Carmen Puzo

Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: A randomized trial

Transbronchial lung biopsy (TBLB) is required for evaluation in selected patients with interstitial lung disease (ILD). The diagnostic yield of histopathologic assessment is variable and is influenced by factors such as the size of samples and the presence of crush artefacts left by conventional biopsy forceps. We compared the diagnostic yield and safety of TBLB with cryoprobe sampling versus conventional forceps sampling.

Utilización de criosondas para la realización de la biopsia pulmonar transbronquial

BACKGROUND AND OBJECTIVES Transbronchial lung biopsy (TBLB) is a bronchoscopy procedure used to obtain peripheral lung tissue. Small size samples and artefacts lead to variable, and usually poor, diagnostic yield. The use of cryoprobes may enable larger size and better quality biopsy samples to be obtained. The purpose of this study was to evaluate the feasibility of TBLB with cryoprobes and analyse the histological quality of samples obtained. PATIENTS AND METHODS We selected 10 patients with interstitial lung disease who were suitable for TBLB. A cryoprobe (Erbokryo CA, Erbe, Germany) was introduced through the bronchoscope work channel. Then, under fluoroscopic control, the cryoprobe was placed in an area of the peripheral lung previously selected according to CT findings. A temperature of -89.5 degrees C was applied for 3s and the cryoprobe and bronchoscope were removed with the frozen lung sample attached to the probe. The procedure was performed under sedation and the patient was intubated to allow bronchoscope and cryoprobe removal. Safety, duration of the procedure and histological findings has been evaluated. RESULTS There were 10 patients (64+/-8 years, 6 males). Procedure length was 35 min. The specimen area was 9.5 mm2 (range 3 to 25 mm2) and the mean number of alveolar spaces was 29.62. No pneumothorax was registered. 6/10 patients had mild post-biopsy bleeding controlled with standard bronchoscopy measures. CONCLUSIONS The use of cryoprobes for TBLB may become an alternative technique to increase diagnostic yield.

Propuesta de terminología de las lesiones endobronquiales en pacientes con sospecha de neoplasia bronquial

La descripcion de lesiones endoscopicas en el cancer de pulmon varia segun el endoscopista. Este trabajo pretende evaluar la probabilidad de neoplasia en relacion con los hallazgos endoscopicos segun una clasificacion original. Las lesiones endoscopicas se clasifican en: infiltracion (lesion en superficie sin limite preciso con la mucosa normal) y masa (lesion exofitica, facil de diferenciar de la pared). Cada lesion tiene 3 grados con relacion a la probabilidad de malignidad. En la infiltracion grado I, la lesion presenta una de las siguientes caracteristicas: perdida de brillo, aumento de grosor o enrojecimiento, de superficie regular; en la infiltracion grado II coinciden 2 de los cambios anteriores, con superficie irregular; en la infiltracion grado III estan presentes 3 de las caracteristicas anteriores; la masa grado I es una lesion exofitica de superficie lisa y coloracion uniforme; la masa grado II presenta una superficie regular de coloracion distinta, y en la masa III la superficie y coloracion son irregulares. Se evaluo a 377 pacientes con sospecha de neoplasia. Fueron carcinomas un 23% de las infiltraciones grado I, un 74% de las infiltraciones grado II y un 95% de las infiltraciones grado III. Por lo que respecta a las masas, fueron neoplasias el 23% de las de grado I, el 77% de las de grado II y el 97% de las de grado III. En ambos tipos de lesiones la probabilidad de malignidad aumenta de acuerdo con el grado (p < 0,001). En conclusion, existe una correlacion positiva entre la terminologia descrita y la probabilidad de carcinoma. En la mayoria de los casos las lesiones grado III son carcinomas, pero a su vez las lesiones grado I, aparentemente inofensivas, pueden ser carcinomas en un numero significativo de los casos.

Complicaciones de la broncofibroscopia

La broncofibroscopia es una exploracion con pocas complicaciones. La mayoria de estas se deben a caracteristicas de los pacientes, al uso de premedicacion excesiva o se asocian a determinadas tecnicas. La edad avanzada de los pacientes, la presencia de hiperreactividad bronquial o de enfermedades graves, son factores de riesgo que deben evaluarse antes de la indicacion y realizacion de la BF para tomar las medidas adecuadas. En el lavado broncoalveolar se han descrito algunas complicaciones (deterioro de la funcion pulmonar, broncoespasmo, fiebre, etc.) en general de escasa trascendencia. Las complicaciones mas frecuentes de la biopsia transbronquial son el neumotorax y la hemorragia, aunque su incidencia es escasa. En enfermos criticos y en ventilacion mecanica hay que tomar medidas especificas para asegurar la ventilacion adecuada y el control hemodinamico. Ademas del conocimiento de los riesgos, es exigible disponer de los medios adecuados para intervenir cuando se presenten las complicaciones.

Cytology of postbronchoscopically collected sputum samples and its diagnostic value.

