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Diagnostics
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Advances in Diagnostic Bronchoscopy
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Advances in Diagnostic Bronchoscopy

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 12385

Special Issue Editor

Dr. Byeong-Ho Jeong

E-Mail Website
Guest Editor
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
Interests: bronchoscopic intervention (rigid bronchoscopy, endobronchial ultrasound, flexible bronchoscopy); chronic lung infection (non-tuberculous mycobacteria, aspergillosis, tuberculosis)

Special Issue Information

Dear Colleagues,

Since the introduction of flexible bronchoscopy in the 1960s, bronchoscopy has been continuously developed. In particular, since the convex-probe endobronchial ultrasound (EBUS) was developed in the early 2000s, EBUS-TBNA (transbronchial needle aspiration) has come to replace mediastinoscopy, which was the former gold standard for the N-staging of lung cancer. In addition, the systematic and combined EBUS plus EUS-B (endoscopic ultrasound using the EBUS scope), which puts the EBUS scope into the esophagus and implements EUS-B-FNA (fine needle aspiration) in one session, has increased the sensitivity of lung cancer staging to the maximum. It also plays a great role in the diagnosis of benign diseases, as well as malignancies other than lung cancer.

As low-dose computed tomography is applied to lung cancer screening, the prevalence of pulmonary nodules has increased and, in particular, the demand for the histological diagnosis of PPNs (peripheral pulmonary nodules) is increasing. While TTNB (transthoracic needle biopsy) currently has a large role in the diagnosis of PPNs, TTNB has some limitations when there are emphysemas or vessels around the PPNs, so there is an increasing demand for bronchoscopic approaches. However, there is currently no bronchoscopic technique that shows a sufficiently satisfactory diagnosis rate for PPNs. Accordingly, various equipment (radial probe EBUS, guided sheath, fluoroscopy, thin bronchoscope, ultrathin bronchoscope, VBN (virtual bronchoscopic navigation), and ENB (electromagnetic navigation bronchoscopy)) are used in various combination according to the circumstances of each hospital, and many studies on which combinations are more useful are pouring out.

Given the importance of diagnostic bronchoscopy in the field of pulmonary disease, the journal Diagnostics is launching this Special Issue. The aim of the Special Issue is to gather accurate and up-to-date scientific information which will further strengthen our knowledge about the role of bronchoscopy in diagnosing pulmonary disease. We warmly invite you and your colleagues to submit any articles, preferably reviews or original articles, regarding advanced bronchoscopy techniques and the diagnosis of pulmonary diseases.

Dr. Byeong-Ho Jeong
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bronchoscopy
  • diagnosis
  • endobronchial ultrasound (EBUS)
  • electromagnetic navigation bronchoscopy (ENB)
  • virtual bronchoscopic navigation (VBN)
  • pulmonary nodule

Published Papers (6 papers)

