Mediastinum,
Год журнала:
2024,
Номер
8, С. 51 - 51
Опубликована: Дек. 1, 2024
Diagnosis
of
pathology
in
the
mediastinum
has
proven
quite
challenging,
given
wide
variability
both
benign
and
malignant
diseases
that
affect
a
diverse
array
structures.
This
complexity
led
to
development
many
different
non-invasive
invasive
diagnostic
modalities.
Historically,
diagnosis
relied
on
imaging
modalities
such
as
chest
X-ray,
computed
tomography
(CT),
magnetic
resonance
imaging,
positron
emission
topography.
Once
suspicious
lesion
was
identified
with
one
these
techniques,
gold
standard
for
mediastinoscopy
staging
disease.
More
recently,
minimally
techniques
CT-guided
biopsy,
endobronchial
ultrasound
transbronchial
needle
aspiration,
endoscopic
fine
aspiration
have
revolutionized
mediastinum.
review
provides
comprehensive
analysis
all
available
diagnosing
mediastinal
disease
an
emphasis
bronchoscopic
techniques.
Literature
search
performed
via
PubMed
database.
We
included
types
articles
study
designs,
including
original
research,
meta-analyses,
reviews,
abstracts.
Minimally
ultrasound-transbronchial
(EBUS-TBNA)
ultrasound-fine
(EUS-FNA)
demonstrated
high
yield
low
complication
rate
made
significant
difference
time
lives
patients.
There
continues
be
innovation
field
bronchoscopy
new
technologies
confocal
laser
endomicroscopy,
optical
coherence
tomography,
artificial
intelligence.
Bronchoscopy
is
will
continue
integral
modality
Pediatric Pulmonology,
Год журнала:
2024,
Номер
unknown
Опубликована: Ноя. 11, 2024
A
15-year-old
male
with
a
history
of
panuveitis
presented
to
the
emergency
department
(ED)
slurred
speech
and
difficulty
ambulation.
He
was
born
in
tuberculosis
endemic
region
had
moved
United
States
about
1
year
prior.
diagnosed
during
routine
eye
exam
5
months
Initial
lab
work
notable
for
an
elevated
erythrocyte
sedimentation
rate
(ESR)
29
mm/h.
Infectious
rheumatologic
workup
were
unremarkable.
started
on
difluprednate
systemic
steroids.
As
he
no
signs
autoimmune
disease,
idiopathic
uveitis.
chest
radiograph
been
ordered
but
not
completed.
methotrexate
adalimumab
2
before
hospitalization.
While
his
steroids
initially
stopped
after
initiation
adalimumab,
required
reinitiation
progression
Several
days
presentation
our
ED,
difficulties
refilling
steroid
prescription.
Within
stopping
steroids,
developed
speech,
diplopia,
balance.
In
unstable
gait
decreased
strength.
labs
aspartate
aminotransferase
68
U/L
ESR
31
acute
Histoplasmosis,
sexually
transmitted
infections,
Epstein-Barr
virus,
human
herpes
virus
6,
immunodeficiency
simplex
influenza
SARS-CoV-2
all
negative.
brain
magnetic
resonance
imaging
(MRI)
revealed
findings
concerning
cerebellitis.
demonstrated
right
hilar
mass.
computed
tomography
then
completed
that
large
8.8
cm
posterior
paraesophageal
mediastinal
mass
(Figure
1A).
The
Pulmonary
team
consulted
endobronchial
ultrasound
guided
transbronchial
biopsy
patient
brought
operating
room
hospital
day
four
flexible
bronchoscopy,
bronchoalveolar
lavage,
needle
aspiration
(EBUS-TBNA)
plus
cryobiopsy
1B).
Utilizing
Olympus
EBUS
bronchoscope
(BF-UC180F)
equipped
ultrasonic
7.5
MHz
longitudinal
transducer,
subcarinal
lymph
node
identified.
Transbronchial
aspirations
using
19-gauge
needle.
After
removing
needle,
1.1
cryoprobe
advanced
into
via
entry
point.
Seven
cryobiopsies
Histology
from
specimen
fibrotic
lymphoid
tissue
infiltrate
lymphocytes
plasma
cells
separated
by
bands
fibrous
2A).
Admixed
large,
atypical
mononuclear
occasionally
binuclear
multiple
distinct-to-prominent
nucleoli,
vesicular
chromatin,
eosinophilic
cytoplasm
consistent
Hodgkin/Reed-Sternberg
(HRS)
2B).
Immunostaining
reactive
CD30,
CD15,
PAX5
(weak)
while
negative
CD45,
CD20
CD79a
2C).
background
lymphocytic
composed
mixed
population
CD3-positive
T
CD20-positive,
PAX5-positive,
CD79-positive
B
cells.
classic
Hodgkin
lymphoma
(CHL).
