Erdoğan Çetinkaya

Value of real-time endobronchial ultrasound-guided transbronchial needle aspiration.

AIM: The diagnostic value of real-time convex-probe endobronchial ultrasound (CP-EBUS)-guided transbronchial needle aspiration (TBNA) in mediastinal pathologies, and the factors influencing it are not clearly known. This study has been designed to examine factors affecting the efficacy and diagnostic value of CP-EBUS-TBNA. METHODS: Patients (n = 321) with mediastinal mass or enlarged lymph node in the mediastinum, participated in this study, conducted between April 2007 and May 2009. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. Histopathologic (in all samples) and microbiologic (in 151 patients’ samples) evaluations were carried out. Biopsy using an appropriate surgical method was taken when the result of the TBNA procedure was nondiagnostic. Thirty-four patients were excluded from the analysis due to several reasons. The diagnostic efficacy of the procedure was analyzed in the remaining 287 patients. RESULTS: The diagnostic rate was 92% (89.7% for the benign diseases and 92.6% for the malignant diseases (P = 0.59)). In granulomatous diseases, the rate was 96% for sarcoidosis and 79% for tuberculosis (P = 0.002). Patients in whom only one lymph node was sampled and in whom two or more lymph nodes were sampled had a diagnostic rate of 85% and 95%, respectively (P = 0.03). When left hilar nodes were sampled, a higher diagnostic rate was achieved (P = 0.01). CONCLUSIONS: CP-EBUS-guided TBNA has a high diagnostic rate. Sampling of at least two separate lymph nodes and the discovery of left hilar station in these lymph nodes increase the rate of diagnosis.

Epidemiology and distribution of interstitial lung diseases in Turkey

There is very few data on the epidemiological features of interstitial lung diseases (ILD) in the literature. These studies on this subject suffer from limited number of patients.

Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: A study in a tuberculosis-endemic country.

BACKGROUND Mediastinal lymphadenopathy in patients with malignancy is a common clinical problem in tuberculosis-endemic countries. The recently developed endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure enables direct and real-time aspiration of mediastinal and hilar lymph nodes. The aim of the study was to determine the efficacy of EBUS-TBNA results in the evaluation of mediastinal lymph nodes in patients with extrathoracic malignancy. MATERIALS AND METHODS Retrospective analysis was performed in 40 patients with proven (n = 38) or suspected metastasis of unknown origin (n = 2) who underwent EBUS-TBNA between July 2007 and August 2011. RESULTS All 40 patients successfully underwent EBUS-TBNA and no complications were observed. EBUS-TBNA diagnosed metastasis from extrathoracic malignancy in 16 (40%) patients, new lung cancer in 2 (5%), reactive lymph node in 9 (22.5%), sarcoidosis in 5 (12.5%), anthracosis in 5 (12.5%) and tuberculosis in 3 (7.5%). The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EBUS-TBNA based on the number of patients were 90.0%, 100%, 100%, 90.9% and 95.0%, respectively. In 33 patients with available data of fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) scans, the diagnostic sensitivity, specificity, PPV, NPV and accuracy of PET/CT scan based on the number of patients were 94.7%, 35.7%, 66.6%, 83.3%, and 69.6%, respectively. The association between larger lymph node size on EBUS and malignancy of lymph node sample on pathological examination was statistically significant (P = 0.018). CONCLUSIONS EBUS-TBNA is a sensitive, specific, minimally invasive and a safe procedure for the diagnosis of mediastinal and hilar metastasis from extrapulmonary malignancy in a tuberculosis-endemic country.

Does aspirin use prevent acute coronary syndrome in patients with pneumonia: multicenter prospective randomized trial.

