Methylation Assessment for the Prediction of Malignancy in Mediastinal Adenopathies Obtained by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients with Lung Cancer.

The evaluation of mediastinal lymph nodes is critical for the correct staging of patients with lung cancer (LC). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for mediastinal staging, though unfortunately lymph node micrometastasis is often missed by cytological analysis. The aim of this study was to evaluate the predictive capacity of methylation biomarkers and provide a classification rule for predicting malignancy in false negative EBUS-TBNA samples. The study included 112 patients with a new or suspected diagnosis of LC that were referred to EBUS-TBNA. Methylation of p16/INK4a, MGMT, SHOX2, E-cadherin, DLEC1, and RASSF1A was quantified by nested methylation-specific qPCR in 218 EBUS-TBNA lymph node samples. Cross-validated linear regression models were evaluated to predict malignancy. According to EBUS-TBNA and final diagnosis, 90 samples were true positives for malignancy, 110 were true negatives, and 18 were false negatives. MGMT, SHOX2, and E-cadherin were the methylation markers that better predicted malignancy. The model including sex, age, short axis diameter and standard uptake value of adenopathy, and SHOX2 showed 82.7% cross-validated sensitivity and 82.4% specificity for the detection of malignant lymphadenopathies among negative cytology samples. Our results suggest that the predictive model approach proposed can complement EBUS-TBNA for mediastinal staging.

Revisión de la enfermedad del pulmón de granjero / Farmer's Lung Disease. A Review

La enfermedad del pulmón de granjero (EPG) es una forma de neumonitis por hipersensibilidad (NH) producida por la inhalación de microorganismos procedentes del heno o grano almacenado en condiciones de alta humedad en el ámbito laboral agrícola. Se trata de una enfermedad probablemente infradiagnosticada, sobre todo en el Norte de España, donde las condiciones climáticas son propicias para el desarrollo de la misma. Según estudios previos los antígenos más frecuentes suelen ser hongos y actinomicetos termofílicos. La epidemiología de la enfermedad no es del todo bien conocida, y se basa en estudios realizados por grupos centroeuropeos y asiáticos. La presentación clínica puede ser variada, diferenciándose las formas agudas (tras exposición a elevadas concentraciones del antígeno) y las crónicas (exposición a menores concentraciones del antígeno, pero más prolongada en el tiempo). En estos casos es esencial, en aquellos pacientes con clínica respiratoria durante la exposición laboral agrícola, demostrar una radiología y función pulmonar compatible, así como una sensibilización al antígeno, una linfocitosis en el lavado broncoalveolar en su caso y/o una anatomía patológica concordante. El tratamiento principal es la evitación antigénica, por lo que la educación de los pacientes en las medidas preventivas es fundamental. Por el momento, no existen estudios controlados que permitan evaluar el papel de tratamientos inmunosupresores en esta enfermedad. El tratamiento con corticosteroides solo ha demostrado acelerar la resolución de las formas agudas, pero no hay estudios que demuestren su efectividad a largo plazo, con el fin de evitar la progresión de la enfermedad ni disminuir su mortalidad

Farmer's lung disease (FLD) is a form of hypersensitivity pneumonitis (HP) caused by inhaling microorganisms from hay or grain stored in conditions of high humidity in the agricultural workplace. It is probably underdiagnosed, especially in northern Spain, where climatic conditions favor the development of this disease. According to previous studies, the most common antigens are usually thermophilic actinomycetes and fungi. The epidemiology of the disease is not well known, and is based on studies conducted by Central European and Asian groups. The clinical presentation may vary, differentiating the chronic (exposure to lower concentrations of the antigen over a longer period time) and the acute forms (after exposure to high concentrations of the antigen). In patients with respiratory symptoms and agricultural occupational exposure, radiological, lung function and/or anatomical pathology findings must be compatible with FLD, bronchoalveolar lavage must show lymphocytosis, and tests must find sensitivity to the antigen. The main treatment is avoidance of the antigen, so it is essential to educate patients on preventive measures. To date, no controlled studies have assessed the role of immunosuppressive therapy in this disease. Corticosteroid treatment has only been shown to accelerate resolution of the acute forms, but there is no evidence that it is effective in preventing disease progression in the long-term or reducing mortality

Farmer's Lung Disease. A Review. / Revisión de la enfermedad del pulmón de granjero.

