Naoyuki Imai

Clinical impact of prevalence and severity of COPD on the decision-making process for therapeutic management of lung cancer patients

BackgroundRecent studies suggest that coexistence of chronic obstructive pulmonary disease (COPD) might be independently related to a worse prognosis for lung cancer. However, because data on the substantial prevalence of COPD and its severity in Asian lung cancer patients remain limited, clinical impact of prevalence and severity of COPD among the population has not been fully evaluated. Furthermore, patients with COPD often have comorbidities. Thus, whether the decision-making process for therapeutic management of lung cancer patients might be independently affected by COPD remains elusive.MethodsClinical impact of prevalence and severity of COPD were evaluated in 270 Japanese patients with newly diagnosed lung cancer who were sequentially registered and underwent bronchoscopy from August 2010 to July 2012 at Nagoya University hospital. Furthermore, to explore whether or not the severity of airflow obstruction might affect the decision to propose thoracic surgery with curative intent, we evaluated data from patients with lung cancer at stage 1A to 3A who underwent spirometry and bronchoscopy.ResultsThe prevalence rate of COPD was 54.4% among Japanese patients with lung cancer who underwent bronchoscopy. The incidence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2 was significantly higher than that of GOLD grade 3. Although COPD-related comorbidities were not independent factors for proposing thoracic surgery, the number of thoracic surgeries performed was significantly less in the COPD group than the non-COPD group. Multivariate analysis showed that more severe airway obstruction, advanced clinical staging, and higher age, were independent factors associated with the decision on thoracic surgery.ConclusionsWe demonstrated a high prevalence of COPD among Japanese lung cancer patients. Based on the knowledge that severity of COPD is one of the most important factors in the therapeutic decision, comprehensive assessment of COPD at bronchoscopy might allow us to implement the optimum management for lung cancer patients.

Febrile complications after endobronchial ultrasound-guided transbronchial needle aspiration for intra-pulmonary mass lesions of lung cancer—a series of 3 cases

Recent case reports have shown that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions is sometimes accompanied by severe infectious complications. Here, we report 3 cases with refractory febrile complications following EBUS-TBNA for intra-pulmonary large mass lesion of lung cancer (squamous cell carcinoma, n=2; adenocarcinoma, n=1). After the EBUS-TBNA, all cases showed prolonged fever and systemic inflammation despite receiving a sufficient dose of broad-spectrum antibiotics. The presence of a low-density area inside the masses upon CT examination, suggesting necrosis, may be a predictive sign of febrile complications associated with EBUS-TBNA.

Endobronchial ultrasound transbronchial needle aspiration in older people

The usefulness and safety of endobronchial ultrasound transbronchial needle aspiration (EBUS‐TBNA) have been established recently, but no study has evaluated whether or not aging increases the risk of the procedure. In the present study, we aimed to assess the usefulness and safety of EBUS‐TBNA in older patients.

Aqueous fraction of Sauropus androgynus might be responsible for bronchiolitis obliterans

Background and objective:  Bronchiolitis obliterans (BO) has been reported to develop following ingestion of Sauropus androgynus (SA), a leafy shrub distributed in Southeast Asia. Little is known about direct effects of SA on airway resident cells or haematopoietic cells in vitro. Identification of the SA component responsible for the development of BO would be an important key to elucidate its mechanism. We sought to elucidate the direct effects of SA on airway resident cells or haematopoietic cells and identify the SA element responsible for the pathogenesis of BO.

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer.

Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (≤30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT bronchus sign positivity, a solid nodule, and a probe position that was within the lesion.

Two cases of paragonimiasis westermani diagnosed after eosinophilic pleural effusion-induced hydropneumothorax.

Our hospital is located in the Tono region in the southeastern district of Gifu Prefecture in which there are forests and inhabitants who still hunt and eat game meat. Therefore, boar meat increases the risk of contracting paragonimiasis. We treated two patients who were infected by Paragonimus westermani after eating boar meat. They developed hydropneumothorax in association with eosinophilic pleural effusion. For patients who have pneumothorax with concomitant pleural effusion and eosinophilia in the pleural fluid analysis, it is necessary to take a detailed history, which includes flesh food consumption and travel to an endemic area, and to make a careful examination while taking into consideration parasitic infections such as paragonimiasis.

Report on the breakage of the tip of a radial endobronchial ultrasonic probe sheath during bronchoscopy: Broken ultrasonic probe sheath

A lesion in a 73‐year‐old woman that was suspected to be right lung cancer was biopsied under ultrasound‐guided bronchoscopy with a guide sheath. The procedure was completed without a noticeable problem, but after 3 days, it was found that the tip of the ultrasonic probe sheath was broken and that the broken fragment was missing. Based on the concern that the fragment had been left in the lung, the patient was examined by computed tomography scan 4 days after the biopsy, and bronchoscopy was repeated 38 days after the biopsy, but no fragment was detected. These procedures and an investigation by the Olympus Corporation led to the conclusion that the fragment was not in the lung, and it was not found in a subsequent surgical specimen. Breakage of devices may occur at any time regardless of progression of fatigue (wear) with increased use, and thorough device management before, during, and after use is important.

Sudden Death from Cardiopulmonary Arrest on Arrival of a Patient with Pulmonary Tuberculosis: A Case Diagnosed by Postmortem CT and Autopsy

Sudden death due to massive hemoptysis during management of tuberculosis occurs in a considerable number of patients. However, when massive airway hemorrhage occurs in a patient in whom tuberculosis has not been confirmed and a blood is not apparent externally on the face/body, it is difficult to immediately identify the cause of death as airway obstruction by tuberculous bleeding in the airway. We encountered an 83‐year‐old Japanese woman with her medical history included treatment of tuberculosis in her 20s who was in cardiopulmonary arrest on arrival (CPAOA), and the cause of sudden death could not initially be identified. Postmortem CT (PMCT) and autopsy revealed that the cause of sudden death was airway obstruction/asphyxia by tuberculous massive airway hemorrhage. Identification of the cause of death facilitated a subsequent active contact investigation and led to prevention of secondary tuberculosis infection.

Required thoracic drainage through the respiratory tract during transbronchial biopsy using EBUS-GS

A 71‐year‐old woman was referred to our department due to an abnormal chest shadow. Imaging revealed a pulmonary nodule shadow in the left S6 segment, multiple small nodule shadows in the left pleura, and left pleural effusion. Transbronchial biopsy using endobronchial ultrasonography (EBUS) with a guide sheath was conducted. EBUS showed the probe of the sheath located in the lesion and biopsy was performed in this area. A yellow turbid fluid appeared in the sheath and vacuum aspiration resulted in collection of 200 mL of this fluid. We suspected that drainage occurred because the sheath tip had ruptured the pleural cavity. The pathological diagnosis was adenocarcinoma. It is likely that the EBUS images reflected pleural effusion adjacent to the lesion, and that the complication occurred because the biopsy was performed without awareness of these findings. This complication may be prevented by closer examination of echo findings and rotation of the X‐ray source to ensure performance of the biopsy directly under the pleura.

Endobronchial ultrasound echoic image of pulmonary hamartoma

A 62‐year‐old man with an indicated chest radiographic abnormality was referred to our hospital for more thorough examinations. Endobronchial ultrasound‐guided transbronchial needle aspiration was performed because of a mass at the left hilum. Endobronchial ultrasound images showed scattered high‐density spots in a low echoic and mosaic density. The pathological findings revealed pulmonary hamartoma. Subsequently, the mass was resected and comparison of ultrasound findings and pathological findings indicated that the scattered high echoic spots appeared to reflect cartilaginous tissues and bronchial epithelium inside the tumor.