sensitivity was 53%. In conclusion, endobronchial ultrasonography with guide sheath-guided Transbronchial Biopsy was feasible and effective for diagnosing peripheral pulmonary lesions.
Chunta Huang - One of the best experts on this subject based on the ideXlab platform.
-
the value of repeat radial probe endobronchial ultrasound guided Transbronchial Biopsy after initial non diagnostic results in patients with peripheral pulmonary lesions
BMC Pulmonary Medicine, 2017Co-Authors: Chunta Huang, Yiju TsaiAbstract:Radial-probe endobronchial ultrasound (rEBUS)-guided Transbronchial Biopsy (TBB) is invaluable in the diagnosis of peripheral pulmonary lesions (PPLs); however, in certain instances, the procedure has to be repeated because of initial non-diagnostic procedure(s). Little if any literature has been published on this issue. Therefore, the aim of this study was to investigate the utility of repeat rEBUS-guided TBB in achieving a definitive diagnosis of PPLs. All patients who underwent rEBUS-guided TBB of PPLs at National Taiwan University Hospital between 2011 and 2015 and had a repeat procedure after non-diagnostic initial procedures were identified as the study subjects. The primary outcome of interest was the diagnostic yield of repeat rEBUS-guided TBB for PPLs. Also, we sought to discover features associated with the yield of repeat procedures. Forty-three (11%) out of 384 patients with initial non-diagnostic TBB were included for analysis. A diagnosis of PPLs was able to be confirmed with repeat TBB in 23(53%) patients. The pathology of the first TBB was significantly associated with the yield of repeat procedures (P = 0.011). Further, patients with normal lung tissue in initial pathology rarely (2/12, 17%) had a definite diagnosis on repeat TBB. Yet, patients with pathology showing atypical cells and other non-specific findings were more likely (21/31, 68%) to obtain a confirmed diagnosis. The diagnostic yield of repeat procedures was not affected by the size, location or CT appearance of the lesions, or position of the rEBUS probe. No death or other serious adverse events occurred with the repeat rEBUS-guided procedures. If clinically indicated, it is reasonable to repeat rEBUS-guided TBB after an initial non-diagnostic procedure as the diagnostic yield will be at least 50% and the side effect profile is favorable.
-
experience improves the performance of endobronchial ultrasound guided Transbronchial Biopsy for peripheral pulmonary lesions a learning curve at a medical centre
PLOS ONE, 2017Co-Authors: Chunta Huang, Shengyuan Ruan, Yiju TsaiAbstract:Background Endobronchial ultrasound(EBUS)-guided Transbronchial Biopsy(TBB) is the preferred diagnostic tool for peripheral pulmonary lesions(PPLs) and mastering this procedure is an important task in the training of chest physicians. Little has been published about the learning experience of physicians with this technique, particularly at an institutional level. We aimed to establish a learning curve for EBUS-guided TBB for PPLs at a medical center. Methods Between 2008 and 2015, consecutive patients with PPLs referred for EBUS-guided TBB at National Taiwan University Hospital were enrolled. To build the learning curve, the diagnostic yield of TBB (plus brushings and washings) was calculated and compared. Meanwhile, lesion characteristics, and procedure-related features and complications were obtained to analyze associations with TBB yield and safety profile. Results A total of 2144 patients were included and EBUS-guided TBB was diagnostic for 1547(72%). The TBB yield was 64% in 2008 and reached a plateau of 72% after 2010. It took approximately 400 EBUS-guided procedures to achieve stable proficiency. Further analysis showed that improvement in diagnostic yield over time was mainly observed in PPLs, in cases in which the diameter was ≤2 cm or the EBUS probe could not be positioned within. Complication rates were low, with 1.8% and 0.5% for pneumothorax and hemorrhage, respectively. Conclusions Even though EBUS-guided TBB is an easy-to-learn technique, it takes 3 years or around 400 procedures for a medical center to achieve a better and stable performance. In particular, the diagnostic yield for lesions without the probe within or those sized ≤2 cm could improve with time.
