Yuka Miyazu

Narrow Band Imaging Applied to Pleuroscopy for the Assessment of Vascular Patterns of the Pleura

Background: Narrow band imaging (NBI), which enhances blood vessels, is a new endoscopic technology for diagnosing malignancies, but it has not been investigated for pleuroscopy. Objectives: To evaluate the efficacy of NBI applied to pleuroscopy for detecting malignant lesions by assessing vascular patterns of the pleura. Methods: From May 2006 to September 2008, 45 patients with undiagnosed pleural ef-fusion underwent pleuroscopy using a pleura-videoscope with white light (WL) and NBI under local anesthesia. For this prospective study, 73 biopsy specimens were obtained from sites where images under both WL and NBI were recorded and classified regarding vascular patterns. Results: Of the 73 lesions, WL showed blood vessels in 32 lesions, and NBI in 52 lesions (WL vs. NBI; p = 0.0014). The accuracy, sensitivity and specificity in the detection of irregular vascular patterns, e.g. blood vessels with irregular caliber or punctate vessels indicating malignant lesions, were 60.3, 76.5 and 55.4% in WL, and 80.8, 85.3 and 76.9% in NBI, respectively, resulting in a significant increase in NBI (p = 0.0106 for accuracy and p = 0.0494 for specificity). For flat lesions, NBI revealed a higher accuracy rate (90.6%) in the detection of irregular vascular patterns indicating malignant lesions. Conclusion: Our study demonstrated that NBI applied to pleuroscopy displayed blood vessels significantly better than WL. NBI was useful to detect irregular vascular patterns suggesting malignant lesions, especially for flat lesions. Therefore, NBI was considered useful in the selection of optimal biopsy sites by assessing vascular patterns.

Diagnosis of Tuberculous Pleurisy Using a Flexirigid Thoracoscope

A 62-year-old man with a right-sided pleural effusion could not be diagnosed despite the analysis of pleural fluid, and subsequently medical thoracoscopy was carried out under local anesthesia. The instrument used was a rigid thoracoscope with a working channel and a bidirectional flexible tip (a flexirigid thoracoscope), which was attachable to an endoscopic video imaging system. The pleural cavity was relatively narrow with adhesions. Small white nodules were observed on the parietal pleura. Biopsies were collected under direct visualization through the working channel. Although acid-fast bacilli staining and the identification of tuberculous DNA by polymerase chain reaction (TB-PCR) of thoracoscopic biopsies were negative, and the biopsy specimens showed only nonspecific inflammation, a positive tuberculosis culture was obtained from the thoracoscopic biopsy specimens. The flexirigid thoracoscope was useful in making a diagnosis of tuberculous pleurisy.

Endobronchial Ultrasound for Difficult Airway Problems

Radial-type endobronchial ultrasound (EBUS) is useful for a diagnosis based on the depth of invasion of bronchial carcinoma, because it has the ability to analyze the delicate layer structure of the a

Endobronchial ultrasonography and magnetic resonance imaging in tracheobronchial stenosis from ulcerative colitis.

A 49-year-old woman presented with continuous cough, progressive dyspnea on exertion, and hoarseness. She had a total colectomy for ulcerative colitis 17 years earlier. Bronchoscopy showed circumferential mucosal erythema. The surface of the tracheal mucosa was irregular and bled easily on contact. Endobronchial ultrasonography and magnetic resonance imaging (MRI) showed characteristic findings that suggested that the lesion was located within the tracheal mucosa and submucosa. Endobronchial ultrasonography images showed circumferential thickening of the mucosa, but tracheobronchial cartilage was preserved intact. Moreover, the comparison between tracheal tissues from tracheostomy and colon tissues resected 17 years earlier showed similarities in pathologic findings. These findings suggested that inflammatory bowel disease can cause the tracheobronchial stenosis.

Contents Vol. 78, 2009

P.J. Barnes, London E.D. Bateman, Cape Town E. Brambilla, Grenoble P. Camus, Dijon M. Cazzola, Rome P.N. Chhajed, Mumbai U. Costabel, Essen K. Dorrington, Oxford A. Foresi, Sesto San Giovanni M.E. Froudarakis, Alexandroupolis F.J.F. Herth, Heidelberg G. Hoheisel, Leipzig M. Humbert, Clamart M. Kneussl, Vienna J.G. Mastronarde, Columbus, Ohio L.E. Nery, São Paulo A. Palla, Pisa H.-B. Ris, Lausanne J.L. Robotham, Seattle, Wash. F. Rodriguez Panadero, Tomares International Journal of Thoracic Medicine