Given
importance
prompt
treatment
avoid
irreversible
cerebellar
damage
vision
loss,
high
dose
prednisone
within
3
biopsy.
positron
emission
tomography-computed
bulky
disease.
staged
as
IIA
bulk.
Based
this
ESR,
risk
stratified
Children's
Oncology
Group
intermediate
risk.
chemotherapy
same
per
AHOD0031
ABVE-PC
(doxorubicin,
bleomycin,
vincristine,
etoposide,
prednisone,
cyclophosphamide).
Initiation
CHL
resulted
good
control
His
symptoms
improved
did
fully
resolve
despite
addition
intravenous
immunoglobulins
exchange.
is
currently
improving
rehabilitation.
affects
around
8540
new
patients
annually
[1].
diagnosis
requires
assessment
architecture
Excisional
recommended
because
fine
core
often
do
provide
enough
material
Accurate
immunostaining
also
essential
diagnosis,
prognosis,
selection
appropriate
therapy
Two
recent
prospective
studies
adult
lesions
included
total
23
who
underwent
EBUS-TBNA
[2,
3].
established
majority
both
(87.5%
93.3%)
This
substantial
increase
diagnostic
yield
above
alone,
where
typically
closer
13−40%
[2-4].
Adverse
events
pneumothorax
(1%),
bleeding
minor
(majority
grade
or
2)
resolved
without
need
intervention
beyond
time
procedure
safety
profile
children
[4].
Cryobiopsy
minimally
invasive
yields
samples
undergo
pathologic
3,
5].
approach
particularly
advantageous
undergoing
malignancy
traditional
excisional
carries
higher
morbidity
longer
recovery
time.
described
here,
use
provided
adequate
sample
architecture,
substantially
larger
than
biopsies.
led
timely
therapy.
For
patient,
critical.
Both
uveitis
cerebellitis/paraneoplastic
degeneration
(PDC)
have
reported
paraneoplastic
phenomena
lymphoma.
Prompt
necessary
permanent
affected
tissues.
Pediatric
includes
doses
count
suppressive
chemotherapy,
which
are
problematic
immediately
following
surgeries
due
impaired
wound
healing
infectious
risks.
allowed
us
initiate
soon
established,
needing
procedural
healing.
likely
halting
disease
processes.
Our
patient's
well
controlled.
Although
we
anticipate
PDC
experienced
will
be
reversible,
making
great
strides
towards
recovery.
centers
experts
cryobiopsy,
should
strongly
considered
option
malignancy.
retrospective
case
report
require
informed
consent
institutional
review
board
Hospital
Philadelphia
policy.
Lauren
M.
C.
Grant:
conceptualization,
writing–original
draft,
writing–review
editing.
Dana
Bellissimo:
Alex
J.
Katz:
Antoinette
Wannes
Daou:
Elizabeth
Margolskee:
Kathrin
Bernt:
Joseph
Piccione:
Dr.
Grant
wrote
manuscript.
Drs.
Grant,
Bellissimo,
Katz,
Daou,
Margolskee,
Bernt
Piccione
revised
manuscript
figures.
Institutional
committee
waived
policy
reports.
authors
declare
conflicts
interest.
data
support
study
available
corresponding
author
upon
reasonable
request.
Journal of Clinical Medicine,
Год журнала:
2024,
Номер
13(23), С. 7085 - 7085
Опубликована: Ноя. 23, 2024
Patients
with
interstitial
lung
disease
(ILD)
are
about
five
times
more
likely
to
develop
cancer
than
those
without
ILD.
The
presence
of
ILD
in
patients
complicates
diagnosis
and
management,
resulting
lower
survival
rates.
Diagnostic
treatment
procedures
needed
for
can
increase
the
risk
acute
exacerbation
(AE),
one
most
severe
complications
these
patients.
Bronchoscopic
techniques
generally
considered
safe,
but
they
trigger
AE-ILD,
particularly
after
cryoprobe
biopsies.
Surgical
cancer,
including
biopsies
resections,
carry
an
elevated
AE-ILD.
Postoperative
mortality
rates
highlight
importance
meticulous
surgical
planning
postoperative
care.
Furthermore,
treatments,
such
as
chemotherapy,
all
burdened
by
a
AE-ILD
occurrence.
Radiotherapy
is
important
managing
both
early-stage
advanced
it
also
poses
risks.
Stereotactic
body
radiation
particle
beam
therapies
have
varying
degrees
safety,
latter
potentially
offering
AE.
Percutaneous
ablation
help
who
not
eligible
surgery.
However,
may
complicate
ILD,
their
associated
risks
still
need
be
fully
understood,
necessitating
further
research
improved
safety.
Overall,
while
advancements
outcomes
many
patients,
complexity
concomitant
needs
careful
consideration
multidisciplinary
assessment.
This
review
provides
detailed
evaluation
risks,
emphasizing
personalized
approaches
monitoring
improve
patient
this
challenging
population.