-
risk factors of pneumothorax after endobronchial ultrasound guided Transbronchial Biopsy for peripheral lung lesions
PLOS ONE, 2012Co-Authors: Chunta Huang, Shengyuan Ruan, Weiyu Liao, Yaowen Kuo, Chiying Lin, Yiju TsaiAbstract:Background The risk of endobronchial ultrasound-guided Transbronchial Biopsy-related pneumothorax is a major concern and warrants further studies. The aim of our study was to estimate the risk of pneumothorax after this procedure and identify its risk factors. Methods From 2007 to 2011, 399 patients who underwent endobronchial ultrasound-guided Transbronchial Biopsy for peripheral lung lesions were included in this study. The variables analyzed included patient factors, lesion factors and procedure factors. Multivariate logistic regression analysis was used to identify independent risk factors for pneumothorax. Results The incidence of pneumothorax was 3.3% (13/399). Chest tube placement was required for 31% (4/13) of pneumothoraces. Independent risk factors for pneumothorax included pulmonary emphysema (OR, 55.09; 95% CI, 9.37–324.03; p<0.001) and probe position adjacent to the lesion (OR, 17.01; 95% CI, 2.85–101.64; p = 0.002). The number of Biopsy specimens, age, sex, history of prior lung surgery and lesion size, location and character did not influence the risk of pneumothorax in our analyses. Conclusions The risk of pneumothorax after endobronchial ultrasound-guided Transbronchial Biopsy is low. To further reduce the risk of pneumothorax, every effort should be made to advance the endobronchial ultrasound probe into the bronchus where it is imaged within the target lesion before embarking on Transbronchial Biopsy.
-
endobronchial ultrasound guided Transbronchial Biopsy of peripheral pulmonary lesions how many specimens are necessary
Respiration, 2012Co-Authors: Chunta Huang, Yiju Tsai, Weiyu Liao, Panchyr YangAbstract:Background: Although endobronchial ultrasound (EBUS)-guided Transbronchial Biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of Biopsy specimens required has not been thoroughly investigated. Objectives: We sought to examine whether the number of Biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions. Methods: The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of Biopsy specimens, with the diagnostic yield was analysed. Results: A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p Conclusions: Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of Biopsy specimens should be decided on a case-by-case basis.
-
factors influencing visibility and diagnostic yield of Transbronchial Biopsy using endobronchial ultrasound in peripheral pulmonary lesions
Respirology, 2009Co-Authors: Chunta Huang, Chaochi Ho, Yiju Tsai, Chongjen Yu, Panchyr YangAbstract:Background and objective: Endobronchial ultrasound (EBUS) has increased the diagnostic yield of bronchoscopic Biopsy of peripheral pulmonary lesions (PPL). However, certain lesions cannot be localized by EBUS, and the factors associated with the visibility of PPL by EBUS have not been investigated. This study evaluated the factors predicting the visualization of EBUS in PPL and the diagnostic yield of EBUS-guided Transbronchial Biopsy (TBB). Methods: n 2007, 83 patients with PPL underwent EBUS-guided TBB, and their medical records were reviewed and analysed retrospectively. Results: Of the 83 patients examined, EBUS images could not be obtained in 23 patients (28%). Lesion size was a determining factor for the visibility of PPL, with thevisualizationyieldofEBUSinlesions <20 mmbeing significantly lower than that in lesions 20 mm (P < 0.001). A definitive diagnosis of PPL localized by EBUS was established using EBUS-guided TBB in 73% of patients. There were no significant differences in diagnostic yield related to underlying disease, lobar distribution, CT scan appearance or presence of complications.Multivariate analysis revealed that the location of PPL on CT scans and position of the probe were independentpredictorsofthediagnosticyieldbyEBUSguidedTBB (P < 0.001 and P = 0.001,respectively). Conclusions: Lesion size is a significant factor predicting visualization of EBUS for PPL. The location of PPL on CT scans and position of the probe are significantly related to a higher diagnostic yield with EBUSguided TBB.