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15 pages, 1624 KiB  
Article
Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions
by Ching-Kai Lin, Hung-Jen Fan, Zong-Han Yao, Yen-Ting Lin, Yueh-Feng Wen, Shang-Gin Wu and Chao-Chi Ho
Diagnostics 2022, 12(1), 41; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010041 - 25 Dec 2021
Cited by 5 | Viewed by 2425
Abstract
Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has [...] Read more.
Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs. Full article
(This article belongs to the Special Issue Advances in Diagnostic Bronchoscopy)
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11 pages, 632 KiB  
Article
A Preliminary Study on the Prognostic Impact of Neutrophil to Lymphocyte Ratio of the Bronchoalveolar Lavage Fluid in Patients with Lung Cancer
by Woo Kyung Ryu, Yeonsook Moon, Mi Hwa Park, Jun Hyeok Lim, Young Sam Kim, Kyung-Hee Lee, Seung Min Kwak, Changhwan Kim and Hae-Seong Nam
Diagnostics 2021, 11(12), 2201; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122201 - 25 Nov 2021
Cited by 5 | Viewed by 1554
Abstract
The cumulative results indicate that the neutrophil to lymphocyte ratio of peripheral blood (pbNLR) is a useful prognostic factor in patients with various cancers. In contrast to peripheral blood, the bronchoalveolar lavage (BAL) fluid is in direct contact with the lung lesion. However, [...] Read more.
The cumulative results indicate that the neutrophil to lymphocyte ratio of peripheral blood (pbNLR) is a useful prognostic factor in patients with various cancers. In contrast to peripheral blood, the bronchoalveolar lavage (BAL) fluid is in direct contact with the lung lesion. However, no study has reported on the clinical utility of the NLR of BAL fluid (bNLR) for patients with lung cancer. To investigate the clinical utility of the bNLR as a prognostic factor in patients with lung cancer, we conducted a retrospective review of the prospectively collected data. A total of 45 patients were classified into high bNLR (n = 29) and low bNLR (n = 16) groups. A high pbNLR and high bNLR were associated with a shorter overall survival (p < 0.001 and p = 0.011, respectively). A multivariable analysis confirmed that ECOG PS (p = 0.023), M stage (p = 0.035), pbNLR (p = 0.008), and bNLR (p = 0.0160) were independent predictors of overall survival. Similar to the pbNLR, a high bNLR value was associated with a poor prognosis in patients with lung cancer. Although further studies are required to apply our results clinically, this is the first study to show the clinical value of the bNLR in patients with lung cancer. Full article
(This article belongs to the Special Issue Advances in Diagnostic Bronchoscopy)
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11 pages, 1095 KiB  
Article
Is Methionyl-tRNA Synthetase Applicable as a Diagnostic Marker for Lung Cancer in Bronchial Ultrasound-Guided Brushing Cells?
by Kyungjong Lee, Mijung Oh, Kyo-Sun Lee, Yoon Jin Cha and Yoon Soo Chang
Diagnostics 2021, 11(10), 1830; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11101830 - 03 Oct 2021
Cited by 1 | Viewed by 1637
Abstract
Background and objective: Methionyl-tRNA synthetase (MARS) and A variant of Aminoacyl-tRNA synthetase interacting multifunctional protein 2 (AIMP2) with an exon 2 deletion (AIMP2-DX2) are known to be overexpressed in lung cancer. However, their role as diagnostic markers in lung cancer has not been [...] Read more.
Background and objective: Methionyl-tRNA synthetase (MARS) and A variant of Aminoacyl-tRNA synthetase interacting multifunctional protein 2 (AIMP2) with an exon 2 deletion (AIMP2-DX2) are known to be overexpressed in lung cancer. However, their role as diagnostic markers in lung cancer has not been well established. Thus, we evaluated their diagnostic performance in brushed cells obtained from nodular lung lesions suspected of lung cancer. Methods: Samples obtained by radial endobronchial ultrasound-guided brushing were processed for cytological examination with Papanicolaou (Pap) staining. Then, double IF staining with MARS and AIMP2-DX2 antibodies was measured in the cytology samples for peripheral lung nodules. The diagnostic performance was compared against biomarkers. Results: MARS IF staining was the only independent staining method used for the prediction of malignant cells. The area under the curve (AUC) of conventional cytology, MARS IF, and MARS IF plus cytology was 0.64, 0.68, and 0.69, respectively. The diagnostic accuracy was increased in MARS IF plus conventional cytology compared with cytology alone (71% vs. 47%). Conclusions: The combination of MARS staining with conventional cytology showed increases in the diagnostic accuracy for diagnosing lung nodules suspected of lung cancer on chest-computed tomography scans. Full article
(This article belongs to the Special Issue Advances in Diagnostic Bronchoscopy)
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11 pages, 546 KiB  
Article
Diagnostic Performance of Electromagnetic Navigation Bronchoscopy-Guided Biopsy for Lung Nodules in the Era of Molecular Testing
by Ju Hyun Oh, Chang-Min Choi, Seulgi Kim, Se Jin Jang, Sang Young Oh, Mi Young Kim, Hee Sang Hwang and Wonjun Ji
Diagnostics 2021, 11(8), 1432; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11081432 - 09 Aug 2021
Cited by 8 | Viewed by 2066
Abstract
Electromagnetic navigation bronchoscopy (ENB) is an emerging technique used to evaluate peripheral lung lesions. The aim of this study was to determine the diagnostic yield, safety profile, and adequacy of specimens obtained using ENB for molecular testing. This single-center, prospective pilot study recruited [...] Read more.
