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Schwannomas are classified as neurogenic tumors and are the most frequent nerve sheath tumors in the paravertebral mediastinum. Recently, the addition of endobronchial ultrasound‐guided intranodal forceps biopsy (EBUS‐IFB) using standard‐sized biopsy forceps (SBFs) to endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for metastatic lymph nodes in lung cancer patients reportedly improved the quality and quantity of the obtained specimens without significant complications. However, reports on the usefulness of this technique for benign diseases remain scarce. Here we report a case of schwannoma in the middle mediastinum, which was diagnosed by EBUS‐IFB using SBFs, despite inadequate specimens obtained via EBUS‐TBNA. An 80‐year‐old woman presented with dyspnea and a 5‐cm sized middle mediastinal tumor. EBUS‐TBNA and EBUS‐IFB using SBFs were performed for histological diagnosis. No complications were associated with the bronchoscopy procedure, and schwannoma was solely diagnosed using the EBUS‐IFB specimens. EBUS‐IFB using SBFs is potentially useful for diagnosing benign diseases, including schwannomas, which are often difficult to diagnose with EBUS‐TBNA. [ABSTRACT FROM AUTHOR]

Background and Objective: Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a diagnostic procedure with adequate performance; however, its ability to provide specimens of sufficient quality and quantity for treatment decision‐making in advanced‐stage lung cancer may be limited, primarily due to blood contamination. The use of a 0.96‐mm miniforceps biopsy (MFB) permits true histological sampling, but the resulting small specimens are unsuitable for the intended applications. Therefore, we introduced a 1.9‐mm standard‐sized forceps biopsy (SFB) and compared its utility to that of MFB. Methods: We prospectively enrolled patients from three institutions who presented with hilar/mediastinal lymphadenopathy and suspected advanced‐stage lung cancer, or those who were already diagnosed but required additional tissue specimens for biomarker analysis. Each patient underwent MFB followed by SFB three or four times through the tract created by TBNA using a 22‐gauge needle on the same lymph node (LN). Two pathologists assessed the quality and size of each specimen using a virtual slide system, and diagnostic performance was compared between the MFB and SFB groups. Results: Among the 60 enrolled patients, 70.0% were diagnosed with adenocarcinoma. The most frequently targeted sites were the lower paratracheal LNs, followed by the interlobar LNs. The diagnostic yields of TBNA, MFB and SFB were 91.7%, 93.3% and 96.7%, respectively. The sampling rate of high‐quality specimens was significantly higher in the SFB group. Moreover, the mean specimen size for SFB was three times larger than for MFB. Conclusion: SFB is useful for obtaining sufficient qualitative and quantitative specimens. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound‐guided (EBUS) transbronchial needle aspiration (TBNA) has significantly improved the diagnostic workup for intrathoracic lymphadenopathies. More recently, EBUS intranodal forceps biopsy (IFB) has been developed in an attempt to maximize diagnostic yield by providing additional tissue. In this study, we aimed to assess the improvement of diagnostic yield with EBUS‐TBNA combined with EBUS‐IFB, compared to EBUS‐TBNA alone. Methods: Consecutive patients who had 19‐G EBUS‐TBNA and EBUS‐IFB from August 30, 2018, to September 28, 2021, were included. Four senior pathologists retrospectively analyzed, independently and blindly, first, only the EBUS‐TBNA samples (cell block), then, at least 1 month later, both samples from EBUS‐TBNA and from EBUS‐IFB together. Results: Fifty patients were included in the study and 52 lymph nodes were analyzed. Diagnostic yield was 77% (40/52) for EBUS‐TBNA alone and 94% (49/52) when combined with EBUS‐IFB (p = 0.023). Malignancy was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 25/26 cases (96%), versus 22/26 (85%) with EBUS‐TBNA alone (p = 0.35); and 4/5 (80%) versus 2/5 (40%) for lymphoma specifically. Kappa interobserver agreement was 0.92 for EBUS‐IFB and 0.87 for EBUS‐TBNA alone. Nonmalignant condition was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 24/26 cases (92%), versus 18/26 (69%) for EBUS‐TBNA alone (p = 0.07). Conclusion: The use of EBUS‐IFB combined with 19‐G EBUS‐TBNA improves the mediastinal lymph node diagnostic yield However the benefit appears to be mainly restricted to nonmalignant histology. [ABSTRACT FROM AUTHOR]

Background: Management of diminutive pharyngeal neoplasms is controversial. Thus, we conducted a single‐center, prospective pilot study to investigate the efficacy and safety of endoscopic excision with cold forceps biopsy (CFB) of these lesions. Patients and Methods: Thirty‐nine lesions endoscopically diagnosed with narrow‐band imaging as pharyngeal neoplasms of 3 mm or smaller were excised with CFB using jumbo biopsy forceps (cap diameter 2.8 mm, jaw volume 12.4 mm3). The primary outcome was endoscopically determined local remnant/recurrence rate 3 months after CFB. The secondary outcomes were histopathologically determined local remnant/recurrence rate; risk factors associated with the endoscopic remnant/recurrence; and incidence of intraoperative or delayed bleeding and other adverse events. Results: Histological diagnosis of the 39 CFB‐excised lesions were: 11 high‐grade dysplasia (28.2%), 22 low‐grade dysplasia (56.4%), two basal cell hyperplasia (5.1%) and four atypical squamous epithelium (10.3%).Twenty‐seven patients (30 lesions) underwent follow‐up endoscopy 3 months after CFB; the endoscopic and pathological local remnant/recurrence rate was 20% (6/30; 95% confidence interval (CI), 7.7–36.6%) and 16.7% (5/30; 95% CI, 5.6–34.7%), respectively. Location of the lesion in the hypopharynx was a significant risk factor associated with the endoscopic local remnant/recurrence (P = 0.049). No significant adverse events occurred. Conclusions: Cold forceps biopsy with jumbo biopsy forceps appears to be a safe and effective technique for excising diminutive pharyngeal neoplasms. Although small, the excised lesions may have a remarkably high frequency of high‐grade dysplasia. (Clinical trial registration number: UMIN000037980). [ABSTRACT FROM AUTHOR]

