Asok Dasgupta

Transbronchial Needle Aspiration

To determine the value of transbronchial needle aspiration biopsy in the diagnosis of sarcoidosis, we reviewed a one-year experience of consecutive patients with sarcoidosis presenting with hilar and/or paratracheal adenopathy. The sensitivity of transbronchial needle aspiration biopsy in obtaining noncaseating granulomas was 90%. This yield exceeds that of most published reports of transbronchial lung biopsy and bronchial mucosal biopsy and suggests that transbronchial needle aspiration biopsy may be a valuable diagnostic tool in the evaluation of these forms of sarcoidosis.

Role of Tc-99m MIBI in the evaluation of single pulmonary nodules: a preliminary report

BACKGROUND Survival in bronchial carcinoma is closely related to the stage of the disease at the time of diagnosis and a single pulmonary nodule represents a potentially curable stage. This study was conducted to assess the feasibility of using Tc-99m labelled 2-methoxy isobutyl isonitrile (MIBI) to differentiate benign from malignant single pulmonary nodules. METHODS A prospective study was conducted in the outpatient pulmonary clinic at the Cleveland Clinic Foundation. Twenty five patients with single pulmonary nodules considered indeterminate by their physicians and undergoing a procedure for tissue diagnosis were evaluated by Tc-99m MIBI SPECT scanning prior to definitive testing. Assessment of MIBI uptake was done qualitatively (subjectively) and quantitatively and correlated with the histopathology and nodule size. RESULTS Of the 21 patients with malignant lesions, 18 had increased uptake of MIBI corresponding to the location of the nodule and were considered positive. The predominant tumour types were large cell (n = 5) and adenocarcinoma (n = 10). All four patients with benign lesions had negative MIBI scans. For malignancy the overall specificity was 100%, sensitivity was 85.7%, positive predictive value was 100%, and negative predictive value was 57%. Quantitative uptake of MIBI correlated with the diameter of the nodule with a correlation coefficient of 0.61 by Spearmans rank sum test. This relationship was statistically significant (p = 0.02). CONCLUSION This preliminary study suggests that Tc-99m MIBI has a very high specificity and positive predictive value for malignant single pulmonary nodules and might be a useful non-invasive diagnostic modality in their management.

Airway complications of esophageal self-expandable metallic stent

The primary therapeutic objective in patients with advanced esophageal cancer is to relieve symptomatic dysphagia. Traditionally, palliative radiotherapy, chemotherapy, and periodic bougie dilation have been used for this purpose. Rapid palliation is possible with placement of a plastic esophageal prosthesis. However, such devices are associated with a high rate of complications such as migration, esophageal perforation, and aspiration pneumonia.1 In recent years, self-expandable metallic stent (SEMS) have been used to relieve esophageal obstruction. Although complications are less frequent with SEMS as compared with conventional plastic stents,2 we have seen two patients who developed severe tracheobronchial complications after SEMS placement.

Use of wallstents in central airway obstruction

Tracheobronchial stents are playing an increasing role in the management of select large airway obstruction. Despite more than 20 years of experience, stent technology remains far from being perfect. Tube stents are the most commonly used endobronchial prosthesis yet, flawed by the need for rigid bronchoscopy and complications such as migration. Self-expandable metallic (SEM) stents offer ease of insertion and minimized risk of migration. The following article describes our experience with the SEM wallstent in 45 patients. The preliminary experience is encouraging yet, long-term follow-up is necessary.