Clinical Application of the FICE Technique for Biopsy of Bronchial Mucosal Lesions.

OBJECTIVE: To determine the diagnostic accuracy of flexile spectral imaging color enhancement (FICE) of abnormal morphologic changes in bronchial mucosal lesions. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Department of endoscopy, the 10th People's Hospital of Shenyang, China, from January 2015 to April 2016. METHODOLOGY: Patients aged 17-71 years, who presented with abnormal lesions of lung and bronchus, were included. Patients with severe heart disease, arrhythmias, aneurysm of aorta, blood pressure >160/100 mmHg, allergic to anaesthetic drugs, and unwilling to undergo endoscopy were excluded. The bronchoscopic FICE technique was used to observe abnormal bronchial mucosa in 85 patients. Targeted brushings, lavage, and tissue biopsies were performed under the FICE mode. RESULTS: With routine pathological results under white light as a reference, high definition electronic bronchoscopy combined with FICE biopsy yielded a positive rate for bronchial mucosal lesions and bronchial tumors in up to (73 87%) of cases. CONCLUSION: The FICE technique showed significant enhancement of bronchial mucosal lesion diagnosis, which can help endoscopists in the early and accurate diagnosis. Key Words: FICE, Bronchial mucosal lesions, Biopsy, Diagnostic accuracy.

GeneXpert MTB/RIF for rapid diagnosis and rifampin resistance detection of endobronchial tuberculosis.

BACKGROUND AND OBJECTIVE: Delayed diagnosis and treatment of tuberculosis (TB) contribute to poor outcomes, especially for endobronchial TB (EBTB), which typically leads to tracheobronchial stenosis. Finding rapid and accurate diagnostic tools for EBTB is crucial. GeneXpert Mycobacterium tuberculosis (MTB)/rifampin (RIF) was recommended by the World Health Organization (WHO) as a standard molecular biological diagnostic technique for MTB. The aim of this study was to evaluate the efficacy of GeneXpert MTB/RIF for diagnosing EBTB and for evaluating RIF resistance. METHODS: Biopsy tissue and bronchial brushings from EBTB patients were prospectively assessed with GeneXpert MTB/RIF. The diagnostic yields of auramine O-stained sputum smears and bronchial brush smears were obtained, and the results were compared with the cultures of sputum and biopsy tissues for MTB. RESULTS: In 61 confirmed cases of EBTB, the sensitivities of sputum smear, bronchial brush smear, sputum culture and tissue culture to diagnose EBTB were 13.1%, 32.8%, 36.1% and 68.9%, respectively. For bronchial brushings and biopsies, our data showed sensitivities of 57.4% and 63.9%, respectively, and a specificity of 100% for GeneXpert MTB/RIF, and these results were superior to those of sputum smears, bronchial brush smears and sputum culture. GeneXpert MTB/RIF for bronchial brushings and biopsies showed complementarity in its diagnostic performance. Resistance to RIF was identified in 17.4% (8/46) of GeneXpert MTB-positive cases. CONCLUSION: GeneXpert MTB/RIF may enable more rapid EBTB diagnosis and determination of RIF resistance, which are crucial for timely treatment.