Background: Although the SpyGlass Direct Visualization System can be clinically useful for diagnosing indeterminate biliary stricture, it employs SpyBite forceps, which typically obtain only a small amount of tissue and have a low sampling rate. An improved forceps biopsy device for SpyGlass DS has recently been released (SpyBite MAX). The aim of this prospective registration study was to assess the diagnostic yield and efficacy of histological biopsy tissue obtained with SpyBite MAX forceps compared with SpyBite forceps in patients with indeterminate biliary stricture. Methods: The primary outcome of the study was the diagnostic accuracy of biopsy specimens obtained by SpyBite MAX forceps. The secondary outcomes were tissue size, number of forceps biopsies, rate of obtaining adequate tissue, and adverse events in the SpyBite MAX forceps group compared with the SpyBite group. Results: Forceps biopsies using SpyBite MAX (n = 47) and SpyBite (n = 50) were performed successfully in all patients. The number of biopsies performed before visible core tissue was obtained was significantly lower in the SpyBite (mean, 1.5 ± 0.7) than in the SpyBite forceps group (mean, 2.3 ± 1.1 mm; P <.001). Tissue sample size was larger in the SpyBite MAX group (mean, 1.8 ± 1.6 mm2) than in the SpyBite group (mean, 1.0 ± 0.9 mm2; P =.004) but there was no significant difference in diagnostic accuracy. Conclusion: Improvements in dedicated forceps for biopsy in SpyGlass DS may contribute to improving the rates of adequate tissue and tissue sample size obtained, and to reducing the number of forceps biopsies required. [ABSTRACT FROM AUTHOR]

Background. It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of the digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens. Methods. A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with upgrade discrepancy and 756 concordant cases. We compared clinicopathological data of EFB and ER specimens between these two groups. Multivariate analysis was performed to identify predictors for this upgrade histopathology. Results. The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (114/918, 12.4%), followed by upgrades to intramucosal carcinoma (33/918, 3.6%), submucosal adenocarcinoma (10/918, 1.1%), and advanced adenocarcinoma (5/918, 0.5%). NSAID history (OR 4.83; 95% CI, 2.27-10.27; p < 0.001), insufficient EFB number (OR 2.99; 95% CI, 1.91-4.68; p < 0.001), maximum diameter ≥ 1.0 cm (OR 6.18; 95% CI, 1.32-28.99; p = 0.021), lobulated shape (OR 2.68; 95% CI, 1.65-4.36; p < 0.001), erythema (OR 2.42; 95% CI, 1.50-3.91; p < 0.001), erosion (OR 7.12; 95% CI, 3.91-12.94; p < 0.001), surface unevenness (OR 2.31; 95% CI, 1.33-4.01; p = 0.003), and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; p < 0.001) were associated with the histologically upgrade discrepancies. Conclusion. NSAID history, insufficient EFB number, adenoma size and location, and abnormal macroscopic patterns are potential predictors for upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB number and advanced imaging techniques could minimize the risk of neglecting the potential of this upgrade histopathology. [ABSTRACT FROM AUTHOR]

Background and Aim: Transpapillary biliary forceps biopsy (TBFB) is a common method to obtain histological evidence for the differential diagnosis of biliary stricture. This study aimed to evaluate the factors associated with a positive cancer diagnosis from TBFB and the number of tissue samples required to increase the diagnostic yield in patients with malignant biliary strictures. Methods: A total of 376 patients who underwent TBFB for investigation of biliary stricture were included. Factors affecting the diagnostic yield of TBFB were determined using univariate analysis and multivariate logistic regression analyses. Results: Bile duct cancer (odds ratio [OR] = 3.50, P = 0.002), intraductal growing type (OR = 9.01, P = 0.001), and number of tissue samples (n < 5 vs 5 ≤ n < 10, OR = 4.13, P = 0.01; n < 5 vs n ≥ 10, OR = 12.25, P < 0.001; 5 ≤ n < 10 vs n ≥ 10, OR = 2.97, P = 0.046) were significant factors associated with positive results for malignancy. In patients with periductal infiltrating‐type bile duct cancer, the number of tissue samples was a significant factor for diagnostic sensitivity (54.3% in the n < 5 group, 83.3% in the 5 ≤ n < 10 group and 98.2% in the n ≥ 10 group) (P < 0.001). Conclusions: Bile duct cancer, intraductal growing type, and five or more tissue samples were significant predictors of positive TBFB results in patients with malignant biliary stricture. Increasing the number of tissue samples by five or more led to higher sensitivity in bile duct cancer patients with the periductal infiltrating type. [ABSTRACT FROM AUTHOR]