Farmer's lung disease (FLD) is a form of hypersensitivity pneumonitis (HP) caused by inhaling microorganisms from hay or grain stored in conditions of high humidity in the agricultural workplace. It is probably underdiagnosed, especially in northern Spain, where climatic conditions favor the development of this disease. According to previous studies, the most common antigens are usually thermophilic actinomycetes and fungi. The epidemiology of the disease is not well known, and is based on studies conducted by Central European and Asian groups. The clinical presentation may vary, differentiating the chronic (exposure to lower concentrations of the antigen over a longer period time) and the acute forms (after exposure to high concentrations of the antigen). In patients with respiratory symptoms and agricultural occupational exposure, radiological, lung function and/or anatomical pathology findings must be compatible with FLD, bronchoalveolar lavage must show lymphocytosis, and tests must find sensitivity to the antigen. The main treatment is avoidance of the antigen, so it is essential to educate patients on preventive measures. To date, no controlled studies have assessed the role of immunosuppressive therapy in this disease. Corticosteroid treatment has only been shown to accelerate resolution of the acute forms, but there is no evidence that it is effective in preventing disease progression in the long-term or reducing mortality.

Diagnóstico de lesiones paratraqueobronquiales no adenopáticas mediante ecobroncoscopia lineal / Diagnosis of Non-nodal Paratracheobronchial Lesions by Linear Endobronchial Ultrasound

La ultrasonografía endobronquial lineal (USEB) facilita la obtención de muestras de lesiones próximas a la vía aérea, ya que permite realizar la punción bajo control visual en tiempo real, abriendo nuevas posibilidades de exploración mínimamente invasiva del mediastino. Mientras que existen multitud de publicaciones acerca de su utilidad en el estudio de adenopatías mediastínicas o hiliares, son escasas aquellas que analizan el papel de la punción guiada por USEB para el diagnóstico de otras lesiones adyacentes a la vía área o digestiva. Describimos las características y los resultados obtenidos en una serie de 26 casos de lesiones no adenopáticas de diferentes etiologías estudiadas mediante punción guiada por USEB a través de la vía aérea o esofágica, demostrando la utilidad y seguridad de esta técnica en el diagnóstico de este tipo de lesiones (AU)

Linear endobronchial ultrasound (EBUS) allows samples of lesions close to the airways to be obtained, as it enables aspiration to be performed under visual control in real time, opening new possibilities for minimally invasive examination of the mediastinum. While there are many publications on its usefulness in the study of mediastinal or hilar lymphadenopathies, there are few that analyse the role of EBUS-guided transbronchial needle aspiration for the diagnosis of other lesions adjacent to the airways or digestive tract. We describe the characteristics and results obtained in a series of 26 cases of non-nodal lesions of different aetiologies studied by EBUS-guided transbronchial needle aspiration through the airways or oesophagus, demonstrating the usefulness and safety of this technique in the diagnosis of these types of lesions (AU)

Diagnosis of non-nodal paratracheobronchial lesions by linear endobronchial ultrasound.

Linear endobronchial ultrasound (EBUS) allows samples of lesions close to the airways to be obtained, as it enables aspiration to be performed under visual control in real time, opening new possibilities for minimally invasive examination of the mediastinum. While there are many publications on its usefulness in the study of mediastinal or hilar lymphadenopathies, there are few that analyse the role of EBUS-guided transbronchial needle aspiration for the diagnosis of other lesions adjacent to the airways or digestive tract. We describe the characteristics and results obtained in a series of 26 cases of non-nodal lesions of different aetiologies studied by EBUS- guided transbronchial needle aspiration through the airways or oesophagus, demonstrating the usefulness and safety of this technique in the diagnosis of these types of lesions.

Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies.

BACKGROUND: The aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome. METHODS: We performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis. RESULTS: Overall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site. CONCLUSION: The sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.

Extraction of airway foreign bodies in adults: experience from 1987-2008.

To determine the incidence and the clinical, radiographic, and endoscopic characteristics of adult patients in our area diagnosed with tracheobronchial foreign bodies (FBs), we have performed a descriptive retrospective study analysing rigid and flexible bronchoscopies practised at our department between 1987 and 2008 in patients older than 14 years. Of the 9781 bronchoscopies performed, 32 involved cases of bronchoaspiration of FBs. The mean age of the patients was 43.81 years (S.D. 21.43); 65.6% were male and 34.4% were female. Acute or recurrent infection was the most frequent clinical presentation. Chest radiographs provided data for diagnosis in 68% of the cases. The most common FB aspirated were inorganic (pins and plastic devices 21.4%, respectively). In conclusion, we can state that in our area tracheobronchial aspiration of FBs by adults is not common. The clinical symptoms are highly variable and the FBs are usually lodged in the right bronchial tree.

Influence of glutathione S-transferase M1 and T1 homozygous null mutations on the risk of antituberculosis drug-induced hepatotoxicity in a Caucasian population.

OBJECTIVES: Genetic variations in enzymes of isoniazid metabolism confer an increased risk for antituberculosis drug-induced hepatotoxicity in Asian populations. The present study was aimed at investigating the possible association of antituberculosis drug-induced hepatotoxicity with polymorphisms at the glutathione S-transferase (GST) gene in a Caucasian population. METHODS: A prospective case-control study was nested in a cohort of patients with active tuberculosis who were treated with a combination of isoniazid, rifampicin and pyrazinamide. Cases constituted patients with antituberculosis drug-induced hepatotoxicity (n=35), and controls constituted patients without any evidence of this complication (n=60). Homozygous null polymorphisms at GST loci M1 and T1 were analysed from genomic DNA from all participants. RESULTS: The GSTT1 homozygous null polymorphism was significantly associated with antituberculosis drug-induced hepatotoxicity [odds ratio (OR) 2.60, 95% confidence interval (CI) 1.08-6.24, P=0.03]. No significant association was observed between the GSTM1 homozygous null polymorphism and antituberculosis drug-induced hepatotoxicity (OR 0.73, 95% CI 0.31-1.73, P=0.48). CONCLUSION: The GSTT1 homozygous null polymorphism may be a risk factor of antituberculosis drug-induced hepatotoxicity in Caucasians.

[Mutations in the gene encoding bone morphogenetic protein receptor 2 in patients with idiopathic pulmonary arterial hypertension]. / Mutaciones en el gen que codifica BMPR2 en pacientes con hipertensión arterial pulmonar esporádica.

OBJECTIVE: Pulmonary arterial hypertension (PAH) is a rare disease that can have a familial component. It has been shown that more than 50% of cases of familial PAH are associated with mutations in the gene encoding bone morphogenetic protein receptor 2 (BMPR2), which acts as a receptor for members of the transforming growth factor beta superfamily. Some studies in patients with idiopathic PAH have also shown varying percentages of mutations in this gene. The aim of this study was to determine the frequency of these mutations in a group of patients with idiopathic PAH. PATIENTS AND METHODS: The study population included patients with idiopathic PAH who were seen during 2006 in our unit specialized in this entity. Patients were excluded if they had relatives who had been diagnosed with PAH or who had symptoms that led to suspicion of the disease. Diagnosis was obtained according to the protocol used in our unit. A hemodynamic study was carried out in all cases and patients were included if they had a mean pulmonary arterial pressure of greater than 25 mm Hg. DNA was extracted from peripheral leukocytes and amplified by polymerase chain reaction. Seventeen primer pairs were used for the 13 exons that make up the gene. Using the single strand conformational polymorphism (SSCP) technique we detected anomalous DNA fragments for subsequent sequencing. RESULTS: The study included 8 patients (4 women). In 5 patients, no abnormalities were observed, whereas in the remaining 3, anomalous electrophoresis patterns were obtained in the SSCP and sequencing revealed mutations. In 1 case, 2 different electrophoresis patterns were observed by SSCP, but it was only possible to sequence 1 of them due to the low concentration of DNA obtained. CONCLUSIONS: The presence of mutations in the gene encoding BMPR2 is not infrequent in patients with idiopathic PAH, suggesting that this family of growth factors may be important in the pathogenesis of the disease and could have therapeutic implications.