The usefulness of the cytology of postbronchoscopically collected sputum (PBS) samples in the diagnosis of neoplastic lung disease has been studied in 113 cases. The overall diagnostic yield of fiberoptic bronchoscopy (FB) alone was 77%, 87% in 77 central tumors and 58% in 36 peripheral ones. With the addition of PBS, the positive results increased to 91% in the 113 cases (p less than 0.01), to 94% n central tumors (p greater than 0.05) and to 83% in peripheral lesions (p less than 0.02). In 15 cases PBS offered the unique positive results. 73 cases with histological confirmation showed a good cytohistological correlation in 82%. Our report suggests that PBS is a useful technique in the diagnosis of lung cancer. Its systematic use does not seem to be justified in central tumors, but it is of great value in peripheral tumors when fluoroscopic control is not available.

Punción bronquial aspirativa en las neoplasias localizadas en bronquios centrales

Se estudia la posible utilidad de la puncion bronquial aspirativa a traves del broncofibroscopio en 125 neoplasias localizadas en bronquios centrales accesibles a la vision endoscopi-ca. En todos los casos, la imagen endobronquial sugeria la posible negatividad de la biopsia, el legrado y el broncoaspirado debido a: 1) crecimiento peribronquial del tumor o 2) masa endobronquial dificil de biopsiar de forma eficaz a causa de necrosis, caracter hemorragiparo o dificil acceso. En ambas circunstancias, la adicion de la puncion a las demas tecnicas aumento de forma significativa el rendimiento diagnostico de la broncoscopia: del 72% al 83% (p

Proposed Terms for Endobronchial Lesions in Patients Suspected of Having a Bronchial Neoplasm

Endoscopists describe lung cancer lesions using varying terminology. This study aimed to assess the probability of neoplastic disease in terms of endoscopic findings expressed in an original classification system. The endoscopic lesions were classified as infiltrations (superficial lesions without a clear border with normal mucosa) or masses (exophytic lesions easily distinguished from the bronchial wall). Each lesion was categorized according to 3 grades reflecting probability of malignancy. A grade I infiltration was a lesion presenting 1 of the following characteristics: loss of luster, increased thickness, or redness, with a smooth surface. A grade II infiltration presented 2 of the aforementioned characteristics, with a rough surface. A grade III infiltration presented 3 of those characteristics. A grade I mass was an exophytic lesion with a smooth surface, uniformly colored. A grade II mass presented a smooth surface of a distinct color, and a grade III mass had a rough surface and irregular coloring. We assessed 377 patients with suspicion of neoplasm. Twenty-three percent of the infiltrations were grade I carcinomas, 74% were grade II, and 95% were grade III. Twenty-three percent of masses were grade I, 77% were grade II, and 97% were grade III. The probability of malignancy increased significantly with grade (P< .001) for both types of lesion. In summary, there is a positive correlation between the terms used and the probability of carcinoma. Most grade III lesions were carcinomas, but apparently innocuous grade I lesions could be carcinomas in a significant number of cases.

Carcinomas bronquiales in situ e invasores precoces. Estudio de 11 casos

Se estudian once casos de carcinomas bronquiales in situ o microinvasivos que fueron resecados en un periodo de tiempo comprendido desde el ano 1977 al 1984. En todos los casos el diagnostico fue realizado mediante citologia de las secreciones obtenidas por lavado y aspirado bronquial. La radiologia fue negativa en todos los casos excepto en uno en que habia una imagen neumonica. Tos acompanada de esputo hemoptoico, fue el sintoma mas frecuente (ocho casos). Un paciente tuvo dolor toracico y neumonitis contralateral y los dos restantes fueron asintomaticos. El tumor se localizo mediante examen de broncoaspirados selectivos, requiriendose en algunos casos intervalos largos de tiempo hasta que se realizo el diagnostico (14 meses en uno de ellos) y varios broncoaspirados (siete). La lobectomia fue el tratamiento quirurgico mas frecuente, en siete casos, seguido de la segmentectomia en tres casos, solamente en un caso se realizo una neumonectomia debido a la gran extension del tumor en superficie. Estos pacientes tienen un buen pronostico, aunque tres de ellos han desarrollado un segundo tumor maligno. El estudio de supervivencia oscila entre ocho anos para el primer paciente operado, a seis meses para el ultimo paciente.

Recidiva endobronquial de linfoma difuso de células grandes B. Diagnóstico con criosonda

The bronchial involvement of diffuse large B-cell lymphoma (DLBCL) is an exceptional finding. Histological diagnosis is done with lung tissue samples. In these cases, the need for immunohistochemistry studies in order to establish the diagnosis requires obtaining tissue samples of adequate size and quality. Sometimes, endoscopic explorations may be repeated to obtain further biopsies. We present the first documented case of recurrent endobronchial DLBCL that was diagnosed from a bronchial biopsy taken with a cryoprobe.