Introduction: Radial probe endobronchial ultrasound (RP‐EBUS) is a modern technique for diagnosis of peripheral lung lesions. It is assumed that the addition of transbronchial cryobiopsy (TBCB) could increase the diagnostic value for RP‐EBUS. Objectives: The main objectives were to evaluate the efficacy and safety of RP‐EBUS‐guided TBCB for diagnosis of peripheral lung lesions and comparing it with RP‐EBUS‐guided transbronchial forceps biopsy. Methods: Sixty patients with peripheral lung diseases were divided into two groups. Group I included 45 patients who were eligible for TBCB and they subjected to forceps transbronchial biopsy (forceps TBB) and TBCB guided by RP‐EBUS. Fifteen patients who were not eligible for TBCB were included in group II and they were subjected to forceps TBB and/or cytology retrieval procedures guided by RP‐EBUS. Results: In group I, forceps TBB had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of; 67.5%, 100%, 100%, 18.8%, and 69.8%, respectively, while TBCB had sensitivity, specificity, PPV, NPV, and accuracy of 75%, 100%, 100%, 23.1%, and 76.7%, respectively. The sensitivity in group II was 80% and the overall results including both groups were sensitivity, specificity, PPV, NPV, and accuracy of 85.2%, 100%, 100%, 42.8%, and 86.7%, respectively. Regarding the complications, only one patient (1.7%) had significant bleeding. One patient (1.7%) had pneumothorax and another patient (1.7%) suffered from hypoxemia. Conclusions: RP‐EBUS‐guided TBCB is a safe and effective technique for diagnosis of peripheral lung lesions. TBCB has achieved higher diagnostic values and better quality of samples. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) provides a high diagnostic yield in lung cancer, but the yield for benign conditions and lymphoma is lower. The material obtained by EBUS‐TBNA is limited by the lack of histopathological samples in some cases. The current 'expanded' aims of mediastinal lymph node (MLN) sampling are both an accurate diagnosis and adequate material for 'targeted' processing in malignant and benign disease. The sample obtained with the 21/22G EBUS needle may not be sufficient in all situations. Objectives: The aim of the study was to evaluate the role of a novel technique for EBUS‐guided MLN forceps biopsy (EBUS‐TBFB) when EBUS‐TBNA with rapid on‐site‐evaluation (ROSE) failed to provide a diagnosis. In addition, the technical aspects and safety of EBUS‐TBFB were studied. Methods: About 30 consecutive patients with enlarged MLN, with a negative EBUS‐TBNA ROSE were included. EBUS‐TBFB was done by the method described below. The histopathology and complications were recorded. Results: Adequate samples for analysis were obtained in all the patients with both EBUS‐TBNA and EBUS‐TBFB. In patients with a non‐diagnostic EBUS‐ROSE, EBUS‐TBFB led to positive diagnostic results in an additional 8/30 patients (27%). Mild bleeding was noted in two patients who underwent EBUS‐TBFB, which resolved with conservative management. The procedure was safe with no major complications. Conclusion: In patients with a negative EBUS‐ROSE, EBUS‐TBFB using this technique is safe and augments the diagnostic yield. EBUS‐TBFB adds to the armamentarium of EBUS, especially in benign aetiologies of MLN enlargement. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic forceps biopsy results that reflect the final pathologic results of an entire lesion are essential for making accurate diagnoses and appropriate therapeutic decisions for patients with superficial esophageal squamous neoplasms (SESNs). This study investigated the histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens to elucidate the factors contributing to such discrepancies. Methods: This retrospective observational study involved 77 patients (84 lesions) who underwent endoscopic resections for SESNs, between January 2005 and August 2017, at the Pusan National University Hospital. The SESNs were classified as low‐grade intraepithelial neoplasms (LGINs), high‐grade intraepithelial neoplasms (HGINs), or squamous cell carcinomas (SCCs). Following slide reviews, the histopathologic concordance between endoscopic forceps biopsy and endoscopic resection specimens was assessed, in each case. Results: The histopathologic discrepancy rate between the endoscopic forceps biopsy and endoscopic resection specimens was 34.5% (29/84 lesions). Among the 29 diagnostically discordant lesions, upgrades and downgrades of the histopathologic diagnoses occurred for 27 and 2 lesions, respectively. The predominant discrepancies results in lesion upgrades from HGIN to SCC (n = 21) and from LGIN to SCC (n = 5). The two downgraded cases included one from SCC to HGIN and one from HGIN to LGIN. Multivariate analyses identified two factors that were significantly associated with the histopathologic discrepancies: upper esophageal location (odds ratio, 7.743; 95% confidence interval, 1.031–58.174; P = 0.047) and tumor area per biopsy ≥ 158.6 mm2/biopsy (odds ratio, 5.933; 95% confidence interval, 1.051–44.483; P = 0.044). Conclusion: Histopathologic discrepancies were observed between endoscopic forceps biopsy and endoscopic resection specimens in patients with SESNs. Tumor location and tumor area/biopsy were both significantly associated with the discrepancies. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP)‐related tissue acquisition, including fluoroscopy‐guided forceps biopsy (F‐FB), is a common technique in diagnosing indeterminate biliary lesions. Recently, peroral cholangioscopy (POCS) and POCS‐guided forceps biopsy (POCS‐FB) has also been used for the diagnosis of indeterminate biliary lesions. However, it is uncertain which of those techniques were superior for the diagnosis of extrahepatic cholangiocarcinoma (ECC). We aimed to evaluate the diagnostic yield and safety of F‐FB for indeterminate biliary lesions compared with POCS‐FB. Methods: Patients who underwent F‐FB or POCS‐FB to evaluate indeterminate biliary lesions between October 2011 and August 2019 were enrolled retrospectively. We carried out propensity score matching to balance these clinical differences between the F‐FB group and POCS‐FB group. In the propensity score‐matched cohort, we compared the diagnostic performance of F‐FB with that of POCS‐FB based on the pathological evaluation. We also evaluate adverse events associated with F‐FB and POCS‐FB. Results: We enrolled 113 patients with biliary diseases, and 62 patients were analyzed in the propensity score‐matched cohort. Sensitivity, specificity, and accuracy of F‐FB were 82.4, 100, and 90.3%, and for POCS‐FB, those values were 83.3, 100, and 90.3%, respectively. There were no significant differences in the diagnostic performance between F‐FB and POCS‐FB. There were also no significant differences in the occurrence of adverse events between F‐FB and POCS‐FB (41.9 vs 29.0%, P = 0.289). Conclusions: The diagnostic yield of F‐FB for ECC is similar to that of POCS‐FB. POCS‐FB is not necessary for the initial pathological diagnosis of indeterminate biliary lesions. [ABSTRACT FROM AUTHOR]