Mutaciones en el gen que codifica BMPR2 en pacientes con hipertensión arterial pulmonar esporádica / Mutations in the gene encoding bone morphogenetic protein receptor 2 in patients with idiopathic pulmonary arterial hypertension

Objetivo: La hipertensión arterial pulmonar (HAP) es una enfermedad poco frecuente que puede tener un componente familiar. En este caso se ha comprobado que un porcentaje superior al 50% se asocia a mutaciones en el gen que codifica el receptor tipo 2 de las proteínas morfogenéticas del hueso (BMPR2), un receptor de la superfamilia del factor transformador del crecimiento beta. Algunos estudios en pacientes con HAP idiopática también muestran porcentajes variables de mutaciones en este gen. El objetivo de nuestro trabajo ha sido conocer la frecuencia de estas mutaciones en nuestros pacientes con HAP idiopática. Pacientes y métodos: Los pacientes con HAP idiopática seguidos en nuestra unidad de HAP durante el año 2006 constituyeron la población de estudio. Se excluyó la existencia de familiares con diagnóstico de esta enfermedad o síntomas que pudieran hacer pensar en ella. El diagnóstico de HAP fue acorde con el protocolo utilizado en la unidad. En todos los casos se realizó estudio hemodinámico y se incluyó a pacientes con presión arterial pulmonar media mayor de 25 mmHg. Se efectuó extracción del ADN de los leucocitos periféricos y se amplificó mediante la técnica de reacción en cadena de la polimerasa. Se utilizaron 17 parejas de cebadores para los 13 exones que componen el gen. Mediante técnica de conformación de hebra simple y electroforesis posterior se detectaron los fragmentos anómalos, para posteriormente proceder a la secuenciación del gen mediante un lector automático. Resultados: Se estudió a 8 pacientes (4 mujeres). En 5 de ellos no se encontraron alteraciones, pero 3 mostraron patrones anómalos en la electroforesis y en la secuenciación se observaron mutaciones. En uno de los casos se presentaron 2 patrones anómalos en la electroforesis, pero sólo fue posible secuenciar uno de ellos por la baja concentración del ADN recogido. Conclusiones: La presencia de mutaciones en el gen que codifica BMPR2 no es infrecuente en pacientes con HAP idiopática, lo que probablemente indique un papel importante de esta familia de factores de crecimiento en la patogenia de la enfermedad y, por tanto, podría tener implicaciones terapéuticas

Objective: Pulmonary arterial hypertension (PAH) is a rare disease that can have a familial component. It has been shown that more than 50% of cases of familial PAH are associated with mutations in the gene encoding bone morphogenetic protein receptor 2 (BMPR2), which acts as a receptor for members of the transforming growth factor Beta superfamily. Some studies in patients with idiopathic PAH have also shown varying percentages of mutations in this gene. The aim of this study was to determine the frequency of these mutations in a group of patients with idiopathic PAH. Patients and methods: The study population included patients with idiopathic PAH who were seen during 2006 in our unit specialized in this entity. Patients were excluded if they had relatives who had been diagnosed with PAH or who had symptoms that led to suspicion of the disease. Diagnosis was obtained according to the protocol used in our unit. A hemodynamic study was carried out in all cases and patients were included if they had a mean pulmonary arterial pressure of greater than 25 mm Hg. DNA was extracted from peripheral leukocytes and amplified by polymerase chain reaction. Seventeen primer pairs were used for the 13 exons that make up the gene. Using the single strand conformational polymorphism (SSCP) technique we detected anomalous DNA fragments for subsequent sequencing. Results: The study included 8 patients (4 women). In 5 patients, no abnormalities were observed, whereas in the remaining 3, anomalous electrophoresis patterns were obtained in the SSCP and sequencing revealed mutations. In 1 case, 2 different electrophoresis patterns were observed by SSCP, but it was only possible to sequence 1 of them due to the low concentration of DNA obtained. Conclusions: The presence of mutations in the gene encoding BMPR2 is not infrequent in patients with idiopathic PAH, suggesting that this family of growth factors may be important in the pathogenesis of the disease and could have therapeutic implications

