Maciej Gnass

Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

INTRODUCTION EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopists feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIAL AND METHODS The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. RESULTS Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. CONCLUSIONS The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.

Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes

This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion.

Transbronchial lung cryobiopsy guided by endobronchial ultrasound radial miniprobe in interstitial lung diseases: preliminary results of a prospective study

259 low but significant mortality risk.6,7 Considering all these complications, it is necessary to develop minimally invasive methods of LB in ILD with pulmonary fibrosis. A biopsy with the use of a flexible cryoprobe was introduced to clinical practice a few years ago and initially proved its diagnostic value both in endobronchial and transbronchial tissue sampling.8,9 Studies published to date have suggested that the diagnostic yield of transbronchial lung cryobiopsy (TBLC) in establishing proper diagnosis of ILD reaches 70% to 80%.10 A review of cryobiopsy literature revealed that there are no established standards for TBLC procedure. While the basic technique of TBLC is nearly the same, the approach differs as to prevention and management of the most common complications: pneumothorax and severe bleeding. The risk of pneumothorax increases when the cryoprobe is inserted too far into the bronchi and freezing hurts the visceral pleura. On the other hand, when the cryoprobe is too close to the pulmonary vessels, the risk of severe bleeding is higher. There is no doubt that choosing a correct site for LB and controlling the cryoprobe’s position during the procedure is crucial both for its efficacy and safety. The most common method of controlling the position of cryoprobe’s tip is fluoroscopy.11 In our center, a radial endobronchial ultrasound miniature probe (r-EBUS) is routinely used for diagnosing peripheral solid and semisolid lung lesions. A few years ago, we introduced Introduction Interstitial lung diseases (ILD), also known as diffuse parenchymal lung diseases, are a heterogeneous group of diseases. Their common pathological mechanism is the presence of inflammation and/or fibrosis in the lung parenchyma. When clinical outcome and radiology findings (especially on high-resolution computed tomography [HRCT]) are not sufficient to establish proper diagnosis, a pathological assessment of the involved lung tissue may be necessary in selected patients. A transbronchial lung biopsy (TBLB) with endoscopic forceps is the most common approach. While its high value in diagnosing a few ILDs (such as sarcoidosis) is well established,1,2 it is not recommended for diagnosing pulmonary fibrosis. According to American Thoracic Society / European Respiratory Society guidelines on the management of idiopathic pulmonary fibrosis, surgical lung biopsy (LB; usually video-assisted thoracic surgery LB [VATS-LB]) is recommended if HRCT results are inconclusive.3 Another important indication for LB in patients with diffuse lung infiltrations is to exclude malignancy. Considering that the most common primary lung cancer, adenocarcinoma, is quite often diagnosed among patients with no smoking history and with radiological appearance of diffuse lung infiltrates mimicking ILD, a histological assessment is crucial in many cases.4,5 Patients after VATS-LB require a few days of hospitalization and may develop complications, such as prolonged air leak and bronchopleural fistula, which in some cases necessitates reoperation and is associated with RESEARCH ARTICLE

A novel flexible 19G EBUS-TBNA needle: Absolute and relative performance in patients

Introduction: Endobronchial Ultrasound guided Trans-bronchial Needle Aspiration, (EBUS-TBNA) is used for the diagnosis and/or staging of cancer and other disorders. A novel 19G EBUS-TBNA needle ([Olympus Respiratory America], Redmond, WA, USA) with a larger diameter was developed to collect larger samples. Aims and Objectives: Evaluations were done in patients to assess the performance of the new 19G EBUS-TBNA needle. Methods: Product performance evaluations were conducted in 4 countries by 13 physicians experienced with EBUS-TBNA from Sept 2015 to Nov 2015. Physicians in each country were provided with 20 needles and asked to evaluate their performance in patients by completing evaluation forms. The forms asked physicians to rate the needles9 absolute (stand-alone) and relative performance (with respect to their experience of using current commercially available 21G and 22G needles) in the areas of penetration, visibility, and sample collection. Eighty completed evaluation forms were returned and analyzed. Results: For relative performance, physicians rated the 19G needle as comparable or better on 97.5% of the forms for sample collection, 92.5% for penetration, and 95% for visibility. For absolute performance, physicians rated the ability of the device to collect samples, its penetration, and its visibility as acceptable 98.75%, 97.5%, and 97.5% of the time respectively. One subject in Poland experienced bleeding after puncturing of the right hilum. Conclusions: Product performance evaluations of the 19G needle suggest that its performance is equivalent to or better than currently commercially available needles. However, additional clinical evaluations are warranted.