Forceps biopsy (FB) is the most commonly used diagnostic tool for lung pathologies. FB is associated with a high diagnostic failure rate. Cryobiopsy (CB) is a novel technique providing a larger specimen size, few artefacts, more alveolar parts and superior diagnostic yield. CB, however, has drawbacks such as higher bleeding and pneumothorax rate. We conducted a meta-analysis to investigate the specimen area, diagnostic rate and bleeding severity in CB versus FB in interstitial lung diseases (ILDs) and lung tumours. A systematic literature search of PUBMED, BIOSIS PREVIEW and OVID databases was conducted using specific search terms. Eligible studies including RCTs and non-RCTs comparing cryobiopsy/cryotransbronchial biopsy (CB/CTBB) and forceps biopsy/forceps transbronchial biopsy (FB/FTBB) for specimen area, diagnostic rate and bleeding rate in ILDs and lung tumours were analysed. Two reviewers independently extracted data and evaluated the quality of the studies. Eight studies involving 916 patients were analysed. Specimen area (mm2) was significantly larger in CB/CTBB than FB/FTBB (standard mean difference = 1.21, 95% confidence interval (0.94, 1.48), P < 0.00001). The diagnostic rate was significantly higher in CB/CTBB than FB/FTBB (Risk ratio 1.36, 95% confidence interval (1.16, 1.59), P = 0.0002). Three studies compared the bleeding severity with only one showing significantly more bleeding in CB. Cryobiopsy/cryotransbronchial shows superiority to FB/FTBB for specimen area and diagnostic rate. CB/CTBB has better efficacy over FB/FTBB. [ABSTRACT FROM AUTHOR]

Abstract: Background: Trans‐bronchial forceps biopsy (TBFB) is the gold standard to establish the presence of allograft rejection or infection after lung transplantation. We aimed to analyze the diagnostic yield and safety of trans‐bronchial cryobiopsy (TBCB) in lung allografts. Methods: Retrospective analysis of 402 TBB procedures in 362 lung recipients was performed between 2011 and 2016. Half of the cases (201) were performed by TBCB and the other half by TBFB. One hundred random slides of TBB specimens from lung allografts were reviewed for artifacts, bleeding, and histological evidence. Results: Both TBB groups were comparable in age, gender distribution, and time following transplantation. Acute rejection was diagnosed in 21.9% of the TBCB group vs 14.9% in the TBFB group (P = .09) and only 2 cases (1%) of nondiagnostic tissue in TBCB group and 4 cases (2%) in TBFB group (P = .685). Complications of pneumothorax and bleeding occurred in 9 (4.5%) vs 8 (4%) and 5 (2.5%) vs 4 (2%) in TBCB vs TBFB groups, respectively. The TBCB specimens were larger than TBFB (average 16.6 vs 6.6 mm2; P < .001). Crush and bleeding artifacts were seen in 11 (22%) and 23 (46%) of TBFB, respectively, yet none in TBCB group (P < .001). Conclusion: Trans‐bronchial cryobiopsy is safe and effective for diagnosis of lung allograft rejection. [ABSTRACT FROM AUTHOR]

Background: Making a specific diagnosis of pancreatic cysts preoperatively is difficult. The new disposable Moray micro forceps biopsy (MFB) device allows tissue sampling from the pancreatic cyst wall/septum and aims to improve diagnosis. This study compares the diagnostic performance of the MFB with the current conventional analysis of pancreatic cyst fluid (PCF)., Methods: A total of 48 patients sampled with MFB were identified. Cysts were classified as mucinous on PCF based on extracellular mucin/mucinous epithelium, carcinoembryonic antigen (CEA) levels ≥192 ng/mL, or KRAS/GNAS mutation. A diagnosis of intraductal papillary mucinous neoplasm was supported by GNAS mutation; a diagnosis of serous cystadenoma was supported by Von Hippel-Lindau tumor suppressor (VHL) mutation. A diagnosis of mucinous cystic neoplasm required the presence of subepithelial ovarian-type stroma. A high-risk cyst was defined as a mucinous cyst with high-grade dysplasia or an adenocarcinoma. Comparisons in diagnostic performance between PCF and MFB were made., Results: The mean age of the patients was 69.6 years (range, 27-90 years); 25 of 48 patients (52.1%) were female. Cysts were in the pancreatic head (13 patients), neck (2 patients), body (20 patients), and tail (13 patients), averaging 3.1 cm (range, 1.2-6.0 cm). There was concordance with mucinous versus nonmucinous classification (60.4% for PCF vs 58.3% for MFB; P = .949). Three high-risk cysts were detected by PCF and 2 were detected by MFB (P = .670). However, MFB diagnosed significantly more specific cysts compared with PCF (50.0% for MFB vs 18.8% for PCF; P<.001)., Conclusions: PCF analysis and MFB have comparable performance in distinguishing between mucinous and nonmucinous cysts and for detecting high-risk cysts. However, MFB was found to be superior for diagnosing specific cyst subtypes, thus adding significant value to preoperative patient management. Cancer Cytopathol 2018;126:414-20. © 2018 American Cancer Society., (© 2018 American Cancer Society.)