Monaldi Archives for Chest Disease,
Год журнала:
2024,
Номер
unknown
Опубликована: Дек. 6, 2024
In
this
prospective
study,
we
evaluated
the
diagnostic
yield
and
safety
of
two
endobronchial
ultrasound
(EBUS)
biopsy
techniques
–
mediastinal
cryobiopsy
(EBUS-MCB)
Franseen
tip
needle
(EBUS-ANB)
in
patients
with
undiagnosed
lymphadenopathy.
The
study
included
30
who
underwent
both
EBUS-MCB
EBUS-ANB,
four
biopsies
taken
from
each
patient
using
methods.
results
demonstrated
that
provided
a
higher
(96.4%)
compared
to
EBUS-ANB
(73.3%).
Specimens
showed
fewer
artifacts
density
granulomas
were
adequate
for
ancillary
studies
all
cases.
most
common
complication
observed
was
minor
bleeding,
which
more
(36.6%
versus
13.3%,
p=0.04).
This
demonstrates
EBUS-guided
has
when
have
an
acceptable
profile.
Larger
comparing
these
are
necessary
confirm
findings
current
study.
British Journal of Hospital Medicine,
Год журнала:
2024,
Номер
85(12), С. 1 - 19
Опубликована: Дек. 9, 2024
Aims/Background
Endobronchial
ultrasound-guided
transbronchial
needle
aspiration
(EBUS-TBNA)
is
the
standard
method
for
sampling
mediastinal/hilar
lymph
node
disease.
However,
smaller
samples
obtained
via
have
a
lower
diagnostic
rate
benign
compared
to
malignant
diseases.
The
low
rates
been
reported
be
improved
through
using
endobronchial
intranodal
forceps
biopsy
(EBUS-IFB),
but
implementation
of
IFB
presents
technical
challenges,
as
described
with
variable
results
in
certain
studies.
main
objective
this
study
was
investigate
value
and
safety
EBUS-IFB
Methods
A
retrospective
analysis
conducted
on
150
patients
disease
at
Tianjin
Medical
University
General
Hospital.
EBUS-TBNA
performed
rigid
bronchoscope
same
each
patient
under
general
anesthesia,
rapid
on-site
evaluation
(ROSE)
determine
presence
pathological
tissue.
Following
this,
tunnel
established,
1.5
mm
employed
EBUS-IFB.
Subsequently,
methods
used
were
determined.
Results
+
(the
combined
strategy)
exhibited
highest
rates,
addition
bronchial
mucosa
biopsy/transbronchial
lung
biopsy/neoplasm
contributing
successful
97.2%
(139/143).
strategy
(90.2%)
alone
(88.1%)
contributed
diagnosis
all
diseases,
significantly
higher
than
that
(60.1%)
(p
<
0.001).
detected
(97.4%)
(93.6%)
(71.8%)
Both
sarcoidosis
87.8%,
which
(46.9%)
procedures
implemented
did
not
engender
major
complications.
Conclusion
Routine
followed
by
ROSE
acquire
tissue,
formation
EBUS-IFB,
can
enhance
overall
lesions.
This
approach
particularly
valuable
diagnosing
diseases
sarcoidosis.
serves
safe
feasible
complement
EBUS-TBNA,
despite
fact
procedure
extended
duration.
Mediastinum,
Год журнала:
2024,
Номер
8, С. 51 - 51
Опубликована: Дек. 1, 2024
Diagnosis
of
pathology
in
the
mediastinum
has
proven
quite
challenging,
given
wide
variability
both
benign
and
malignant
diseases
that
affect
a
diverse
array
structures.
This
complexity
led
to
development
many
different
non-invasive
invasive
diagnostic
modalities.
Historically,
diagnosis
relied
on
imaging
modalities
such
as
chest
X-ray,
computed
tomography
(CT),
magnetic
resonance
imaging,
positron
emission
topography.
Once
suspicious
lesion
was
identified
with
one
these
techniques,
gold
standard
for
mediastinoscopy
staging
disease.
More
recently,
minimally
techniques
CT-guided
biopsy,
endobronchial
ultrasound
transbronchial
needle
aspiration,
endoscopic
fine
aspiration
have
revolutionized
mediastinum.
review
provides
comprehensive
analysis
all
available
diagnosing
mediastinal
disease
an
emphasis
bronchoscopic
techniques.
Literature
search
performed
via
PubMed
database.
We
included
types
articles
study
designs,
including
original
research,
meta-analyses,
reviews,
abstracts.
Minimally
ultrasound-transbronchial
(EBUS-TBNA)
ultrasound-fine
(EUS-FNA)
demonstrated
high
yield
low
complication
rate
made
significant
difference
time
lives
patients.
There
continues
be
innovation
field
bronchoscopy
new
technologies
confocal
laser
endomicroscopy,
optical
coherence
tomography,
artificial
intelligence.
Bronchoscopy
is
will
continue
integral
modality