ObjectivesThe aim of this study was to test the hypothesis that aspirin would reduce the risk for acute coronary syndromes (ACSs) in patients with pneumonia. BackgroundsPooled data suggest that pneumonia may trigger an ACS as a result of inflammatory reactions and the prothrombotic changes in patients with pneumonia. Hypothetically considering its antiaggregating and anti-inflammatory effects, aspirin might also be beneficial for the primary prevention of ACS in patients with pneumonia. MethodsOne hundred and eighty-five patients with pneumonia who had more than one risk factor for cardiovascular disease were randomized to an aspirin group (n=91) or a control group (n=94). The patients in the aspirin group received 300 mg of aspirin daily for 1 month. ECGs were recorded on admission and 48 h and 30 days after admission to assess silent ischemia. The level of high-sensitivity cardiac troponin T was measured on admission and 48 h after admission. The primary endpoint was the development of ACS within 1 month. The secondary endpoints included cardiovascular death and death from any cause within 1 month. ResultsThe &khgr;2-test showed that the rates of ACS at 1 month were 1.1% (n=1) in the aspirin group and 10.6% (n=10) in the control group (relative risk, 0.103; 95% confidence interval 0.005–0.746; P=0.015). Aspirin therapy was associated with a 9% absolute reduction in the risk for ACS. There was no significant decrease in the risk of death from any cause (P=0.151), but the aspirin group had a decreased risk of cardiovascular death (risk reduction: 0.04, P=0.044). ConclusionThis randomized open-label study shows that acetyl salicylic acid is beneficial in the reduction of ACS and cardiovascular mortality among patients with pneumonia.

Lymph node characteristics of sarcoidosis with endobronchial ultrasound

Background: Sonographic features of lymph nodes on endobronchial ultrasound (EBUS) have been shown to be useful in prediction of malignancy in mediastinum and hilum. The aim of this study was to assess the utility of morphologic features of mediastinal and/or hilar lymph nodes obtained by EBUS in patients with sarcoidosis. Materials and Methods: We retrospectively reviewed the records of 224 patients with mediastinal/hilar lymph node enlargements who underwent EBUS for diagnostic purpose. The lymph nodes were characterized based on the EBUS images as follows: (1) Size; based on short-axis dimension, <1 cm or ≥1 cm, (2) shape; oval or round, (3) margin; distinct or indistinct, (4) echogenicity; homogeneous or heterogeneous, (5) presence or absence of central hilar structure, and (6) presence or absence of granular (sandpaper) appearance. Results: One hundred (24.4%) nodes exhibited indistinct margins while 309 (75.6%) had distinct margins. One hundred and ninety nine (48.7%) nodes were characterized as homogeneous, and 210 (51.3%) nodes as heterogeneous. Granular appearance was observed in 130 (31.8%) lymph nodes. The presence of granules in lymph nodes on EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Logistic regression analysis revealed the finding of distinct margin alone as an independent predictive factor for the diagnosis of sarcoidosis. Conclusions: The presence of granular appearance in lymph nodes by EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Lymph nodes having distinct margins tend to suggest sarcoidosis.

Left atrial mass demonstrated during endobronchial ultrasound session.