Objective The diagnostic yields of endoscopic transpapillary brush cytology and forceps biopsies for malignant biliary strictures (MBS) remain unclear and predictive factors for diagnosis have not been established. We aimed to clarify the diagnostic yields of both methods and the predictive factors Methods We reviewed 241 patients with biliary strictures who underwent transpapillary brush cytology ( n = 202) or forceps biopsy ( n = 208) between 2004 and 2014 at a single academic center. Results The sensitivity of forceps biopsy for MBS was significantly higher than that of brush cytology [60.6% (97/160) vs 36.1% (57/158), P < 0.01). The sensitivity of forceps biopsy was significantly higher in diagnosing bile duct cancer than pancreatic cancer [78.8% (52/66) vs 42.4% (28/66), P < 0.01). Multivariate analysis revealed that serum total bilirubin (TB) level (T-Bil) ≥ 4 mg/dL [odds ratio (OR) 2.506, 95% confidence interval (CI): 1.139-5.495, P = 0.022) was an independent predictor for positive diagnosis by brush cytology, while bile duct cancer (OR 4.926, 95% CI 2.183-11.111, P < 0.001), stricture length ≥ 30 mm (OR 2.941, 95% CI 1.119-7.752, P = 0.029) and TB ≥4 mg/dL (OR 2.252, 95% CI 1.052-4.831, P = 0.037) were significant indicators of a positive diagnosis by forceps biopsy. Conclusions Endoscopic transpapillary forceps biopsy shows higher sensitivity than that of brush cytology for MBS. Bile duct cancer, stricture length ≥ 30 mm and TB ≥4 mg/dL are good indicators of forceps biopsy. [ABSTRACT FROM AUTHOR]

Background: The sensitivity of transpapillary biliary forceps biopsy for malignancy has been reported as varying from 43-81%. Therefore, there are false negatives in more than 20% of patients, which makes it difficult to diagnose benign biliary stricture as benignancy in a clinical setting. Methods: To clarify the number of tissue samples that should be obtained during transpapillary forceps biopsy to distinguish benign biliary stricture from malignancy, patients undergoing transpapillary biliary forceps biopsy at our institute were examined retrospectively in this study. Results: Seventy-two biliary forceps biopsy procedures were performed on 61 patients. The final diagnoses were malignant biliary stricture in 34 patients and benign stricture in 27 patients. The overall sensitivity and specificity for malignancy in this study were 76.5% and 100%, respectively. There were zero out of 10 (0%) false-negative patients when three or more tissue samples were obtained. In contrast, when four or more tissue samples were obtained, eight out of eight (100%) patients had negative diagnoses for malignancy and were finally diagnosed with benignancy. Conclusion: We suggest that three or more tissue samples are recommended for the diagnosis of biliary malignant stricture. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic forceps biopsy (EFB) as the primary histological diagnosis of gastric epithelial neoplasia (GEN) is debated in the era of endoscopic resection (ER). Our aim was to investigate the diagnostic reliability of EFB in patients with GEN compared with ER specimens as the reference standard for the final diagnosis in a large consecutive series. Methods: This was a cross-sectional retrospective study at a tertiary-referral center. A total of 354 consecutive patients with 397 GENs underwent ER (endoscopic mucosal resection or endoscopic submucosal dissection). Discrepancy rates between the histological results from EFB and ER specimens were assessed. Discrepancies that could affect patient outcome or clinical care were considered major. Results: The overall histological discrepancy rate between EFB and ER specimens was 44.5% (95% confidence interval [CI], 39.7–49.5%) among the enrolled patients. The overall discrepancy rate was significantly higher in the intraepithelial neoplasia (IEN) group than in the carcinoma group (49.8% vs 25.6%, P < 0.001). The major discrepancy rate was also significantly higher in the IEN group than in the carcinoma group (36.6% vs 7.0%, P < 0.001). In subgroup analysis of the IEN group, a major histological discrepancy rate of 33.6% (70/208) for low-grade and 42.7% (44/103) for high-grade IEN was found, respectively. Conclusions: Endoscopic forceps biopsy was insufficient for a definitive diagnosis and therapeutic planning in patients with GEN. ER should be considered as not only definitive treatment but also a procedure for a precise histological diagnosis for lesions initially assessed as GEN by forceps biopsy specimens. [ABSTRACT FROM AUTHOR]

In malignant biliary stricture ( MBS), the diagnostic accuracy of ERCP-based tissue sampling is insufficient. EUS-guided fine needle aspiration biopsy ( EUS- FNAB) is emerging as a reliable diagnostic procedure. This study aimed to evaluate the usefulness of a diagnostic approach using ERCP-guided transpapillary forceps biopsy ( TPB) or EUS- FNAB according to the characteristics of suspected MBS. Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with intraductal ultrasonography ( IDUS) and TPB were performed as initial diagnostic procedures. Based on the results of imaging studies and IDUS, all MBS were classified as extrinsic or intrinsic type. If the malignancy was not confirmed by TPB, EUS- FNAB for extrinsic type or second TPB for intrinsic type was performed. Among a total of 178 patients, intrinsic and extrinsic types were detected in 88 and 90 patients, respectively. The diagnostic accuracy of first TPB was significantly higher in the intrinsic than in the extrinsic type (81.8% vs. 67.8, P = 0.023). In 33 patients with extrinsic type and negative for malignancy on first TPB, the diagnostic accuracy of EUS- FNAB was 90.9%. In 19 patients with intrinsic type and negative for malignancy on first TPB, the diagnostic accuracy of second TPB was 84.2%. The diagnostic accuracies of the combination of initial TPB with EUS- FNAB and second TPB were 96.7% and 96.6%, respectively. A diagnostic approach using EUS- FNAB or TPB according to the origin of MBS is considered effective to improve the diagnostic accuracy of MBS with negative for malignancy on first TPB. (Clinical trial registration number: UMIN000016886). [ABSTRACT FROM AUTHOR]

