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Following the principles of image-enhanced endoscopy and using standardized endoscopic classifications, it is possible to predict the morphological diagnosis of colorectal neoplasms with high accuracy. The large size and uneven surface of lesion significantly complicates a thorough examination, and routine biopsy is still widely practiced, despite its drawbacks. This makes it necessary to compare the results of optical and forceps biopsy and determine the expediency of performing the latter for different types of colorectal laterally spreading tumors (LST). Aim. To compare the pit and vascular pattern, determined endoscopically, with histopathological findings in LST, with the calculation of the diagnostic accuracy of optical evaluation and forceps biopsy. To ascertain the relationship between lesion size, morphological type, and the presence of malignant changes. Materials and methods. 80 LST ≥20 mm were included in the study. Expert image-enhanced endoscopy with NBI and utilizing Paris, Kudo, JNET and Hiroshima classifications was employed for optical evaluation and stratification of lesions. Target forceps biopsy was obtained from areas showing the most progressive changes. The data from optical biopsy and the pathohistology of forceps biopsy specimens were compared with the results of the pathohistological findings of removed LST. Statistics were calculated in the Statistica 13. Results. Group 1 comprised 30 patients with non-granular type LST, while group 2 consisted of 50 patients with granular type LST. The median diameter was 20 mm (IQR, 20; 25) and 40 mm (IQR, 25; 50), adenocarcinoma loci were found in 10 % and 32 % in the first and second groups, respectively. Correlations between lesion localization and LST subtype were assessed, as well as between the presence of malignant changes and the size and morphological type of the lesions. Comparative indicators of sensitivity (80.0 % / 81.8 % in the first and 76.7 % / 80.0 % in the second group), diagnostic acc

BACKGROUND Acute cellular rejection (ACR) is a complication after lung transplantation (LTx). The diagnosis of ACR is based on histologic findings using transbronchial forceps biopsy (FB). However, its diagnostic accuracy is limited because of the small biopsy size and crush artifacts. Transbronchial cryobiopsy (CB) provides a larger tissue size compared with FB. METHODS FB and CB were obtained consecutively during the same bronchoscopy (February 2020-April 2021). All biopsies were scored according to the ISHLT criteria by three pathologists. Interobserver agreement was scored by the kappa index. We assessed the severity of bleeding and the presence of pneumothorax. RESULTS In total, 35 lung transplant recipients were included, and 126 CBs and 315 FBs were performed in 63 consecutive bronchoscopies. ACR (A1-A3, minimal-moderate) was detected in 18 cases (28.6%) by CB, whereas ACR was detected in 3 cases (4.8%) by FB. Moderate and severe bleeding complicated FB and CB procedures in 23 cases (36.5%) and 1 case (1.6%), respectively. Pneumothorax occurred in 6.3% of patients. The interobserver agreement was comparable for both CB and FB. CONCLUSIONS CB provided an improved diagnostic yield for ACR diagnosis, leading to reclassification and changes in treatment strategies in 28.6% of cases. Prospective studies should better define the role of CB after LTx.

Jiang Y, Wang J, Chen Y, Sun H, Dong Z, Xu S. Ther Clin Risk Manag. 2022;18:561–569. The authors have advised that the Funding statement was missed from page 568 of the published paper. The funding statement should read as follows. Funding This study was funded by Shanghai Shenkang Hospital Development Center (grant number SHDC12016109) and Shanghai Municipal Health Commission (grant number 202040079). The authors apologize for this error.

Yuanxi Jiang, Junwen Wang, Ying Chen, Huihui Sun, Zhiyu Dong, Shuchang Xu Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Shuchang Xu; Zhiyu Dong, Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Putuo District, Shanghai, People’s Republic of China, Tel +86-136 0199 9711, Email xsc-students@hotmail.com; 1253292@tongji.edu.cnPurpose: To identify pathology discrepancy between forceps biopsies and polypectomy specimens in colorectal polyps, as well as the reliability of biopsy-based treatment strategy.Methods: All endoscopic polypectomy cases with forceps biopsies performed within 6 months were included in the study. The biopsies were compared with polypectomy specimens in terms of concordance of histological diagnosis. A logistic regression model was used to investigate the independent predictors of upgrade in histological diagnosis compared with concordance in histological diagnosis.Results: A total of 1686 paired screening-therapeutic colonoscopies and 1739 paired biopsy-polypectomy specimens were enrolled in the study. The grade of dysplasia in 84.5% of biopsy specimens were concordant to polypectomy specimens, but this proportion decreased to 75.4% when the specimens were classified using tubular or villousness structure. 10.1% and 5.4% of biopsy specimens were upgraded and downgraded in assessing grade of dysplasia, respectively, while 14.3% and 10.3% of biopsy specimens were upgraded and downgraded in assessing tubular or villousness structure, respectively. In subgroup analysis stratified by size of polyps, 9.0% and 10.6% of biopsies obtained from polyps smaller than 10 mm were upgraded in assessing dysplasia and tubular or villousness structure, respectively. This proportion increased to 10.7% and 21.3%, respectively, in biopsies obtained from polyps larger than 10 mm. Larger size of polyps and pedunculated

Endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) have changed the landscape of pulmonology. Mediastinal structures beyond the confines of airway walls are visualized in real-time with EBUS, leading to improved accuracy of tissue sampling and diagnostic yield. With the development of various needle sizes ranging from 25-G to 19-G, the sampling of lymph nodes is becoming easier and more commonplace. Yet, certain conditions such as sarcoidosis and lymphoma may still be difficult to diagnose via EBUS-TBNA. Furthermore, in the age of targeted therapy, there are more demands on EBUS-TBNA samples for molecular marker testing and next-generation sequencing. Here, we present a complementary methodology, EBUS-guided intranodal forceps biopsy (EBUS-IFB), for tissue acquisition that may help address these deficiencies. Specifically, we aim to propose indications, contraindications, outline approaches in performing IFB, and provide an overview of the data for this complementary technique.

Highlights:1. In this study, new primers designed using the semi-nested polymerase chain reaction (PCR) method were utilized to identify MAGE-A11 and MAGE-A12 expressions in specimens collected from core biopsy, forcep biopsy, and bronchoalveolar lavage. 2. The histopathological analysis revealed positive expressions of MAGE-A11 and MAGE-A12 in specimens diagnosed with non-small cell lung cancer (NSCLC) as well as in specimens with no malignant cells. 3. This study provides evidence indicating that the detection of messenger ribonucleic acid (mRNA) of MAGE-A11 and MAGE-A12 by nested reverse transcription PCR can improve the accuracy of lung cancer diagnosis. AbstractThe melanoma antigen gene (MAGE) belongs to the group of cancer-testis antigens that are exclusively expressed in germ cells but may be re-expressed in cancer cells. The highly expressed MAGE-A subfamily in lung cancer may potentially be a diagnostic and prognostic biomarker. This study aimed to identify MAGE-A11 and MAGE-A12 expressions in lung tumors obtained from core biopsy, forceps biopsy, and bronchoalveolar lavage specimens. A cross-sectional observational study was conducted on 90 patients clinically diagnosed with lung tumors. These patients received core biopsy, forceps biopsy, and bronchoalveolar lavage interventions after ethical approval was obtained. The complementary deoxyribonucleic acid (cDNA) quality was assessed by the polymerase chain reaction (PCR) of glyceraldehyde-3-phosphate dehydrogenase (GAPDH). The assessment was performed to ascertain if all specimens exhibited positive PCR amplification of the GAPDH gene. MAGE-A11 and MAGE-A12 were identified through a semi-nested reverse transcription PCR. The positive results were detected by measuring the PCR products, with MAGE-A11 and MAGE-A12 at base pairs (bp) of 858 and 496 in the first and second rounds, respectively. The expressions of MAGE-A11 and MAGE-A12 were observed in 3 (3.33%) and 40 (44.44%) out of 90 specimens, respective

Pulmonary tuberculosis and lung cancer are public health problems, causing significant morbidity and mortality worldwide. The coexistence of the two diseases has rarely been reported while their causative association has been noticed leading to diagnosis delayed and prognosis worsening. In this case report, we present the case of a patient with coexistence of pulmonary tuberculosis and small cell lung carcinoma. A 54-year-old male was presented with the complained of lower left chest pain for six months, which was getting worse four days before admission to the hospital. The patient also complained of cough and decreased appetite and weight loss. Initial chest X-ray revealed an infiltrate and cavity in the upper right lung and inhomogeneous consolidation in the left paracardial. After the patient was diagnosed with pulmonary tuberculosis and was given anti-tuberculosis drugs for two months, the cavity and consolidation decreased with no clinically significant improvement. We performed a bronchoscopy with suspicion of lung cancer and a forceps biopsy in which small cell carcinoma was confirmed. The patient received two cycles of chemotherapy and anti-tuberculosis was continued for four months. During the observation in the fourth month, there was a reduction in the tumor size. This case highlights that similarity of clinical symptoms between pulmonary tuberculosis and lung cancer often lead to misdiagnosis of both. Therefore, in the absence of complete clinical and radiological improvement in pulmonary tuberculosis patients, the coexistence of lung cancer should be considered. This also highlights that early diagnosis is critical for the favorable outcome.