enitis in favour of sarcoidosis. The patient was diagnosed as having stage I sarcoidosis. She underwent surgical resection of the atrial mass (online supplementary video 1, www.karger.com/doi/10.1159/000319701). The definitive diagnosis was left atrial myxoma ( fig. 3 ). Real-time EBUS-guided TBNA has been shown to be diagnostic in a variety of pulmonary diseases affecting the mediastinal and hilar lymph nodes. It has been shown to be an accurate technique, especially in the diagnosis of stage I sarcoidosis [1, 2] . We did not perform transbronchial biopsy because of the high diagnostic yield of EBUSguided TBNA and lack of parenchymal disease. EBUS can be used to assess other mediastinal structures. Left atrium and proximal portions of great arteries can be visualized through CP-EBUS [3, 4] . We demonstrated the left atrial mass during an EBUS session primarily performed for mediastinal lymphadenopathy. We suggest that all neighbouring structures of large airways should be evaluated, in order to detect any asymptomatic congenital anomalies (e.g. atrial septal defect), acquired cardiac diseases (e.g. valvular heart disease, masses and thrombi) and vascular pathologies (e.g. pulmonary thromboembolism). Incidental findings on EBUS must be confirmed by appropriate tests (i.e. contrast CT scan, echocardiography). A 59-year-old female patient was admitted to the clinic with a three-month history of dry cough and dyspnoea. Her chest roentgenogram revealed mediastinal and bilateral hilar widening and a heterogenous density on the right lower zone. Lung function tests showed a restrictive pattern. A CT of the thorax showed multiple mediastinal and hilar lymphadenopathy and complete right middle lobe collapse but no signs of parenchymal disease. There was a homogenous mass in the left atrium ( fig. 1 ). Bronchoscopy revealed a normal bronchial tree without any endobronchial lesion. We performed transbronchial needle aspiration (TBNA) and took pathological samples from the left hilar, left inferior paratracheal and subcarinal stations under the guidance of convex probe endobronchial ultrasound (CP-EBUS; BF 240 EU-ME1, Olympus, Tokyo, Japan). During the session, we evaluated the left atrium through the anteromedial wall of the intermediate bronchus and the medial wall of the left main bronchus. A well-defined, mobile, hyperechogenic mass was demonstrated ( fig. 2 ). It was 30 ! 40 mm in diameter, localized in the left atrium and attached to the interatrial septum with a peduncle. Informed consent was obtained. Cytopathological studies showed non-caseating granulomatous lymphadPublished online: August 3, 2010

An Unusual Complication of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): the Needle Breakage

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now becoming a widely accepted procedure to investigate the mediastinum for the staging of non-small-cell lung cancer and diagnosing mediastinal lesions. During the intervention, some minor or major complications may occasionally occur. The present case report describes the first reported case of needle breakage during EBUS-TBNA.

Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions

Background and Objectives: Electromagnetic navigation bronchoscopy (ENB) is a promising new technology to increase the diagnostic yield of peripheral lung and mediastinal lesions. Conventional flexible bronchoscopy has a limited yield in peripheral pulmonary lesions, even in experienced hands. Radial endobronchial ultrasound (r-EBUS) with its real-time imaging capability can help to diagnose peripheral pulmonary lesions. In the present study, we aimed to investigate the diagnostic yield and safety of ENB with or without r-EBUS for peripheral lung lesions. Materials and Methods: This study was conducted in a tertiary medical center, and 56 consecutive patients who were thought to be the best candidates for bronchoscopic biopsies at a multidisciplinary meeting were enrolled. ENB was performed under conscious sedation by using an electromagnetic tracking system with multiplanar reconstruction of previously acquired computed tomography (CT) data. Sampling was performed by biopsy forceps, endobronchial brush, and bronchoalveolar lavage. Results: Fifty-six patients (50 men and 6 women; mean age, 60 ± 9 years) were studied. While an electromagnetic navigation system was used in all patients, r-EBUS was used in 26 of 56 patients. The median diameter of the lesions was 30 mm (interquartile range: 23-44 mm). Mean distance of the lesions from the pleura was 14.9 ± 14.6 mm. Mean procedure time was 20 ± 11.5 min. Mean registration error was 5.8 ± 1.5 mm. Mean navigation error was 1.2 ± 0.5 mm. The diagnostic yield of the procedure was 71.4% for peripheral lesions (non-small cell lung cancer = 23, small cell lung cancer = 3, benign diseases = 14). Pneumothorax occurred in only 1 patient (1.7%). Conclusion: ENB with or without r-EBUS is a safe, efficient, and easily applied method for sampling of peripheral lung lesions, with high diagnostic yield independent of lesion size and location.

An unusual case of pulmonary nocardiosis in immunocompetent patient.

Pulmonary nocardiosis is a subacute or chronic necrotizing pneumonia caused by aerobic actinomycetes of the genus Nocardia and rare in immune-competent patients. A 35-year-old male, who had treated with antituberculosis drugs, presented with cough, dyspnea, and expectoration with episodes of hemoptysis with purulent sputum. The diagnosis of nocardiosis was made by microscopic examination of the surgically resected portion of the lung and revealed filamentous Gram-positive bacteria.

Pulmonary Cement Embolism following Percutaneous Vertebroplasty

Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.