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Medicina
Special Issues
The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease
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The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonary".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 14476

Special Issue Editors

Dr. Hae-Seong Nam

E-Mail Website
Guest Editor
Inha University Hospital, Incheon, Korea
Interests: bronchoscopy; biomarkers of chronic pulmonary disease; COPD; lung cancer
Dr. Changhwan Kim

E-Mail Website
Guest Editor
Jeju National University Hospital, Jeju, Korea
Interests: bronchiectasis; COPD; interventional bronchoscopy

Special Issue Information

Dear Colleagues,

Flexible bronchoscopy (FB) is now one of the prime procedures for the assessment, diagnosis, and treatment of patients with pulmonary diseases. The procedure and applications of FB have progressively evolved and expanded since it was first introduced into clinical practice in 1968. Today, numerous diagnostic procedures using FB, including bronchoalveolar lavage or washing, brushing, endobronchial or transbronchial biopsy, and transbronchial needle aspiration, have become safe and frequently performed less-invasive procedures in patients with pulmonary disease. Furthermore, advanced bronchoscopy techniques such as electromagnetic navigation bronchoscopy, radial-probe endobronchial ultrasound (EBUS), ultrathin bronchoscopy, and virtual bronchoscopy have facilitated the diagnosis of peripheral lung lesions. However, these advanced bronchoscopy techniques are expensive and not feasible in every institution.

Recently, liquid biopsy using bronchial samples as body fluids is an active and advancing field. Continuously evolving technologies and associated bioinformatic tools for liquid biopsy will enable several molecular analyses in body fluids such as bronchial samples. These studies using bronchial samples will contribute to the pathogenesis and diagnosis of pulmonary diseases.

Given the importance of FB in the field of pulmonary disease and research, the journal Medicina 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 FB in diagnosing pulmonary disease. We warmly invite you and your colleagues to submit any articles, preferably reviews or original articles, regarding the pathogenesis and diagnosis of pulmonary diseases using bronchial samples, including advanced bronchoscopy techniques. In addition, we would like to invite you to submit basic and clinical researches focusing on pulmonary diseases and body fluids.

Dr. Hae-Seong Nam
Dr. Changhwan Kim
Guest Editors

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. Medicina is an international peer-reviewed open access monthly 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 1800 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

  • body fluids
  • bronchoscopic samples
  • diagnosis
  • flexible bronchoscopy
  • pulmonary diseases

Published Papers (6 papers)