Electromagnetic navigation bronchoscopy (ENB) is an emerging technique used to evaluate peripheral lung lesions. The aim of this study was to determine the diagnostic yield, safety profile, and adequacy of specimens obtained using ENB for molecular testing. This single-center, prospective pilot study recruited patients with peripheral pulmonary nodules that were not suitable for biopsy via percutaneous transthoracic needle biopsy methods. The possibility of molecular testing, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and programmed death ligand 1 (PD-L1), was identified with non-small cell lung cancer (NSCLC) tissue obtained using ENB. ENB-guided biopsy was performed on 30 pulmonary nodules in 30 patients. ENB-guided biopsy was successfully performed in 96.6% (29/30) of cases, but one case failed to approach the target lesion. The diagnostic accuracy of ENB-guided biopsy was 68.0% (17/25). Biopsy-related pneumothorax occurred in one patient and there was no major bleeding or deaths related to the procedure. Among 13 patients diagnosed with NSCLC, molecular testing was successfully performed in 92.3% (12/13). ENB-guided biopsy demonstrated acceptable accuracy and excellent sample adequacy, with a high possibility of achieving molecular testing and a good safety profile to evaluate peripheral pulmonary nodules, even when the percutaneous approach was difficult and/or dangerous. Full article
(This article belongs to the Special Issue Advances in Diagnostic Bronchoscopy)
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8 pages, 1099 KiB  
Article
Transitioning to Combined EBUS EUS-B FNA for Experienced EBUS Bronchoscopist
by Jeffrey Ng, Hiang Ping Chan, Adrian Kee, Kay Leong Khoo and Kay Choong See
Diagnostics 2021, 11(6), 1021; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11061021 - 02 Jun 2021
Cited by 6 | Viewed by 2372
Abstract
Endobronchial ultrasound (EBUS) combined with trans-esophageal endoscopic ultrasound bronchoscope guided fine need aspirate (EUS-B FNA) of mediastinal lymph nodes is an established procedure for diagnosis. The main barrier to a combined EBUS EUS-B FNA approach is availability of trained and accredited pulmonologist who [...] Read more.
Endobronchial ultrasound (EBUS) combined with trans-esophageal endoscopic ultrasound bronchoscope guided fine need aspirate (EUS-B FNA) of mediastinal lymph nodes is an established procedure for diagnosis. The main barrier to a combined EBUS EUS-B FNA approach is availability of trained and accredited pulmonologist who can perform procedure safely and confidently. To address this gap, we undertook a training program for experienced EBUS bronchoscopists to train, learn, and incorporate combined EBUS EUS-B FNA into their procedural practice. Thirty-two patients were selected based on CT and or PET findings. Four experienced bronchoscopists participated by reading through learning material, observing 5 cases before performing EUS-B FNA under direct supervision. Forty-one lymph nodes and 6 non-nodal lesions were sampled. EUSAT assessment was performed by supervisor. Learning curves were derived from assessment scores. We observed that learning curve tends to plateau when participant can perform 3 or more consecutive cases with EUSAT score above 50. There were no complications. Our experience suggests that there is relative ease in transition to combined EBUS EUS-B TBNA procedures for mediastinal lymphadenopathy and lung cancer diagnosis and staging for experienced bronchoscopist using a program which incorporates direct supervision, EUSAT assessment, and extension of EUS B FNA training into daily real-world practice. Full article
(This article belongs to the Special Issue Advances in Diagnostic Bronchoscopy)
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4 pages, 879 KiB  
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Watch the Mime Carefully! A Refractory Interstitial Lung Disease
by Paolo Graziano, Paolo Fuso and Cristiano Carbonelli
Diagnostics 2022, 12(7), 1743; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071743 - 19 Jul 2022
Viewed by 1176
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of a vascular origin which can arise in different locations such as the lungs, liver, soft tissue, and rarely, in the bones. In the lungs, pulmonary hemangioendothelioma (PEH) shows a variable clinical behavior, displaying a range [...] Read more.
Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of a vascular origin which can arise in different locations such as the lungs, liver, soft tissue, and rarely, in the bones. In the lungs, pulmonary hemangioendothelioma (PEH) shows a variable clinical behavior, displaying a range from either an asymptomatic course to a highly aggressive progression with metastases. Based on radiological features, PEH differential diagnosis mainly includes primary or metastatic lymphangitic carcinomatosis, granulomatous infections, and diffuse interstitial lung diseases where ground glass pattern predominates. In this case, a transbronchial biopsy and subsequent histological and immunohistochemical analysis allowed for the attribution of the scenario to a pulmonary epithelioid hemangioendothelioma. Clinicians should always consider bronchoscopy as a useful and effective tool to better investigate indeterminate and questionable clinical pictures, sparing patients the morbidity and mortality associated with more invasive techniques such as surgical or thoracoscopic biopsy. Full article
(This article belongs to the Special Issue Advances in Diagnostic Bronchoscopy)
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