Background and aimsDifferentiating pancreatic cystic lesions remains a challenge when the current technique of EUS-guided FNA is used. Recently, a miniaturized biopsy forceps with an outer diameter of 0.8 mm has been developed, thus allowing it to be passed through the bore of a standard 19-gauge FNA needle to acquire tissue.MethodsThis study consisted of a retrospective review of all cases of EUS-guided through-the-needle forceps biopsy technique (TTNFB) performed for pancreatic cystic lesions at a single academic tertiary care center over a 12-month period. Technical success was defined as acquisition of adequate tissue for formal histologic analysis. Safety was assessed through the monitoring and recording of periprocedural and postprocedural adverse events.ResultsThe technical success of EUS-guided TTNFB was 87% (13/15). EUS-guided TTNFB with histologic analysis yielded pancreatic cyst diagnoses in 11 of 15 (73%) patients, compared with 0 of 15 (0%) patients with the use of EUS-FNA and cytologic analysis (P < .001). Of the 15 cystic lesions, 8 were diagnosed as intrapapillary mucinous neoplasm based on EUS-TTNFB.ConclusionThis TTNFB technique has the potential to improve the diagnostic yield of EUS-FNA for pancreatic cystic neoplasms.

PurposeTissue acquisition in lung cancer is vital for multiple reasons. Primary reasons reported for molecular testing failure in lung cancer biopsy specimens include insufficient amount of tumor cells provided and inadequate tissue quality. Robotic bronchoscopy is a new tool enabling peripheral pulmonary lesion sampling; however, diagnostic yield remains imperfect possibly due to the location of nodules adjacent to or outside of the airway. The 1.1-mm cryoprobe is a novel diagnostic tool and accesses tissue in a 360-degree manner, thus potentially sampling eccentric/adjacent lesions. This study examines the diagnostic yield of the cryoprobe compared to standard needle aspiration and forceps biopsy. It additionally evaluates yield for molecular markers in cases of lung cancer.MethodsThis is a retrospective analysis of 112 patients with 120 peripheral pulmonary lesions biopsied via robotic bronchoscopy using needle aspirate, forceps, and cryobiopsy.ResultsThe overall diagnostic yield was 90%. Nearly 18% of diagnoses were made exclusively from the cryobiopsy sample. Molecular analysis was adequate on all cryobiopsy samples sent. Digital imaging software confirmed an increase in quantity and quality of samples taken via cryobiopsy compared to needle aspirate and traditional forceps biopsy.ConclusionUsing the 1.1-mm cryoprobe to biopsy PPN combined with the Ion robotic bronchoscopy system is safe, feasible, and provides more diagnostic tissue than needle aspirates or traditional forceps biopsies. The combination of cryobiopsy with robotic-assisted bronchoscopy increased diagnostic yield, likely due to its 360-degree tissue acquisition which is beneficial when targeting extraluminal lesions adjacent to the airway.

Objective: To investigate long-term results of biliary biopsy performed with transluminal forceps in the setting of metastatic biliary involvement. Materials and Methods: Between September 2014 and June 2019, 25 patients—18 males (72%)—with a mean age of 65 ± 15 years, underwent 26 biliary biopsy procedures with a dedicated forceps system. All patients presented with obstructive jaundice that was suspected of being malignant and underwent pre-procedural magnetic resonance cholangiopancreatography. The biopsies were performed during percutaneous placement of an internal-external biliary drainage catheter, under fluoroscopic guidance. Results: The technical success rate was 96% (corresponding to 25 of the 26 procedures). The histological diagnosis was inflammatory biliary stricture in five cases, pancreatic adenocarcinoma in six, liver metastases from colorectal cancer in eight, and hepatocel-lular carcinoma in three, the biliary mucosa being categorized as normal in three cases. In one case, the sample was considered insufficient and the procedure was successfully repeated, after which a diagnosis of pancreatic adenocarcinoma was made. Over a follow-up period of 6–48 months, there were five false-negative results: two findings of inflammatory biliary stricture were later identified as liver metastases from breast and gastric cancer, respectively; and all three patients in which the biliary mucosa was categorized as normal were subsequently diagnosed with metastatic hilar lymph nodes. The procedure was found to have a sensitivity of 77%, a specificity of 100%, and an overall accuracy of 80%. The complication rate was 11.5% (mild, transient hemobilia occurring in three cases). Conclusion: Percutaneous transluminal forceps biopsy is a safe, effective, minimally invasive procedure for histological characterization in patients presenting with obstructive jaundice due to a non-primary biliary tumor. © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem.

Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA. We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection. Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 +/- 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate. With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could

Forceps biopsies of airway lesions have variable yields. The yield increases when combining techniques in order to collect more material. With the use of cryotherapy probes (cryobiopsy) larger specimens can be obtained, resulting in an increase in the diagnostic yield. However, the utility and safety of cryobiopsy with all types of lesions, including flat mucosal lesions, is not established. Aims. Demonstrate the utility/safety of cryobiopsy versus forceps biopsy to sample exophytic and flat airway lesions. Settings and Design. Teaching hospital-based retrospective analysis. Methods. Retrospective analysis of patients undergoing cryobiopsies (singly or combined with forceps biopsies) from August 2008 through August 2010. Statistical Analysis. Wilcoxon signed-rank test. Results. The comparative analysis of 22 patients with cryobiopsy and forceps biopsy of the same lesion showed the mean volumes of material obtained with cryobiopsy were significantly larger (0.696 cm(3) versus 0.0373 cm(3), P = 0.0014). Of 31 cryobiopsies performed, one had minor bleeding. Cryopbiopsy allowed sampling of exophytic and flat lesions that were located centrally or distally. Cryobiopsies were shown to be safe, free of artifact, and provided a diagnostic yield of 96.77%. Conclusions. Cryobiopsy allows safe sampling of exophytic and flat airway lesions, with larger specimens, excellent tissue preservation and high diagnostic accuracy.

The detection of molecular alterations is crucial for the individualized treatment of advanced non-small cell lung cancer (NSCLC). Missing targetable alterations may have a major impact on patient's progression free and overall survival. Although laboratory testing for molecular alterations has continued to improve; little is known about how biopsy technique affects the detection rate of different mutations. In the retrospective study detection rate of epidermal growth factor (EGFR) mutations in tissue extracted by bronchoscopic cryobiopsy (CB was significantly higher compared to other standard biopsy techniques. This prospective, randomized, multicenter, single blinded study evaluates the accuracy of molecular genetic characterization of NSCLC for different cell sampling techniques. Key inclusion criteria are suspected lung cancer or the suspected relapse of known NSCLC that is bronchoscopically visible. Patients will be randomized, either to have a CB or a bronchoscopic forceps biopsy (FB). If indicated, a transbronchial needle aspiration (TBNA) of suspect lymph nodes will be performed. Blood liquid biopsy will be taken before tissue biopsy. The primary endpoint is the detection rate of molecular genetic alterations in NSCLC, using CB and FB. Secondary endpoints are differences in the combined detection of molecular genetic alterations between FB and CB, TBNA and liquid biopsy. This trial plans to recruit 540 patients, with 178 evaluable patients per study cohort. A histopathological and molecular genetic evaluation will be performed by the affiliated pathology departments of the national network for genomic medicine in lung cancer (nNGM), Germany. We will compare the diagnostic value of solid tumor tissue, lymph node cells and liquid biopsy for the molecular genetic characterization of NSCLC. This reflects a real world clinical setting, with potential direct impact on both treatment and survival.

Amyloidosis is a rare condition in which tissue deposits of inert fibrillar protein result in organ damage and dysfunction. There are several types of amyloid fibrils. Some of the most common forms are AL (amyloid light chain) protein and AA (amyloid-associated) type of amyloid fibril protein. Pulmonary amyloidosis is relatively common but is usually asymptomatic. Thus, the diagnosis may be easily overlooked. A 78-year-old male with a history of multiple myeloma followed by systemic amyloidosis presented with abnormal chest CT showing diffuse interlobular thickening in the whole lung field with bilateral pleural effusion. Bronchoalveolar lavage and transbronchial biopsy were performed. Due to the patient’s poor condition and hemorrhage, only one fragment was available from forceps biopsy. Histologically, there was no amyloid deposition in the lung parenchyma; however, some histiocytes showed eosinophilic granular contents which prompted us to perform additional staining. The cytoplasmic material turned to be positive with direct fast scarlet (DFS) staining and AA amyloid immunostaining. Similar macrophages with AA amyloid were also found in the bronchoalveolar fluid. We experienced a case with AA amyloidosis affecting the lung diagnosed by the presence of intracytoplasmic amyloid in alveolar macrophages. The microscopic changes were so subtle that they may be overlooked. Recognition of amyloid deposition in alveolar macrophages may be an important clue to diagnose pulmonary amyloidosis. Such finding is of particular significance in the small-sized specimens, such as biopsies and cytologic smears., Respiratory Medicine Case Reports, 30, art.no.101046; 2020

The role of bronchoscopic brushing for tumor detection and molecular testing in central lung cancer is unclear. In this study, 50 consecutive subjects with suspected central lung cancer underwent bronchoscopic brushing (31 males, median age 70, 5 never smokers). Histological results were: NSCLC/SCLC/low-grade-NET/granulation tissue in 36/8/2/4 cases. Next generation sequencing (NGS) was feasible in 62% of tumor-positive brush smear samples. In 78% of these cases, NGS displayed identical results compared to histology samples, in 22% NGS from brush smears detected specific mutations, whereas DNA quality from forceps biopsy was insufficient for NGS analysis. Sensitivity, specificity, positive predictive value, negative predictive value of brush smear analysis were 66% (95% confidence interval 50-79), 100% (40-100), 100% (85-100), and 21% (7-46). For the combined analysis of brush smear, brush tip washing and sheath tube content sensitivity was slightly elevated at 69% (53-81). In central lung cancer, bronchoscopic brushing detects tumor cells in about two-third of cases and allows a decision for or against targeted therapy in the majority of tumor-positive cases on the basis of NGS analysis.