Abstract: Background: Fluorescence in situ hybridization (FISH) of cytology specimens has been used to diagnose biliary strictures. However, the usefulness of FISH for differentiating between cholangiocarcinoma (CCA) and IgG4‐related sclerosing cholangitis (IgG4‐SC) has not been evaluated in forceps biopsy specimens. Methods: We retrospectively reviewed 74 specimens obtained by transpapillary forceps biopsy between 2008 and 2015 from 49 consecutive patients with CCA and 25 with IgG4‐SC. Specimens were considered positive for malignancy by FISH with UroVysion® if at least five cells exhibited polysomy (a gain of two or more in chromosomes 3, 7, or 17). Results: A total of 27 (55.1%) patients with CCA, but none of the patients with IgG4‐SC, were positive for malignancy by FISH. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FISH for the diagnosis of CCA were 55.1%, 100%, 100%, 53.2%, and 70.3%, respectively. The complementary use of FISH increased the sensitivity of hematoxylin‐and‐eosin (H&E) staining from 69.4% to 77.6%; the specificity was not reduced when either H&E or FISH was positive. Conclusions: The use of FISH in the analysis of forceps biopsy specimens might be one option to differentiate CCA from IgG4‐SC. [ABSTRACT FROM AUTHOR]

Background and Aim: Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated. Methods: After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone. Results: The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage. Conclusions: Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to elucidate characteristics of gastric lesions that are initially diagnosed as low-grade adenomas and to establish appropriate treatment. Methods: We retrospectively reviewed 231 lesions initially diagnosed as gastric adenomas. All forceps biopsy samples were histologically diagnosed as category 3 low-grade adenomas according to the revised Vienna Classification. All patients underwent endoscopic resection with endoscopic findings and post-resection diagnoses evaluated subsequently. Results: Sixty-three lesions were initially diagnosed as depressed adenomas, and 168 lesions were diagnosed as protruding adenomas. The depressed lesions were significantly smaller (11.6 ± 5.0 mm) than the protruding lesions (17.0 ± 10.8 mm) ( P < 0.001). Diagnoses reclassified to category 4 mucosal high-grade neoplasia (i.e. high-grade adenoma, adenocarcinoma in adenoma and adenocarcinoma) were more frequent among depressed lesions (52.4%) than among protruding lesions (31.0%) ( P = 0.004). Multivariate analysis of all 231 lesions showed that lesion size larger than 20 mm ( P < 0.001) and depressed appearance (including central depression) ( P < 0.001) were significant independent factors suggesting cancer. For the 168 protruding lesions, lesion size larger than 20 mm ( P < 0.001) and central depression ( P < 0.001) were significant independent factors suggesting cancer. For the 63 depressed lesions, lesion size larger than 15 mm ( P = 0.016) and a moth-eaten appearance ( P = 0.017) were significant independent factors in the pre-treatment diagnosis of cancer. Conclusions: Adenocarcinoma lesions were often found in depressed lesions and protruding lesions with central depression. Endoscopic resection for total biopsy is recommended, even if forceps biopsy indicates low-grade adenoma, as pre-treatment biopsy may be inadequate for an accurate histological diagnosis. [ABSTRACT FROM AUTHOR]

Background and objective: The need for routine use of bronchial washing in addition to forceps biopsy has been debated in the diagnosis of endoscopically visible lung tumours. Moreover, the optimal sequence for obtaining bronchial washing and forceps biopsy specimens from endoscopically visible tumours through a flexible bronchoscope has not been well established. Methods: A multicentre 13-month prospective randomized study was performed. Two hundred and thirty consecutive patients with endoscopically visible tumours were randomly assigned into a bronchial washing before forceps biopsy (pre-biopsy) group and a bronchial washing after forceps biopsy (post-biopsy) group. Bronchial washing and forceps biopsy were performed according to the assigned sequence. Results: Two hundred and seven patients with a definite cytological or histological diagnosis of lung cancer were included in the analyses. One hundred and three were in the pre-biopsy group and 104 were in the post-biopsy group. The diagnostic yield of bronchial washing was 57.3% (59/103) in the pre-biopsy group and 55.8% (58/104) in the post-biopsy group ( P = 0.88). In addition, bronchial washing provided the diagnosis in six patients without definite diagnosis from forceps biopsy, and its addition to forceps biopsy significantly increased the overall diagnostic yield of bronchoscopy from 93.7% to 96.6% ( P = 0.03). Conclusion: The sequence for performing bronchial washing before or after forceps biopsy did not affect the diagnostic yield of bronchial washing in patients with endoscopically visible lung cancers. However, bronchial washing led to a significant increase in the overall diagnostic yield of bronchoscopy in patients with lung cancers. [ABSTRACT FROM AUTHOR]

