Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under LungPoint guidance for small peripheral pulmonary lesions.

BACKGROUND AND OBJECTIVE: The yield of biopsy performed during bronchoscopy is reduced if the lesion is smaller than 30 mm. We evaluated the performance of a new diagnostic technique combining endobronchial ultrasonography with a guide sheath (EBUS-GS) and a virtual bronchoscopic navigation system, LungPoint (Broncus Technologies, Inc., Mountain View, CA, USA), for the diagnosis of small (≤30 mm) peripheral pulmonary lesions (PPL). METHODS: Between May 2011 and December 2011, we recruited 68 consecutive patients presenting with a PPL 30 mm or less in diameter determined by chest computed tomography. We used the LungPoint system before bronchoscopy to identify the bronchus into which the bronchoscope should be advanced. We used a thin bronchoscope. EBUS-GS was performed using an endoscope ultrasonography system equipped with a 20-MHz mechanical radial-type probe. We used a guide sheath with an external diameter of 1.95 mm, thin forceps and brushing. RESULTS: The diagnostic yield of the 68 PPL was 77.9%; it was 83.7% and 68.0% for the malignant and benign lesions, respectively. Notably, three cases were diagnosed by transbronchial needle-aspiration cytology alone. Univariate and multivariate analyses showed that the EBUS probe localization was the most significant contributor to successful diagnosis (diagnostic yield: within vs adjacent to the lesion = 92.1% vs 60.0%, respectively; P = 0.004 and P = 0.003, respectively). CONCLUSIONS: The combination of EBUS-GS and LungPoint was useful for diagnosing small PPL.

[The contribution of widely used devices in the diagnosis of peripheral pulmonary lesions in patients presenting with respiratory distress].

PURPOSE: We retrospectively reviewed the contribution of widely used devices such as the standard fiberoptic bronchoscope in the diagnosis of peripheral pulmonary lesions (PPLs) in patients who presented with respiratory distress. SUBJECT: We performed bronchoscopy for 106 PPLs in January-December 2007, and diagnosed access to the lesions to be difficult. METHOD: For these lesions, we applied Sasada transbronchial angled forceps (STAF), transbronchial needle aspiration cytology (TBAC), thin bronchoscopy, and ultra-thin bronchoscopy, which are widely used devices, after routinely performing biopsy with standard forceps and saved each specimen separately, and finally compared the pathological diagnosis. RESULTS: The diagnostic yield obtained with specimens using standard forceps was 36.8%; however, the overall diagnosis was improved to 70.8% after we used these other devices and methods. We achieved diagnosis with STAF (10 lesions), followed by thin bronchoscopy (5 lesions), and ultra-thin bronchoscopy (14 lesions). No diagnosis was made by TBAC. CONCLUSION: We conclude that these widely employed devices can contribute to improvements in the diagnosis of cases of respiratory distress in which arrival to the lesions is difficult.

[A patient with diffuse peritoneal metastases of GIST who was administered STI571].

We report a patient with diffuse peritoneal metastases of GIST who was administered STI571 (a tyrosine kinase inhibitor). She was a 45-year-old woman who underwent surgery for a mass that was suspected to be an ovarian tumor. The postoperative diagnosis was GIST developing from the small intestine. Two years later, multiple peritoneal metastases were noted and a complete macroscopic resection was done. Six months after the second operation, she needed a third operation and complete macroscopic resection was repeated. Only 4 months after the third operation, she underwent a fourth operation. We resected massive peritoneal metastases, but diffuse metastases remained. Therefore, we started to administer STI571 at 400 mg/day. She has been free from peritoneal masses for 9 months after the fourth operation. We recommend STI571 for uncontrolled diffuse peritoneal metastases of GIST.