Mukoepidermoidni karcinom (MEC) rijetki je primarni maligni tumor traheobronhalnoga stabla i obuhvaća 0,1 – 0,2% primarnih karcinoma pluća. Tumor sačinjavaju epitelne stanice, stanice koju izlučuju sluz, te stanice intermedijarnog tipa koje se jednake stanicama koje se javljaju u žlijezdama slinovnicama. Prognoza bolesti ovisi o histološkom stupnju malignosti i može biti loša, naročito u starijih bolesnika. Prikazali smo bolesnicu u dobi od 27 godina, koja je bila subfebrilna četiri mjeseca prije javljanja liječniku. Standardna sumacijska snimka torakalnih organa pokazuje homogeno zasjenjenje promjera 50 mm u gornjem lijevom plućnom polju. Višeslojna kompjutorizirana tomografija (MSCT) prsnoga koša pokazuje lobuliranu formaciju veličine 50 x 27 mm s uključenim hipodenznim zonama, koja se utiskuje u lijevi glavni bronh i opstruira ga. Nisu ustanovljene metastaze medijastinalnih limfnih čvorova, niti drugih organa. Bronhoskopijom se nađe tumor koji opstruira ulaz u lijevi B1 + B2 bronh. Patohistološki i imunohistokemijski nalaz biopsije tumora pokazuje MEC niskoga stupnja malignosti. U bolesnice je učinjena gornja lobektomija lijevoga plućnog krila i medijastinalna limfadenektomija. Makroskopski je u reseciranom lobusu, u lumenu lijevoga glavnog bronha viđen dobro ograničeni, žućkasti tumor, promjera 35 mm. Histološki nalaz tumora jednak je nalazu ranije učinjene biopsije tumora. Tumor se većim dijelom nalazio u lumenu bronha, kroz koji je prodro u okolno plućno tkivo, ali nije zahvatio pleuru. U reseciranim limfnim čvorovima nije bilo stanica tumora. Nikakvo adjuvantno liječenje nije provedeno. 15 mjeseci nakon operacije tumora pluća naša je bolesnica rodila treće zdravo dijete. Nakon 37 mjeseci praćenja od operacije, nema znakova recidiva tumora pluća., Mucoepidermoid carcinoma (MEC) is a rare primary malignancy of the tracheobronchial tree and comprising 0.1 – 0.2% of primary lung cancers. The tumour is composed of epithelial cells, mucus secreting cells and cells of an intermediate type identical to those occurring in the salivary glands. The prognosis depends on the histological grade. We report the case of a 27-year-old woman who was four months sub febrile before referring to a physician. Chest radiography revealed a mass shadow measuring 50 mm in diameter in the left upper lung field. Chest CT showed a lobulated mass shadow measuring 50 x 27 mm in which there were hypo dense zones. The tumour was pressed into the left main bronchus, and was obstructing it. No mediastinal lymph node metastasis or other organ metastases were observed. Bronchoscopy revealed a tumour obstructing the entry of left B1+2 bronchus. Pathohistological and immunohistochemical findings of tumour forceps biopsy lead to diagnosis of low-grade MEC. The patient underwent left upper lobe resection and mediastinal lymphadenectomy. Macroscopic findings showed a yellowish well-confined tumour node 35 mm in diameter in the lumen of the main bronchus. The tumour tissue was mainly located in the lumen of the bronchus, and penetrated the wall of the bronchus and entered in the underlying lung tissue. The tumour did not affect the pleura. There were no tumour cells in the resected lymph nodes. No adjuvant treatment was administered. Fifteen months after surgery she gave birth to a third healthy son. The patient remains in remission after 37 months of follow-up from tumour resection.