Fjf Herth - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound guided Transbronchial Biopsy of solitary pulmonary nodules less than 20 mm
European Respiratory Journal, 2009Co-Authors: R. Eberhardt, Armin Ernst, Fjf HerthAbstract:Transbronchial Biopsy of solitary pulmonary nodules (SPNs) is usually performed under fluoroscopic guidance, but success varies widely. Endobronchial ultrasonography (EBUS) may increase the likelihood of success. The ability of EBUS-guided Transbronchial Biopsy to sample SPNs of <20 mm in diameter was assessed. All patients seen between June 2004 and August 2007 in whom computed tomography identified a SPN of <20 mm underwent bronchoscopic general anaesthesia or moderate sedation for a radial EBUS-guided examination. If a typical ultrasonographic picture of solid tissue could be identified, specimens were taken through a catheter with forceps. If the node was not detected within 20 min, the procedure was terminated. Of 100 nodules detected in 100 consecutive patients, 67 (mean diameter 15 mm) were visualised using EBUS and Biopsy specimens taken. A diagnosis was established for 46 (46%) patients. If the lesion was visualised by EBUS, the diagnostic success was 69% (46 out of 67). The 33 patients whose nodules could not be sampled underwent surgical Biopsy. Pneumothorax occurred in three patients. For SPNs of <20 mm that can be detected using ultrasound, EBUS-guided Transbronchial Biopsy is safe and effective.
-
effect of routine clopidogrel use on bleeding complications after Transbronchial Biopsy in humans
Chest, 2006Co-Authors: Armin Ernst, R. Eberhardt, Momen M Wahidi, Heinrich D Becker, Fjf HerthAbstract:Study objectives: Clopidogrel is often prescribed for primary or secondary prevention of cardiovascular disease and has been associated with unwanted bleeding events. After having shown that Transbronchial Biopsy can safely be performed in pigs receiving clopidogrel, we sought to determine whether routine clopidogrel use increases the risk of bleeding after Transbronchial lung Biopsy in humans. Design: Prospective cohort study. Patients and interventions: Data were collected on 604 patients without underlying coagulation problems who underwent Transbronchial lung Biopsy over 13 months. Clopidogrel was not discontinued before Biopsy in patients who were using it. Transbronchial biopsies were performed, and the incidence of bleeding and other complications among patients receiving clopidogrel was compared with that of other patients. Results: The study was stopped early because the bleeding rate in the clopidogrel-only group (n = 18) was excessive (89% [16 of 18 patients] vs 3.4% [20 of 574 control subjects; p > 0.001] and also in the group receiving clopidogrel and aspirin (100% [12 of 12 patients] vs 3.4% among control subjects [p > 0.001]. Bleeding rates were significantly higher in the clopidogrel group for each degree of bleeding severity: mild (27% vs 1.5%), moderate (34% vs 1.5%), and severe (27% vs 0.3%; p > 0.001 for all comparisons). All 12 patients receiving both aspirin and clopidogrel had bleeding: moderate in 6 patients and severe in 6 patients. All bleeding was controlled by endoscopic means. There were no fatalities or need for blood transfusions in the patients enrolled in the trial. Conclusions: Clopidogrel use greatly increases the risk of bleeding after Transbronchial lung Biopsy in humans and therefore should be discontinued before bronchoscopy with biopsies. Aspirin exacerbates the effect of clopidogrel on bleeding.
-
endobronchial ultrasound guided Transbronchial lung Biopsy in solitary pulmonary nodules and peripheral lesions
European Respiratory Journal, 2002Co-Authors: Fjf Herth, Armin Ernst, Heinrich D BeckerAbstract:Transbronchial Biopsy (TBBX) for peripheral lung lesions is usually performed with the help of fluoroscopy, but the yield varies widely. This feasibility study aimed to assess the ability of endobronchial ultrasound (EBUS) to provide imaging guidance for TBBX. In a prospective study, 50 consecutive patients referred for TBBX for peripheral lesions underwent fluoroscopy-guided and EBUS-guided TBBX in random order. Diagnostic yields were compared for both modalities and feasibility was assessed for EBUS. Diagnostic material was obtained in 80% of patients with EBUS and 76% of patients with fluoroscopy. There was a nonsignificant trend for EBUS to be better than fluoroscopy for lesions <3 cm in diameter. Four lesions could not be visualised with EBUS. There were no significant complications associated with the use of EBUS. Endobronchial ultrasound-guided Transbronchial Biopsy is feasible. It appears to be at least equivalent to fluoroscopy without the accompanying radiation exposure. Further large-scale studies are indicated to assess the possible role of endobronchial ultrasound as a potential imaging method of choice for the Biopsy of peripheral lung lesions.