Primary amyloidosis involving mediastinal lymph nodes: diagnosis by transbronchial needle aspiration.

Amyloidosis is an uncommon disease caused by the deposition of abnormal proteins within soft tissues. Pulmonary and mediastinal lymph node involvement of the disease is rare. When mediastinal lymph nodes are affected, the diagnostic approach should include sample collection for pathological examination. Transbronchial fine needle aspiration is a useful and safe procedure for sampling mediastinal lymph nodes. This paper describes the first case of amyloidosis that involves mediastinal lymph nodes diagnosed by transbronchial needle aspiration.

[Clinical utility of transbronchial needle aspiration of mediastinal lymph nodes in the diagnosis of sarcoidosis in stages I and II]. / Utilidad clínica de la punción transbronquial de adenopatías mediastínicas en el diagnóstico de la sarcoidosis en estadios I y II.

OBJECTIVE: To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II. PATIENTS AND METHODS: We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies. RESULTS: A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well. CONCLUSIONS: Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good.

Utilidad clínica de la punción transbronquial de adenopatías mediastínicas en el diagnóstico de la sarcoidosis en estadios I y II / Clinical utility of transbronchial needle aspiration of mediastinal lymph nodes in the diagnosis of sarcoidosis in stages I and II

Objetivo: Analizar tanto la rentabilidad individual como La conjunta y la utilidad clínica de la punción transbronquial (PTB) y la biopsia transbronquial (BTB) en el diagnóstico histológico de sarcoidosis en estadios I y II. Pacientes y métodos: Se ha realizado un estudio prospectivo en el que se incluyó a todos los pacientes con adenopatías mediastínicas de diámetro superior a 10 mm y sospecha clinicorradiológica de sarcoidosis, ingresados entre julio de 2001 y junio de 2006. Se realizó a todos, por este orden, PTB con agujas Bard-Wang 319 de una o más adenopatías hasta obtener un mínimo de 2 muestras satisfactorias; lavado broncoalveolar, y 4-6 BTB. Resultados: Se incluyó en el estudio a 32 pacientes, de los que 26 presentaron un diagnóstico final de sarcoidosis. La edad media ± desviación estándar fue de 38,9 ± 10,6 años y 13 (50%) eran mujeres. El diámetro medio de las adenopatías fue de 23,5 ± 6,5 mm. Las estaciones ganglionares más puncionadas fueron la subcarinal, con 9 casos (34,6%), y la combinación subcarinal-paratraqueal derecha, con 7 (26,9%). Se observó afectación parenquimatosa en la tomografía computarizada de tórax en 12 (46,2%). La BTB fue diagnóstica en 15 pacientes (57,7%) y la PTB en 16 (61,5%), y fueron las únicas técnicas diagnósticas en 7 (26,9%) y 8 (30,8%) casos, respectivamente (p > 0,05). La combinación de ambas fue diagnóstica en 23 casos (88,4%), significativamente superior a la BTB (p = 0,01) y a la PTB (p = 0,02) por separado en todos los casos, y sólo a la BTB (p = 0,01) en los casos con afectación parenquimatosa. Únicamente 4 pacientes (15%) presentaron alguna complicación y en 20 (76,9%) la tolerancia fue buena. Conclusiones: La adición de la PTB a la BTB incrementa significativamente el número de diagnósticos de sarcoidosis, sobre todo en pacientes sin afectación parenquimatosa. El número de complicaciones es bajo y la tolerancia, buena

Objective: To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II. Patients and methods: We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies. Results: A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well. Conclusions: Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good

Efficacy and safety of the eXcelon transbronchial aspiration needle in mediastinal lymph node enlargement: a case-control study.