Background: The use of cytological methods in the diagnosis of malignant lesions of the respiratory tract has been generally acclaimed as one of its most successful applications. Flexible fiberoptic bronchoscopy revolutionized respiratory cytology, as bronchial brushings, broncho-alveolar lavage and bronchial forceps biopsy became more easy, accessible and popular, shifting the emphasis from diagnosis of advanced malignancy in inoperable patients to the use of cytology as a first line diagnostic and management tool. Respiratory tract cytology is well established throughout the world as a diagnostic procedure in the evaluation of patient with suspected lung malignancy. Methodology: The present study compromises of bronchoscopic cytology and histology of bronchial biopsy in 80 patients suspected of lung tumors. The study was carried out in the department of pathology M.P. shah medical college and the samples of the bronchoscopic material were received from tuberculosis and chest department of G.G hospital Jamnagar. Results: Out of 80 patients 66 were found to be malignant. Some of the suspicious lesions turned out to be malignant in biopsy. In the carcinoma of lung squamous cell carcinoma was the most common carcinoma (39.39% ) followed by adenocarcinoma (21.21%) small cell carcinoma 13.63% and large cell carcinoma 7.57 %, majority of the cases 77.5 % were male predominat. Conclusion: Pulmonary cytology is an important, basic diagnostic tool for the detection of lung cancer, that too in early diagnosis. Fibroptic bronchoscopy is an easy, OPD procedure which is minimally invasive and without any risk. It provides direct visualization of respiratory tract as well as lesion proper and variety of specimens can be collected.

The diagnostic accuracy attained with the use of transbronchial fine needle aspiration biopsy, aspiration of bronchial secretion, bronchial washing, brush biopsy and forceps biopsy via a flexible fiberoptic bronchoscope was compared in patients with carcinoma of the lung. In endoscopic visible tumours the sensitivity of forceps biopsy was higher than that of the other methods. When forceps biopsy was combined with bronchial washing the overall diagnostic accuracy was significantly higher than that of any of the single methods, while no appreciable increase was obtained by adding additional methods. Selective brush biopsy from every segment bronchus has been established as a method in the search for occult bronchial carcinoma. The extent of respiratory mucosal damage and wound healing after brush biopsy was therefore studied in rabbits. Large differences in the extension and depth of the damage was observed. The basement membrane was often penetrated. Regeneration started during the first day after brush biopsy and a normal ciliated epithelium was restored within three weeks. To determine if the bronchoscope itself damaged the respiratory epithelium, bronchial mucosa was studied in the pig after examination with a flexible fiberoptic bronchoscope. The columnar epithelial cells were torn off in areas where the bronchoscope had rubbed against the airway wall but the basement membrane was not damaged. Since the function of the respiratory epithelium is to remove inhaled particles from the airways, mucociliary clearance was studied in man after fiberoptic bronchoscopy. The study suggests that the tracheobronchial clearance system has a large reserve for mechanical trauma. Mucociliary clearance can however be decreased after fiberoptic bronchoscopy in some patients. An increasing number of patients with impaired cardiopulmonary function are today subjected to examination with flexible fiberoptic broncoscopy. The haemodynamic effects of fiberoptic bronchoscopy performed un, S. 1-48: sammanfattning, s. 49-126: 5 uppsatser, digitalisering@umu.se

Background: The feasibility of single-operator cholangioscopy (SOC) for biliary diagnostic and therapeutic procedures was previously reported. Objective: To confirm the utility of SOC in more widespread clinical use. Design: Prospective clinical cohort study. Setting: Fifteen endoscopy referral centers in the United States and Europe. Patients: Two hundred ninety-seven patients requiring evaluation of bile duct disease or biliary stone therapy. Interventions: SOC examination and, as indicated, SOC-directed stone therapy or forceps biopsy. Main Outcome Measurements: Procedural success defined as ability to (1) visualize target lesions and, if indicated, collect biopsy specimens adequate for histological evaluation or (2) visualize biliary stones and initiate fragmentation and removal. Results: The overall procedure success rate was 89% (95% CI, 84%-92%). Adequate tissue for histological examination was secured in 88% of 140 patients who underwent biopsy. Overall sensitivity in diagnosing malignancy was 78% for SOC visual impression and 49% for SOC-directed biopsy. Sensitivity was higher (84% and 66%, respectively) for intrinsic bile duct malignancies. Diagnostic SOC procedures altered clinical management in 64% of patients. Procedure success was achieved in 92% of 66 patients with stones and complete stone clearance during the study SOC session in 71%. The incidence of serious procedure-related adverse events was 7.5% for diagnostic SOC and 6.1% for SOC-directed stone therapy. Limitations: The study was observational in design with no control group. Conclusions: Evaluation of bile duct disease and biliary stone therapy can be safely performed with a high success rate by using the SOC system. © 2011 American Society for Gastrointestinal Endoscopy., SCOPUS: ar.j, info:eu-repo/semantics/published

Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.

Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions. © ERS 2010., SCOPUS: re.j, info:eu-repo/semantics/published

Trotz vielfältiger Untersuchungsmöglichkeiten ist die Diagnostik der Dignität von Gallengangstenosen noch eine Herausforderung an Klinik, Bildgebung und Pathologie. Dies wird noch deutlicher vor dem Hintergrund, dass bei malignem Befund ein schnelles Einsetzen einer Therapie gefordert ist, da die Hauptursachen – das Gallenwegs- und Pankreaskarzinom – auch heute noch eine infauste Prognose besitzen. In zahlreichen Veröffentlichungen erreicht die Gewebediagnostik während der endoskopisch retrograden Cholangiopankreatographie nur eine unbefriedigende Sensitivität bis zu maximal 70%. Die im pankreatobiliären Bereich zunehmend eingesetzte endosonographische Feinnadelpunktion kam in Studien mit selektiertem Patientengut auf bessere Ergebnisse von 80% und mehr. Ziel der vorliegenden Studie war es, die beiden Untersuchungen mit den verschiedenen gewebediagnostischen Methoden direkt zu vergleichen. Im Rahmen der ERCP kamen zur Zytologiegewinnung eine Bürste und eine neu entwickelte Spirale von E. Frimberger zum Einsatz, zur Histologiegewinnung eine Biopsiezange. Die endosonographische Feinnadelpunktion wurde mit einer 22Gauge-Nadel durchgeführt. Die in die Studie eingeschlossenen 50 Patienten (29 Männer, 21 Frauen; Durchschnittsalter bei Untersuchung 62,1 Jahre) erhielten alle Untersuchungen mit den entsprechenden Gewebeentnahmen in der Reihenfolge der festgelegten Randomisierung. Im Rahmen der EUS kam es nur zu einer Feinnadelpunktion, wenn ein punktionswürdiger Befund wie eine Raumforderung oder eine lokalisierte Wandverdickung darzustellen war. Als Referenzmethoden dienten Chirurgie, weitere Biopsien oder das klinische Follow up der Patienten, welches sich im Schnitt über 20 Monate erstreckte. Von den untersuchten Patienten hatten 28 eine maligne Raumforderung und 22 einen benignen Befund. Im Detail zeigten sich 16 Pankreas- und zwölf Gallengangkarzinome. Die Sensitivität der ERCP-Biopsie und ERCP-Zytologie betrug 36% bzw. 46%. Die EUS-Feinnadelpunktion kam hier auf 43%., In spite of many different examinations, the diagnosis of the type of biliary obstruction is still a challenge to clinician, diagnostic radiology and pathology. Especially in case of malignancy a rapid starting of therapy is essential, because the main cases – bile duct and pancreas carcinoma – still have a very bad prognosis. In many publications the tissue diagnosis reaches only a low sensitivity to a maximum 70% during endoscopic-retrograde cholangiopancreatography. More and more used in pancreatobiliary region is the endosonographic fine-needle-puncture, which reaches much better results of 80% and more in studies with selected patients. Aim of our study was to compare both examinations with the different methods of tissue diagnosis. In the framework of the ERCP a brush and a newly invented spiral-brush from E. Frimberger were used for the cytology, and for the histological tissue diagnosis the forceps biopsy. The endosonographic fine-needle puncture was done with a 22gauge-needle. Examinations with tissue diagnosis in order of the randomisation were done on all 50 patients of the study (29 men, 21 women; average age 62,1 years). During the EUS there was only a fine-needle puncture, if a tumor or a local wall-thickening was to be approved. Reference methods were surgery, further biopsies or the clinical follow up of the patients, which lasted 20 months on average. Twenty-eight of the examined patients had a malignant tumor and 22 of them a benign result. In detail 16 pancreas and 12 bile duct carcinoma were found. The sensitivity of the ERCP-biopsy and the ERCP-cytology was 36% and 46% respectively. The EUS-fine needle puncture showed 43% sensitivity. In combination of all three methods a sensitivity of 71% was reached. The specificity was always 100%, we had no false positive results. Observing only the punctured cases, the sensitivity of the EUS-punctures improves to 75%. There was a trend for a better diagnosis of bile duct lesion with the ERCP (75% compared