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Research

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8 pages, 7502 KiB  
Article
Use of an Insulation-Tipped Knife during Rigid Bronchoscopic Treatment of Benign Tracheobronchial Stenosis
by Ji-Won Park, Yousang Ko and Changhwan Kim
Medicina 2021, 57(3), 251; https://doi.org/10.3390/medicina57030251 - 08 Mar 2021
Cited by 3 | Viewed by 1654
Abstract
Background and Objectives: Tracheal or bronchial tears are potential complications of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an insulation-tipped (IT) knife in combination with rigid bronchoscopic dilatation for treating benign tracheobronchial stenosis. Materials and Methods: [...] Read more.
Background and Objectives: Tracheal or bronchial tears are potential complications of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an insulation-tipped (IT) knife in combination with rigid bronchoscopic dilatation for treating benign tracheobronchial stenosis. Materials and Methods: We conducted a chart review of patients with benign tracheobronchial stenosis who were treated with rigid bronchoscopy and an IT knife at two referral centers. Treatment success was defined as a clinically stable state without worsening symptoms after 3 months of treatment. Results: Of the 23 patients with benign tracheobronchial stenosis, 15 had tracheal stenosis and 6 had main bronchial stenosis. Among them, three cases were of simple stenosis (13%), while the others were of complex stenosis (87%). The overall treatment success rate was 87.0%. Pneumomediastinum and subcutaneous emphysema occurred due to bronchial laceration in two cases of distal left main bronchial stenosis (8.7%), and no other significant acute complications developed. Silicone stents were inserted in 20 patients, and successful stent removal was possible in 11 patients (55.0%). Six of the seven stents inserted in patients with post-intubation tracheal stenosis were removed successfully (85.7%). However, most of the patients with post-tracheostomy tracheal stenosis required persistent stenting (80%). Pulmonary function was significantly increased after treatment, and the mean increase in the forced expiratory volume in 1 s was 391 ± 171 mL (160–700 mL). Conclusion: The use of an IT knife can be suggested as an effective and safe modality for rigid bronchoscopic treatment of benign tracheobronchial stenosis. Full article
(This article belongs to the Special Issue The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease)
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9 pages, 428 KiB  
Article
Effects of Antithrombotic Treatment on Bleeding Complications of EBUS-TBNA
by Hyun-Il Gil, Ryoung-Eun Ko, Kyungjong Lee, Sang-Won Um, Hojoong Kim and Byeong-Ho Jeong
Medicina 2021, 57(2), 142; https://doi.org/10.3390/medicina57020142 - 05 Feb 2021
Cited by 2 | Viewed by 1529
Abstract
Background and Objectives: The application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been markedly increased over the past decade. EBUS-TBNA is known to be a very safe and accurate procedure; however, the incidence of bleeding complications in patients who are taking antithrombotic [...] Read more.
Background and Objectives: The application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been markedly increased over the past decade. EBUS-TBNA is known to be a very safe and accurate procedure; however, the incidence of bleeding complications in patients who are taking antithrombotic agents (ATAs) is not well established. Materials and Methods: We conducted a retrospective analysis of a prospectively registered EBUS-TBNA cohort in a single tertiary hospital from May 2009 to December 2016. The patients were divided into two groups: an insufficient discontinuation group, defined as having a prescription for ATAs on the procedure day or only interrupting them for a short period of time, and a sufficient discontinuation group, defined as having prescription for ATAs during 30 days prior to the procedure and interrupting them for a sufficient period of time. Results: During the study period, a total of 4271 patients, after excluding 3773 patients who did not take ATAs at all, 498 patients were classified into the insufficient discontinuation group (n = 102) and the sufficient discontinuation group (n = 396). The baseline characteristics of patients and examined lesions between two groups were not significantly different, except insufficient discontinuation group had longer prothrombin times than the sufficient discontinuation group. In the insufficient discontinuation group, the most common reasons for prescriptions of ATAs were ischemic heart disease (48.0%) and cerebral vascular disease (28.4%), and half of the patients were taking two or more ATAs. Eventually, only one bleeding complication in the insufficient discontinuation group (1/102, 1.0%) and one event in the sufficient discontinuation group (1/396, 0.3%) occurred (p = 0.368). Conclusions: EBUS-TBNA is considered a safe procedure in terms of bleeding complications, even in patients with insufficient stopping of ATAs. Full article
(This article belongs to the Special Issue The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease)
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9 pages, 1698 KiB  
Article
Feasibility of Ultra-Low-Dose CT for Bronchoscopy of Peripheral Lung Lesions
by Jung Seop Eom, Geewon Lee, Jiyeon Roh, Hyun Sung Chung and Yeon Joo Jeong
Medicina 2020, 56(9), 479; https://doi.org/10.3390/medicina56090479 - 19 Sep 2020
Cited by 1 | Viewed by 1941
Abstract
Background and objectives: Thin-section computed tomography (CT) is essential for identifying small bronchi during bronchoscopy using radial endobronchial ultrasound. Some patients should receive an additional CT for a thin-section image. We performed a retrospective study with a prospectively collected database to identify [...] Read more.
Background and objectives: Thin-section computed tomography (CT) is essential for identifying small bronchi during bronchoscopy using radial endobronchial ultrasound. Some patients should receive an additional CT for a thin-section image. We performed a retrospective study with a prospectively collected database to identify the optimal radiation dose for thin-section CT during peripheral bronchoscopy. Materials and Methods: In total, 91 patients with peripheral lung lesions underwent thin-section CT (both standard CT as a reference and ultra-low-dose CT (ultra-LDCT)). The patients were randomly assigned to one of four groups according to the ultra-LDCT parameters: group 1 = 120 kVp, 25 mAs; group 2 = 100 kVp, 15 mAs; group 3 = 120 kVp, 5 mAs; and group 4 = 100 kVp, 5 mAs. Two radiologists and two physicians analyzed both the standard CT and ultra-LDCT. Results: The effective doses (EDs) of ultra-LDCT significantly differed among the four groups (median EDs were 0.88, 0.34, 0.19, and 0.12 mSv for groups 1–4, respectively; p < 0.001). Median differences in peripheral airway wall thickness were higher in group 4 than in other groups (differences in median wall thickness measured by two radiologists were 0.4–0.5 mm and 0.8–0.9 mm for groups 1–3 and group 4, respectively). Bronchus signs on ultra-LDCT in groups 1 and 2 were well correlated with those of the standard-dose CT (accuracies of two radiologists and two pulmonary physicians were 95–100%). Conclusions: Our results indicate that ultra-LDCT with ED of >0.34 mSv (ED of group 2) is feasible for peripheral bronchoscopy. Full article
(This article belongs to the Special Issue The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease)
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11 pages, 2229 KiB  
Article
Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis
by Byeong-Ho Jeong, Jeffrey Ng, Suk Hyeon Jeong and Hojoong Kim
Medicina 2020, 56(8), 367; https://doi.org/10.3390/medicina56080367 - 22 Jul 2020
Cited by 13 | Viewed by 2436
Abstract
Background and Objectives: The use of metallic stents in benign TBS is controversial. Here, we report the clinical outcomes of patients who developed complications due to self-expandable metallic stent (SEMS) insertion for benign TBS. Materials and Methods: Our institution, which is the largest [...] Read more.
Background and Objectives: The use of metallic stents in benign TBS is controversial. Here, we report the clinical outcomes of patients who developed complications due to self-expandable metallic stent (SEMS) insertion for benign TBS. Materials and Methods: Our institution, which is the largest and most active referral hospital for airway stenosis in South Korea, only uses silicone stents. We conducted a retrospective review of 20 patients referred after the insertion of SEMS for benign TBS from 2006 to 2015. Results: All 20 patients underwent rigid bronchoscopy for SEMS removal due to airway obstruction from granulation tissue overgrowth. All but one (95%) experienced successful removal of the SEMS. During a median follow-up period of 40 months, a median of seven rigid bronchoscopies per patient was needed to maintain airway patency. Three (15%) patients suffered acute complications during SEMS removal (bleeding (10%) and fistula (5%)). All patients suffered chronic complications (granulation tissue (80%), stent migration (58%), mucostasis (55%), and restenosis (43%)). Eventually, 15 patients (75%) needed airway prostheses (silicone stent (75%) and tracheostomy (25%)). Conclusion: Our findings indicate that SEMS should be avoided until positive results are consistently reported by high-quality studies in patients with benign TBS. Full article
(This article belongs to the Special Issue The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease)
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Review