BACKGROUND: Several different types of needles for transbronchial needle aspiration (TBNA) exist in the market. Recently, the eXcelon transbronchial needle (Boston Scientific, Boston, Mass., USA) was commercialized, and to our knowledge, no comparative studies with other types of needles have been performed up to date. OBJECTIVES: The aim of the present study was to determine the diagnostic yield and safety of the 21-gauge eXcelon transbronchial needle in the diagnosis of mediastinal lesions and to compare it with a 22-gauge Wang cytology needle (Bard-Wang, Billerica, Mass., USA). METHODS: A case-control prospective study was conducted. The study group included 42 TBNA of mediastinal nodes performed in 35 patients with the eXcelon 21-gauge needle from January to June 2005. A control group included 110 TBNA carried out in 99 patients that underwent mediastinal lymph node sampling using a MW-122 needle from June 2002 to December 2004. RESULTS: There was no statistical differentiation in the characteristics of the disease, mediastinal lymph nodes or number of passes between cases and controls. Adequate samples were obtained in 30 (71.4%) cases and 81 (73.6%) controls (p = 0.8). Technical complications occurred in 7 (16.6%) cases and 14 (12.7%) controls (p = 0.7). The only clinical complication was bleeding presented in 2 (4.8%) cases and 3 (2.7%) controls (p = 0.3). CONCLUSION: The eXcelon 21-gauge transbronchial needle is as effective and safe as the MW-122 needle in the diagnosis of mediastinal lymph node enlargement.

[Effect of different bronchial washing sequences on diagnostic yield in endoscopically visible lung cancer]. / Influencia en la rentabilidad diagnóstica del momento de realización del aspirado bronquial en los carcinomas broncogénicos endoscópicamente visibles.

OBJECTIVE: Aspiration of bronchial wash fluid is commonly used in conjunction with brushing and forceps biopsy to diagnose endoscopically visible lung cancer. However, the optimal sequence of these procedures is subject to debate. The objective of this study was to determine if the order in which bronchial washing is performed relative to bronchial brushing and forceps biopsy has any effect on the diagnostic yield. PATIENTS AND METHODS: A prospective, cross-sectional study was carried out on patients with endoscopically visible lung cancer who underwent video-assisted fiberoptic bronchoscopy for diagnostic purposes. Aspiration of bronchial wash fluid was performed on all patients both before and after bronchial brushing and forceps biopsy. The results were analyzed separately for each type of endobronchial lesion and for both together. RESULTS: The study included 75 patients, with a mean age of 63.3 years; 81% were men. Bronchoscopy was diagnostic in 71 (94.7%) cases. Findings from bronchial washing fluid were positive in 40 (53.3%) patients when washing was performed prior to brushing and forceps biopsy; when washing was performed after these procedures, findings were positive in 43 (57.3%) patients (P=.6). The combined diagnostic yield of washing before and after brushing and forceps biopsy was 69.3%, a significantly better result than either washing before (P=.001) or after (P=.004) the other sampling techniques. In cases where findings from washing done after brushing and forceps biopsy were negative (14 of 32, 43.7%), blood in the aspirated sample interfered with cytology. In comparison, when washing was performed prior to brushing and biopsy, that problem arose in only 3 of the 35 cases (8.5%) (P=.002). CONCLUSIONS: The order in which bronchial washing is performed in relation to other sampling techniques for diagnosing bronchial tumors does not influence the diagnostic yield. This is probably because the aspirated fluid sample is more likely to contain excessive blood when washing is performed after brushing and forceps biopsy. However, the diagnostic yield can be significantly increased by combining the findings from bronchial washings performed both before and after other sample collection procedures.