-
aspirin does not increase bleeding complications after Transbronchial Biopsy
Chest, 2002Co-Authors: Fjf Herth, Heinrich D Becker, Armin ErnstAbstract:Study objectives: The present study was performed to determine whether the risk of bleeding after Transbronchial lung Biopsy is increased in patients taking aspirin. Design: Prospective cohort study. Patients and interventions: After excluding patients with other coagulation problems, 1,217 patients who had undergone Transbronchial lung Biopsy during a prospective 1.5-year study period were included in this study. The use of aspirin was not discontinued before the procedure. Two hundred eighty-five patients (23%) had consumed aspirin within 24 h of the procedure, and most of them (82%) used aspirin on a daily basis. Transbronchial biopsies were performed, and the bleeding incidence was compared between the groups. Results: A total of 57 patients (4.7%) experienced procedure-related bleeding. Minor bleeding occurred in 5 of 285 patients (1.8%) taking aspirin and in 27 of 932 control patients (2.9%; not significant). Moderate bleeding was seen in 3 of 285 patients (1.1%) in the aspirin group and in 13 of 932 patients (1.4%) in the control group (not significant). Major bleeding occurred in only 9 patients, 2 of 285 (0.9%) in the aspirin group and 7 of 932 (0.8%) in the control group (not significant). All bleeding was controlled by endoscopic means, and there were no fatalities and no need for blood transfusions. Conclusions: We conclude that the risk of severe bleeding after Transbronchial lung Biopsy is small (ie, < 1%) and that the use of aspirin is not associated with any increased risk of bleeding. (CHEST 2002; 122:1461–1464)
Mordechai R Kramer - One of the best experts on this subject based on the ideXlab platform.
-
safety of cryo Transbronchial Biopsy in diffuse lung diseases analysis of three hundred cases
Respiration, 2015Co-Authors: Evgeni Gershman, Oren Fruchter, Fox Benjamin, Abed Rahman Nader, Dror Rosengarten, Victoria Rusanov, Ludmila Fridel, Mordechai R KramerAbstract:Background: Transbronchial Biopsy (TBB) which is performed with metal forceps (forceps TBB) has been accepted as a useful technique in establishing diagnoses of diffuse lung diseases (DLDs). The use of cryoprobes to obtain alveolar tissue (cryo-TBB) is a new method which is currently used by our institute as well as others with excellent results. Objectives: To assess the safety of cryo-TBB compared with conventional forceps TBB. Methods: We performed a retrospective data evaluation of 300 consecutive patients who underwent cryo-TBB between January 2012 and April 2014 and compared them with historical cases treated with forceps TBB between 2010 and 2012. The results of both diagnostic modalities were compared based on pathological reports. The major complications (significant bleeding and pneumothorax) were compared, along with postprocedural hospitalization. Results: Pneumothorax was observed in 15 cases (4.95%) treated with cryo-TBB versus 9 cases (3.15%) treated with forceps TBB, with no significant difference (p = 0.303). The insertion of a chest tube was necessary in 6 (2%) and 4 (1.3%) of the cases having undergone cryo-TBB or forceps TBB, respectively (p = 0.8). In the cryo-TBB group, bleeding was encountered in 16 cases (5.2%), and it occurred in 13 cases (4.5%) of the forceps TBB group, with no significant difference in rates (p = 0.706). Also, there was no significant difference in hospital admission rates between the groups [cryo-TBB: 10 (3.3%); forceps TBB: 4 (1.44%); p = 0.181]. The safety profile of cryo- and forceps TBB remained the same even when stratified according to indications for TBB, i.e. immunocompromised hosts, patients after lung transplantation and those with DLDs. Conclusion: In patients with DLDs, cryo-TBB is as safe as forceps TBB.