Introduction: Endobronchial biopsy using forceps is generally performed with a standard bronchoscope, while a needle is used with an endobronchial ultrasound (EBUS) bronchoscope. An EBUS video bronchoscope, such as the EB‐530US instrument (Fujifilm, Tokyo, Japan), provides good visibility and may, therefore, enable both forceps biopsies and needle aspirations to be performed. Objectives: The aim of this study was to investigate the feasibility of performing forceps biopsies and needle aspirations using the EBUS video bronchoscope for diagnosing endobronchial lesions. Methods: Seventy patients with suspected endobronchial lesions based on a computed tomography scan were recruited and underwent forceps biopsy using the EB‐530US EBUS bronchoscope. If the result of a rapid on‐site cytological evaluation was negative, an additional needle aspiration of the same lesion or other target lesions was performed. The primary outcome was the completion rate of bronchoscopy, using only the EBUS bronchoscope without removal. Results: In the 70 patients, forceps biopsies and/or needle aspirations using the EBUS video bronchoscope were performed and completed without removing the EBUS bronchoscope in 67 patients (95.7%). The remaining three patients required the removal of the EBUS bronchoscope from the trachea (blood clot obstruction of the working channel in one patient and change to a thin bronchoscope to sample an EBUS bronchoscope‐inaccessible lesion in two others). The EBUS bronchoscope provided diagnostic material in 66 patients (94.3%). One case each of bleeding and pneumonia were observed (1.4%). Conclusion: Both forceps biopsy and needle aspiration are feasible using a Fujifilm EB‐530US EBUS video bronchoscope. [ABSTRACT FROM AUTHOR]

Background and Objective: Ultrathin bronchoscopy aids in the diagnosis of peripheral pulmonary lesions. However, both the working channel and the specimens are small. A 1.1‐mm ultrathin cryoprobe that can enter the working channel of the ultrathin bronchoscope is now available, which may overcome the limitations of small specimen size. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrathin bronchoscopic cryobiopsy using an ultrathin cryoprobe for diagnosing peripheral pulmonary lesions. Methods: Patients with peripheral pulmonary lesions ≤30 mm in diameter were prospectively enrolled in the study. All patients underwent forceps biopsy followed by cryobiopsy using a 3.0‐mm ultrathin bronchoscope under radial probe endobronchial ultrasound guidance, virtual bronchoscopic navigation and fluoroscopic guidance. The primary endpoint was the feasibility of cryobiopsy. Results: In total, 50 patients with peripheral pulmonary lesions were enrolled in the study; the median longest diameter on computed tomography was 17.9 mm. Cryobiopsy was performed successfully in 49 patients (98%). Forceps biopsy, cryobiopsy and the combination of these two methods provided a specific diagnosis in 54% (27/50), 62% (31/50) and 74% (37/50) of patients, respectively. The median size of specimens obtained via cryobiopsy was significantly larger than the median size obtained via forceps biopsy (7.0 vs. 1.3 mm2, respectively, p < 0.001). Mild bleeding during cryobiopsy occurred in 47 patients (94%). No moderate/severe bleeding or pneumothorax occurred. Conclusion: Ultrathin bronchoscopic cryobiopsy is feasible, effective and sufficiently safe for the diagnosis of peripheral pulmonary lesions. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old man who was examined for ascites. The article discusses the diagnosis of peritoneal tuberculosis (PT) using endosonography (EUS)-assisted through the needle forceps biopsy (TTNB), pathological examination of granulomas, and tuberculosis treatment of the patient.

Therefore, we decided to perform EUS-guided through-the-needle biopsy (EUS-TTNB) of the peritoneum to obtain histological diagnosis as well as to determine the primary site of malignancy. GLO:EUW/01aug19:jgh14593-fig-0001.jpg PHOTO (COLOR): 1 (a and b) Computed tomography revealed a tumor surrounding the transverse colon (open arrows) and multiple peritoneal nodules (white arrow). EUS can detect a small amount of ascites, and the diagnostic yield of EUS-guided FNA (EUS-FNA) for malignant ascites is reportedly high. [Extracted from the article]

Background: Because the biopsy specimen of extrahepatic bile duct carcinoma (EHBDC) is small and shows reactive changes, the histological distinction between malignant and benign tissue can be difficult. Recent studies reported that S100P and insulin-like growth factor II mRNA-binding protein 3 (IMP3) were not only diagnostic molecules but also prognostic biomarkers in several organs. The objective of this study is to clarify the diagnostic and prognostic value of immunohistochemical expression of S100P and IMP3 in transpapillary biliary forceps biopsy (TBFB) samples. Methods: The TBFB samples were collected from 80 patients (EHBDC, 68 patients; benign, 12 patients), retrospectively. Results: When using cytoplasmic-positive staining for IMP3 as a marker of malignancy, the sensitivity and specificity reached 79.4 and 91.7 %, respectively. The sensitivity, specificity and accuracy achieved 89.7, 91.7 and 90.0 %, respectively, when using positive staining for IMP3 and/or positive histology as a maker of malignancy. While univariate ( P = 0.033) and multivariate ( P = 0.039) analysis revealed that S100P-positive EHBDC patients showed significantly shorter survival. Conclusions: The results of this study suggest that immunohistochemical staining for IMP3 is useful in the diagnosis of EHBDC and that of S100P is useful as a prognostic marker for EHBDC. [ABSTRACT FROM AUTHOR]