Influencia en la rentabilidad diagnóstica del momento de realización del aspirado bronquial en los carcinomas broncogénicos endoscópicamente visibles / Effect of different bronchial washing sequences on diagnostic yield in endoscopically visible lung cancer

Objetivo: Además del cepillado y de la biopsia bronquiales, el aspirado bronquial (AB) es una técnica utilizada habitualmente en el diagnóstico del cáncer de pulmón endoscópicamente visible. Existe controversia sobre el momento adecuado para su realización. El objetivo del presente estudio ha sido evaluar si el momento de la realización del AB puede influir en el rendimiento diagnóstico. Pacientes y métodos: Se ha llevado a cabo un estudio transversal prospectivo, en el que se incluyó a pacientes con carcinomas broncogénicos endoscópicamente visibles a los que se hizo una videofibrobroncoscopia con fines diagnósticos. A todos se les realizaba AB previo y tras el cepillado y la biopsia bronquiales. El resultado se analizó de forma global y para cada tipo de lesión endobronquial. Resultados: Se incluyó a 75 pacientes con una edad media de 63,3 años siendo el 81% varones. La broncoscopia fue diagnóstica en 71 (94,7%). El AB previo fue positivo en 40 pacientes (53,3%) y el posterior en 43 (57,3%) (p = 0,6). La rentabilidad conjunta de ambos fue del 69,3%, significativamente superior a la del AB previo (p = 0,001) y la del AB posterior (p = 0,004) por separado. En el 43,7% de los casos en que el AB posterior fue negativo, la valoración citológica se vio dificultada por ser muy hemática, frente al 8,5% de los AB previos negativos (p = 0,002). Conclusiones: El orden de la realización del AB en el diagnóstico de neoplasias bronquiales no influye en el rendimiento diagnóstico, probablemente por la mayor frecuencia de AB hemorrágicos que se producen cuando el AB se realiza tras el cepillado y la biopsia bronquiales. El estudio conjunto de ambos AB incrementa significativamente el rendimiento diagnóstico de la técnica

Objective: Aspiration of bronchial wash fluid is commonly used in conjunction with brushing and forceps biopsy to diagnose endoscopically visible lung cancer. However, the optimal sequence of these procedures is subject to debate. The objective of this study was to determine if the order in which bronchial washing is performed relative to bronchial brushing and forceps biopsy has any effect on the diagnostic yield. Patients and methods: A prospective, cross-sectional study was carried out on patients with endoscopically visible lung cancer who underwent video-assisted fiberoptic bronchoscopy for diagnostic purposes. Aspiration of bronchial wash fluid was performed on all patients both before and after bronchial brushing and forceps biopsy. The results were analyzed separately for each type of endobronchial lesion and for both together. Results: The study included 75 patients, with a mean age of 63.3 years; 81% were men. Bronchoscopy was diagnostic in 71 (94.7%) cases. Findings from bronchial washing fluid were positive in 40 (53.3%) patients when washing was performed prior to brushing and forceps biopsy; when washing was performed after these procedures, findings were positive in 43 (57.3%) patients (P=.6). The combined diagnostic yield of washing before and after brushing and forceps biopsy was 69.3%, a significantly better result than either washing before (P=.001) or after (P=.004) the other sampling techniques. In cases where findings from washing done after brushing and forceps biopsy were negative (14 of 32, 43.7%), blood in the aspirated sample interfered with cytology. In comparison, when washing was performed prior to brushing and biopsy, that problem arose in only 3 of the 35 cases (8.5%) (P=.002). Conclusions: The order in which bronchial washing is performed in relation to other sampling techniques for diagnosing bronchial tumors does not influence the diagnostic yield. This is probably because the aspirated fluid sample is more likely to contain excessive blood when washing is performed after brushing and forceps biopsy. However, the diagnostic yield can be significantly increased by combining the findings from bronchial washings performed both before and after other sample collection procedures