-
histological diagnosis of interstitial lung diseases by cryo Transbronchial Biopsy
Respirology, 2014Co-Authors: Mordechai R Kramer, Oren Fruchter, Dror Rosengarten, Ludmila Fridel, Bayya Abed El Raouf, Nader AbdelrahmanAbstract:Background and objective The gold standard for the histological diagnosis of interstitial lung diseases (ILD) is an open lung Biopsy (OLB). Tissue samples obtained by forceps Transbronchial lung biopsies (TBB) are usually too small. We aim to evaluate the efficacy and safety of cryo-TBB for the diagnosis of ILD and to explore its role as substitute for OLB. Methods Seventy-five patients (mean age 56.2 years) with clinical and radiological features suggestive of ILD underwent cryo-TBB under moderate sedation. The diagnostic contribution on the work-up of suspected ILD was assessed. Results No major complications occurred during cryo-TBB procedures. The mean cross-sectional area of the Biopsy specimen obtained was 9 mm2 with an average of 70% alveolated tissue. The most common pathological diagnoses were idiopathic nonspecific interstitial pneumonitis (n = 22), cryptogenic organizing pneumonia (n = 11) and usual interstitial pneumonitis (n = 7). There were three patients of pulmonary Langerhans cell histiocytosis and one patient of pulmonary lymphangioleiomyomatosis. A definite and probable clinicopathological consensus diagnosis was possible in 70% and 28% of patients, respectively. In only 2% of patients' diagnosis could not be established. Conclusions Cryo-TBB is a safe and effective minimally invasive modality for the diagnosis of ILD. No OLB is needed in the majority of patients.
-
is routine chest radiography after Transbronchial Biopsy necessary a prospective study of 350 cases
Chest, 2006Co-Authors: Gabriel Izbicki, David Shitrit, Alex Yarmolovsky, D Bendayan, Galit Miller, Gershon Fink, Asher Mazar, Mordechai R KramerAbstract:Background and study objective Pneumothorax following flexible bronchoscopy (FB) with Transbronchial Biopsy (TBB) occurs in 1 to 6% of cases. Routine chest radiography (CXR) following TBB is therefore requested by most pulmonologists in an attempt to detect complications, particularly pneumothorax. The objective of this study was to determine if routine CXR after bronchoscopy and TBB is necessary. Patients and method The study group included 350 consecutive patients who underwent FB with TBB at our institution between December 2001 and January 2004. Routine CXR was performed up to 2 h after the procedure in all cases. Additionally, the following information was recorded in all patients: sex, age, immune status, indication for bronchoscopy, total number of biopsies done, segment sampled, pulse oxygen saturation, and development of symptoms suggestive of pneumothorax. Results Pneumothorax was diagnosed radiologically in 10 patients (2.9%). Seven patients had symptoms strongly suggestive of pneumothorax prior to CXR, including four patients with large (> 10%) pneumothorax. The other three patients were asymptomatic, with only minimal pneumothorax (≤ 10%), which resolved completely 24 to 48 h later. Conclusions We conclude that routine CXR after bronchoscopy with TBB is necessary only in patients with symptoms suggestive of pneumothorax. In asymptomatic patients, pneumothorax is rare and usually small, so routine CXR is not necessary in this category of patients.
-
the diagnosis of obliterative bronchiolitis after heart lung and lung transplantation low yield of Transbronchial lung Biopsy
Journal of Heart and Lung Transplantation, 1993Co-Authors: Mordechai R Kramer, C Stoehr, J L Whang, Gerald J Berry, Richard K Sibley, Sara E Marshall, G M Patterson, V A Starnes, James TheodoreAbstract:Obliterative bronchiolitis is the most significant long-term complication of lung and heart-lung transplantation characterized by the rapid development of obstructive airway disease. It is thought to be a manifestation of chronic rejection and has been treated, with limited success, with augmentation of immunosuppression. Early detection of obliterative bronchiolitis and prompt initiation of therapy may result in an improved outcome. The role of Transbronchial Biopsy has been reported in the diagnosis of acute rejection and infection but not for obliterative bronchiolitis. To study this problem we retrospectively reviewed the Transbronchial Biopsy results of patients with advanced clinical obliterative bronchiolitis, as defined physiologically. Between January 1, 1988, and December 31, 1991, 46 "sets" of adequate Transbronchial Biopsy specimens were obtained from 16 patients (15 heart-lung recipients and one double lung recipient). Seven sets of Transbronchial Biopsy specimens (15.2%) showed obliterative bronchiolitis by pathologic study. In four patients with severe clinical obliterative bronchiolitis, only one Transbronchial Biopsy specimen of seven (14.3%) showed obliterative bronchiolitis. The pathologic diagnosis of obliterative bronchiolitis was confirmed in three of these patients at the time of autopsy or retransplantation. Twelve patients were still alive at the end of the study period, and all experienced further deterioration of lung function typical for obliterative bronchiolitis. We conclude that the sensitivity of Transbronchial Biopsy for obliterative bronchiolitis is poor. Possible explanations for these results are explored.