Trotz vielfältiger Untersuchungsmöglichkeiten ist die Diagnostik der Dignität von Gallengangstenosen noch eine Herausforderung an Klinik, Bildgebung und Pathologie. Dies wird noch deutlicher vor dem Hintergrund, dass bei malignem Befund ein schnelles Einsetzen einer Therapie gefordert ist, da die Hauptursachen – das Gallenwegs- und Pankreaskarzinom – auch heute noch eine infauste Prognose besitzen. In zahlreichen Veröffentlichungen erreicht die Gewebediagnostik während der endoskopisch retrograden Cholangiopankreatographie nur eine unbefriedigende Sensitivität bis zu maximal 70%. Die im pankreatobiliären Bereich zunehmend eingesetzte endosonographische Feinnadelpunktion kam in Studien mit selektiertem Patientengut auf bessere Ergebnisse von 80% und mehr. Ziel der vorliegenden Studie war es, die beiden Untersuchungen mit den verschiedenen gewebediagnostischen Methoden direkt zu vergleichen. Im Rahmen der ERCP kamen zur Zytologiegewinnung eine Bürste und eine neu entwickelte Spirale von E. Frimberger zum Einsatz, zur Histologiegewinnung eine Biopsiezange. Die endosonographische Feinnadelpunktion wurde mit einer 22Gauge-Nadel durchgeführt. Die in die Studie eingeschlossenen 50 Patienten (29 Männer, 21 Frauen; Durchschnittsalter bei Untersuchung 62,1 Jahre) erhielten alle Untersuchungen mit den entsprechenden Gewebeentnahmen in der Reihenfolge der festgelegten Randomisierung. Im Rahmen der EUS kam es nur zu einer Feinnadelpunktion, wenn ein punktionswürdiger Befund wie eine Raumforderung oder eine lokalisierte Wandverdickung darzustellen war. Als Referenzmethoden dienten Chirurgie, weitere Biopsien oder das klinische Follow up der Patienten, welches sich im Schnitt über 20 Monate erstreckte. Von den untersuchten Patienten hatten 28 eine maligne Raumforderung und 22 einen benignen Befund. Im Detail zeigten sich 16 Pankreas- und zwölf Gallengangkarzinome. Die Sensitivität der ERCP-Biopsie und ERCP-Zytologie betrug 36% bzw. 46%. Die EUS-Feinnadelpunktion kam hier auf 43%., In spite of many different examinations, the diagnosis of the type of biliary obstruction is still a challenge to clinician, diagnostic radiology and pathology. Especially in case of malignancy a rapid starting of therapy is essential, because the main cases – bile duct and pancreas carcinoma – still have a very bad prognosis. In many publications the tissue diagnosis reaches only a low sensitivity to a maximum 70% during endoscopic-retrograde cholangiopancreatography. More and more used in pancreatobiliary region is the endosonographic fine-needle-puncture, which reaches much better results of 80% and more in studies with selected patients. Aim of our study was to compare both examinations with the different methods of tissue diagnosis. In the framework of the ERCP a brush and a newly invented spiral-brush from E. Frimberger were used for the cytology, and for the histological tissue diagnosis the forceps biopsy. The endosonographic fine-needle puncture was done with a 22gauge-needle. Examinations with tissue diagnosis in order of the randomisation were done on all 50 patients of the study (29 men, 21 women; average age 62,1 years). During the EUS there was only a fine-needle puncture, if a tumor or a local wall-thickening was to be approved. Reference methods were surgery, further biopsies or the clinical follow up of the patients, which lasted 20 months on average. Twenty-eight of the examined patients had a malignant tumor and 22 of them a benign result. In detail 16 pancreas and 12 bile duct carcinoma were found. The sensitivity of the ERCP-biopsy and the ERCP-cytology was 36% and 46% respectively. The EUS-fine needle puncture showed 43% sensitivity. In combination of all three methods a sensitivity of 71% was reached. The specificity was always 100%, we had no false positive results. Observing only the punctured cases, the sensitivity of the EUS-punctures improves to 75%. There was a trend for a better diagnosis of bile duct lesion with the ERCP (75% compared

Clinicopathological significance of strip biopsy was evaluated in 23 gastric lesions in 22 patients. The 23 lesions consisted of 16 adenomas, 4 adenomas with focal carcinoma, 1 carcinoma, and 2 "no atypical cell"l. Strip biopsy provided precise information for accurate histological diagnosis and the depth of cancer invasion. Eleven % of lesions diagnosed as Group III by forceps biopsy and 66.7% of Group IV lesions had focal carcinoma in adenoma. Sixteen of 23 lesions were completely resected by strip biopsy. Seven lesions resulted in incomplete resection. One patient of the 7 cases underwent piece-meal resection because the lesion was too large to be resected by single strip biopsy. Four of the 7 lesions received additional endoscopic coagulation by laser or heater probe. All lesions except for 2 lesions which were resected by operation were followed by repeated endoscopy and all remained disappeared. The combination of strip biopsy and coagulation therapy appears to give great benefit in eradicating lesions., Acta Medica Nagasakiensia. 1992, 37(1-4), p.66-70

During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations, P. carinii was found. Sixteen examinations were non-diagnostic and one was unsuccessful. The clinical course confirmed the diagnoses of the P. carinii positive as well as the P. carinii negative patients. Except for a lower total lymphocyte count in the patients harbouring P. carinii, the two groups did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed, it is safe, and it is highly sensitive. The advantage of an early diagnosis compensates for a rather high frequency of negative examinations.