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11 pages, 4679 KiB  
Review
Cryobiopsy in Lung Cancer Diagnosis—A Literature Review
by Mărioara Simon, Ioan Simon, Paul Andrei Tent, Doina Adina Todea and Antonia Haranguș
Medicina 2021, 57(4), 393; https://doi.org/10.3390/medicina57040393 - 19 Apr 2021
Cited by 12 | Viewed by 4100
Abstract
Optimizing the diagnosis of lung cancer represents a challenge, as well as a necessity, for improving the low survival of these patients. Flexible bronchoscopy with forceps biopsy is one of the key diagnostic procedures used for lung tumors. The small sample size and [...] Read more.
Optimizing the diagnosis of lung cancer represents a challenge, as well as a necessity, for improving the low survival of these patients. Flexible bronchoscopy with forceps biopsy is one of the key diagnostic procedures used for lung tumors. The small sample size and crush artifacts are several factors that can often limit access to a complete diagnosis, therefore leading to the need of repeating the bronchoscopy procedure or other invasive diagnostic methods. The bronchoscopic cryobiopsy is a recent technique that proved its utility in the diagnosis of both endobronchial and peripheral lung tumors. In comparison with conventional forceps biopsy, studies report a higher diagnostic yield and a superior quality of the collected samples for both the histopathological and the molecular diagnosis of lung cancer. This method shows promising results in sampling lung tissue, alone, or in conjunction with fluoroscopy or radial endobronchial ultrasound (r-EBUS). With a good safety and cost-benefit profile, this novel method has the potential to improve the diagnosis, and therefore the management of lung cancer patients. The objective of this narrative review is to provide a comprehensive review of the recent data regarding the advantages of cryobiopsy and r-EBUS in lung cancer diagnosis. Full article
(This article belongs to the Special Issue The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease)
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Other

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6 pages, 4629 KiB  
Case Report
Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report
by Jun-Ho Ha and Byeong-Ho Jeong
Medicina 2021, 57(1), 50; https://doi.org/10.3390/medicina57010050 - 08 Jan 2021
Cited by 1 | Viewed by 2184
Abstract
Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, [...] Read more.
Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB. Full article
(This article belongs to the Special Issue The Role of Flexible Bronchoscopy in Diagnosing Pulmonary Disease)
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