Cytologic features and diagnostic value of PeriView FLEX transbronchial needle aspiration targeting pulmonary nodules.

BACKGROUND: Transbronchial needle aspiration (TBNA) of peripheral lung nodules can be difficult with conventional devices due to their limited flexibility. A promising new technology for accessing these lesions is the PeriView FLEX TBNA device, which has a flexible spiral-grooved needle. The present study reports the unique cytologic features, diagnostic value, and potential pitfalls of PeriView FLEX TBNA specimens. METHODS: This study retrospectively evaluates 113 consecutive cases of lung nodules sampled using the PeriView FLEX device with radial endobronchial ultrasound guidance. RESULTS: PeriView FLEX specimens were satisfactory for evaluation in 111 of 113 cases (98%). A diagnosis of malignancy was made on 64 specimens (57%), with 100% specificity and 70% sensitivity for malignancy. In 4 cases, the PeriView FLEX sample was the only specimen from bronchoscopy that was diagnostic of malignancy. Of the 64 PeriView FLEX specimens with malignant cells, 58 (91%) were adequate for immunohistochemistry and 44 (69%) were adequate for molecular genetic testing. Potential pitfalls were largely ameliorated through education regarding the unique features of PeriView FLEX samples, such as the expected abundance of anthracotic pigment and the paucity of lymphocytes. CONCLUSIONS: TBNA using the PeriView FLEX device to sample pulmonary nodules contributed to the diagnostic value of bronchoscopy and tended to provide sufficient tissue for ancillary studies. Many of the possible pitfalls may be avoided through consideration of the unique cytologic features associated with this novel sampling method.

Development and in vivo test of a miniature Raman probe for early cancer detection in the peripheral lung.

The management of cancer in the periphery lung is in critical need of new strategies. Here, the development and test of a novel miniature Raman probe capable of navigating the peripheral lung architecture is reported. The probe was 1.35 mm in diameter, with a minimum bend radius of 13 mm and had a large light collection area for its size. Peripheral lung Raman spectra were successfully obtained from normal tissue and cancerous nodule using the probe coupled to a home-made rapid Raman spectroscopy system with a fast integration time of 1 second and a low excitation power of 15 mW. This is the first time in vivo Raman spectra from the periphery lung being reported. The collected spectra showed lipid, protein and deoxyhemoglobin signatures that might be useful for classifying pathology. Large scale clinical study is planned to confirm the utility of this new technology for improving periphery lung cancer detection. Left: Radial ultrasound image of a peripheral lung nodule: size given by crosshairs D1 and D2. Right: Truncated Raman spectra of a cancerous nodule, whole blood, and normal peripheral airway tissue. Spectra were shifted on intensity scale for clarity.

Initial Clinical Experience With a Flexible Peripheral 21-G Needle Device.

BACKGROUND: Bronchoscopic techniques can be used to safely sample peripheral lung nodules (PLN), and transbronchial needle aspiration (TBNA) can further increase the diagnostic yield. Current needle devices not necessarily designed for this indication have limitations. We report our initial experience with a new flexible nitinol peripheral TBNA needle specifically designed for such sampling. METHODS: Retrospective case review describing the first clinical cases performed with a commercially available 21-G peripheral TBNA device in 4 centers. RESULTS: Eleven different operators performed 40 procedures for PLNs of a mean size of 35.1 mm (±18), and located 18.8 mm (±18.8) from the pleural surface, with 50% of them being present in the upper lobes. Bronchoscopists rated the use of the needle as good or excellent for reaching the PLN in 27/30 (90%) of cases. The TBNA sample was diagnostic in 18/40 cases (45%) overall and in 18/28 (64.3%) of cases where a diagnosis on bronchoscopy was possible. No episode of pneumothorax, significant bleeding, hypoxemia, escalation of care, or other complications were noted. CONCLUSION: Our initial experience with a novel peripheral TBNA device appears safe and effective, and may offer technical advantages over other available devices. Additional studies will be required to confirm the role of this device in the approach to bronchoscopic sampling of parenchymal lung nodules.

Endoscopic high-resolution autofluorescence imaging and OCT of pulmonary vascular networks.

High-resolution imaging from within airways may allow new methods for studying lung disease. In this work, we report an endoscopic imaging system capable of high-resolution autofluorescence imaging (AFI) and optical coherence tomography (OCT) in peripheral airways using a 0.9 mm diameter double-clad fiber (DCF) catheter. In this system, AFI excitation light is coupled into the core of the DCF, enabling tightly focused excitation light while maintaining efficient collection of autofluorescence emission through the large diameter inner cladding of the DCF. We demonstrate the ability of this imaging system to visualize pulmonary vasculature as small as 12 µm in vivo.

Effects of Bronchial Thermoplasty on Airway Smooth Muscle and Collagen Deposition in Asthma.

RATIONALE: The aim of bronchial thermoplasty is to improve asthma symptoms by reducing central airway smooth muscle mass. Up to now, the reduction of smooth muscle mass has been documented for only 1 group of 10 patients who had 15% or more of their pretreatment total bronchial biopsy area occupied by smooth muscle. OBJECTIVES: To evaluate the effects of bronchial thermoplasty on airway smooth muscle mass and airway collagen deposition in adult patients with asthma, regardless of pretreatment smooth muscle area. METHODS: Seventeen patients with asthma underwent bronchial thermoplasty over the course of three visits. At Visit 1, bronchial biopsies were taken from the lower lobe that was not treated during this session. At Visit 2 (3-14 wk after the first visit), all 17 patients underwent biopsy of the lower lobe treated during the first procedure. At Visit 3 (7-22 wk after the first visit), nine patients agreed to undergo biopsy of the same lower lobe. Histological and immunohistochemical analyses were performed on the biopsy specimens. MEASUREMENTS AND MAIN RESULTS: Bronchial thermoplasty decreased airway smooth muscle from 12.9 ± 1.2% of the total biopsy surface at Visit 1 to 4.6 ± 0.8% at Visit 2 (P < 0.0001). For the nine patients who underwent a third biopsy, mean airway smooth muscle area was 5.3 ± 1.3% at Visit 3 (P = 0.0008 compared with baseline). Bronchial thermoplasty also decreased Type I collagen deposition underneath the basement membrane from 6.8 ± 0.3 µm at Visit 1 to 4.3 ± 0.2 µm at Visit 2 (P < 0.0001) and to 4.4 ± 0.4 µm for nine patients at Visit 3 (P < 0.0001 compared with baseline). Over the course of 1 year after treatment, the doses of inhaled corticosteroid, the number of severe exacerbations, and asthma control all improved (P ≤ 0.02). CONCLUSIONS: For patients with severe asthma, bronchial thermoplasty reduced the smooth muscle mass of treated airway segments, regardless of the baseline level of muscle mass. Treatment also altered the deposition of collagen. At follow-up, bronchial thermoplasty improved asthma control; however, the limited number of subjects did not allow us to evaluate possible correlations between these improvements and the studied histological parameters. Further studies are needed to confirm these results and evaluate their persistence.