Newer Modalities in the Work-up of Peripheral Pulmonary Nodules

Narula, Tathagat; Machuzak, Michael; Mehta, Atul C.

doi:10.1016/j.ccm.2013.06.001

Cited by 7 publications

(7 citation statements)

References 147 publications

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“…Technological advances in recent years have led to the availability of newer modalities helping to navigate to SPLs [ 14 ]. The weighted diagnostic yield of ENB, VB, and R-EBUS for the work-up of SPLs without the use of UB is in the range of 67–74 % which is comparable with conventional methods mentioned above [ 5 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial

et al. 2016

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BackgroundThe evaluation of solitary pulmonary lesions (SPL) requires a balance between procedure-related morbidity and diagnostic yield, particularly in areas where tuberculosis (TB) is endemic. Data on ultrathin bronchoscopy (UB) for this purpose is limited. To evaluate feasibility and safety of UB compared to SB for diagnosis of SPL in a TB endemic region.MethodsIn this prospective randomised trial we compared diagnostic yield and adverse events of UB with standard-size bronchoscopy (SB), both combined with fluoroscopy, in a cohort of patients with SPL located beyond the visible range of SB.ResultsWe included 40 patients (mean age 55.2 years, 45 % male) with malignant SPL (n = 16; 40 %), tuberculous SPL (n = 11; 27.5 %) and other benign SPL (n = 13; 32.5 %). Mean procedure time in UB and SB was 30.6 and 26.0 min, respectively (p = 0.15). By trend, adverse events were recorded more often with UB than with SB (30.0 vs. 5.0 %, p = 0.091), including extensive coughing (n = 2), blocked working channel (n = 2), and arterial hypertension requiring therapeutic intervention (n = 1), all with UB. The overall diagnostic yield of UB compared to SB was 55.0 % vs. 80.0 %, respectively (p = 0.18). Sensitivity for the diagnosis of malignancy of UB and SB was 50.0 % and 62.5 %, respectively (p = 0.95).ConclusionUB is not superior to SB for the evaluation of SPL in a region endemic with tuberculosis, when combined with fluoroscopic guidance only.Trial registrationClinicalTrials.gov (Identifier: NCT02490059).Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0225-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial

et al. 2016

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“…With the addition of fluoroscopy-guided bronchoscopy, TBBx in nodules measuring <2 cm in diameter ranges from 5 to 76% (median, 31%) [88,91]. Schreiber and McCrory demonstrated in a meta-analysis, an overall diagnostic sensitivity of 33% (5-76%) for the same size nodules (<2 cm) [92].…”

Section: Bronchoscopymentioning

confidence: 99%

Diagnosis and management of pulmonary nodules

Krochmal

Arias

Yarmus

et al. 2014

Expert Review of Respiratory Medicine

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There are an increased number of pulmonary nodules discovered on CT scan images in part due to those performed for lung cancer screening. Risk stratification and patient involvement is critical in determining management ranging from interval imaging to invasive biopsy or surgery. A definitive diagnosis requires tissue biopsy. The choice of a particular biopsy technique depends on the risks/benefits of the procedure, the diagnostic yield and local expertise. This review will focus on the evaluation and management of pulmonary nodules based on the Fleischner Society and American College of Chest Physician guidelines. There have been recent changes to both societies' recommendations for incidental detection of solid and subsolid nodules, risk stratification, imaging, minimally invasive diagnostic techniques and definitive surgical options.

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“…PPNs are a common radiographic finding, and are still considered a clinical dilemma. The PPN among LTR is of added significance as it involves differential diagnosis such as PTLD (39%), Invasive Pulmonary Aspergillosis (IAP) (37%) and other opportunistic infections [5][6][7][8] .…”

Section: Resultsmentioning

confidence: 99%

New Nodule-Newer Etiology

Mehta¹,

Wang²,

Abuqayyas³

et al. 2016

WJT

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Informed consent statement: Due to the retrospective nature of the study there was no need to obtain patient consent. Conflict-of-interest statement:We have no financial relationships to disclose. Abstract AIM: To evaluate frequency and temporal relationship between pulmonary nodules (PNs) and transbronchial biopsy (TBBx) among lung transplant recipients (LTR). METHODS:We retrospectively reviewed 100 records of LTR who underwent flexible bronchoscopy (FB) with TBBx, looking for the appearance of peripheral pulmonary nodule (PPN). If these patients had chest radiographs within 50 d of FB, they were included in the study. Data was compared with 30 procedures performed among non-transplant patients. Information on patient's demographics, antirejection medications, anticoagulation, indication and type of lung transplantation, timing of the FB and the appearance and disappearance of the nodules and its characteristics were gathered. RESULTS:Nineteen new PN were found in 13 procedures performed on LTR and none among nontransplant patients. Nodules were detected between 4-47 d from the procedure and disappeared within 84 d after appearance without intervention. Core tip: Transbronchial biopsy (TBBx) is routinely performed in lung transplant recipients (LTR). The development of pulmonary nodules (PNs) in this population is common. We investigated LTR who developed PNs post TBBx to determine the temporal relationship between the procedure and the timing of appearance and disappearance of these nodules. Our conclusion is that TBBx in LTR is associated with development of transient nodules at the site of TBBx in 13% of procedures. We hypothesize that these nodules are related to local hematoma and impaired lymphatic drainage. Close observation is a reasonable management approach. CONCLUSION: FB in LTR is

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Newer Modalities in the Work-up of Peripheral Pulmonary Nodules

Cited by 7 publications

References 147 publications

Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial

Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial

Diagnosis and management of pulmonary nodules

New Nodule-Newer Etiology

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