Background and Aims: Histological examination of specimens obtained by forceps biopsy sampling of gastric lesions is of limited accuracy, and their management on this basis is therefore controversial. Endoscopic mucosal resection (EMR) was initially developed in Japan for the resection of early gastric cancer (EGC). The potential use of EMR as a diagnostic tool has been suggested. The aims of the present study were to assess the value of forceps biopsy sampling in establishing the correct diagnosis revealed by EMR and to evaluate the efficacy of EMR. Methods: Fifty-six subjects with sessile gastric polyps of epithelial origin, at least 0.5 cm in diameter, and not associated with polyposis syndromes, were included. Following forceps biopsy sampling, EMR was performed with an inject-and-cut technique or with cap-fitted methods. The histological results on the forceps biopsy and the resected specimens were analyzed. Results: Histology on the resected specimens revealed neoplastic lesions in 34 cases, including seven EGC, and there were hyperplastic-inflammatory lesions in 21 cases. Complete agreement between the previous histological results of the forceps biopsy samples and the resected specimens was seen in only 76.7% of the lesions. Altogether, the sensitivity and specificity of the forceps biopsy procedure for diagnosing neoplastic lesions were 87.5% (95% confidence interval [CI] = 76.0–98.9%) and 65.2% (95% CI = 45.7–84.7), respectively. A clinically relevant discrimination between neoplastic and non-neoplastic lesions was not achieved in seven cases. No complications, such as perforation or massive bleeding necessitating surgical treatment, were encountered. EMR was considered complete in five patients. None of the EGC recurred during the mean 38-month (6–72) follow up. Conclusions: Forceps biopsy is not fully representative of the entire lesion, and a simple biopsy may therefore lead to a faulty differentiation between neoplastic and non-neoplastic lesions. EMR proposes diagnostic and staging advantage in assessing patients with EGC as compared to forceps biopsy, because it provides more intact mucosa and submucosa for histological analysis. Sessile gastric polyps should be fully resected by EMR for a final diagnosis and (depending on the lesion size and type) possibly definitive treatment. [ABSTRACT FROM AUTHOR]

Cryobiopsy is advantageous for collecting larger specimens with minimum crushing compared to forceps biopsy and transbronchial needle aspiration (TBNA), but it has not been widely used for mediastinal tumors. In this report, a leiomyoma of the thoracic esophagus was diagnosed with endobronchial ultrasound‐guided transbronchial mediastinal cryobiopsy (EBUS‐cryo). An asymptomatic 49‐year‐old woman had a 2.6‐cm sized submucosal tumor (SMT) of the esophagus adjacent to the trachea and left main bronchus. EBUS‐TBNA and EBUS‐guided intranodal forceps biopsy were performed, followed by EBUS‐cryo. The biopsy forceps could not be inserted into the tumor, but the cryoprobe was smoothly inserted. EBUS‐TBNA could not obtain enough spindle‐shaped tumor cells for immunohistochemical staining, but EBUS‐cryo provided sufficient specimens for diagnosing the leiomyoma. Adding EBUS‐cryo to EBUS‐TBNA has recently been reported to achieve high diagnostic yields for lymphomas, uncommon tumors, and benign diseases. EBUS‐cryo seems a valid diagnostic option for esophageal SMTs that are difficult to diagnose with needles and forceps. [ABSTRACT FROM AUTHOR]

Percutaneous endovascular biopsy (PEB) including forceps biopsy and catheter aspiration has been used to make a pretreatment diagnosis for pulmonary artery (PA) masses. This retrospective study aims to describe the procedure of PEB and compare the diagnostic yield of forceps biopsy and catheter aspiration for a definite diagnosis in patients with PA masses. All consecutive 22 patients (53 ± 14 years), 11 males and 11 females, who underwent PEB for pathologic confirmation between November 2018 and November 2022 were enrolled. All 22 patients performed computed tomography pulmonary angiography or positron emission tomography-computed tomography to confirm the filling defects suspicious for PA malignancy before intervention. And then, all patients underwent PEB successfully without acute or fatal complications, including both forceps biopsy and catheter aspiration in 15 cases, only forceps biopsy in 5 cases, and only catheter aspiration in 2 cases. Histopathological analysis provided a definite diagnosis in all PEBs with a clinical success of 91.0% (20/22). Among them, in 15 patients who underwent both forceps biopsy and aspiration biopsy, the technical success using forceps biopsy was 93.3% (14/15), and aspiration biopsy was 6.7% (1/15), and there was a significant difference in diagnostic accuracy when comparing two techniques. Twenty-one out of 22 PA masses (95.5%) were malignant, of which, the most frequent malignant lesion observed was PA sarcoma (66.7%, 14/21). Benign lesion included one thrombus (4.5%, 1/22). In conclusion, PEB is an effective and safe diagnostic method for differentiating benign and malignant PA masses and could be peformed when PA masses appeared clinically malignant. [ABSTRACT FROM AUTHOR]

A 76‐year‐old woman underwent transbronchial lung cryobiopsy (TBLC) and transbronchial lung biopsy (TBLB) for examination of interstitial infiltrates. After the examination, the patient's consciousness became clouded, and head computed tomography showed an air embolus. She was started on 100% oxygen, and her consciousness improved, but she remained hemiplegic on the left side and dysphagic. Vascular air embolism (VAE) is a rare but serious complication. Although cases of VAE have been reported with conventional transbronchial forceps biopsy, cases of VAE after TBLC are quite rare, and thus this case is reported. [ABSTRACT FROM AUTHOR]

Background/purpose: In patients in whom there is a suspicion of malignant biliary strictures, bile cytology via an endoscopic nasobiliary drainage tube (ENBD cytology) is often performed, in addition to aspirated bile cytology, brush cytology, and forceps biopsy, during the initial endoscopic retrograde cholangiopancreatography (ERCP). We aimed to reveal the significance of ENBD cytology for the pathological diagnosis of malignant biliary strictures. Methods: We studied 214 patients with malignant biliary strictures. We performed aspirated bile cytology, brush cytology, and forceps biopsy in 93, 130, and 114 patients, respectively. ENBD cytology was performed one or more times in 79 patients. We examined the sensitivity of each sampling method, and analyzed the utility of ENBD cytology. Results: The sensitivities of each sample acquisition method were as follows: 30% (28/93) for aspirated bile cytology, 48% (62/130) for brush cytology, 41% (47/114) for forceps biopsy, and 24% (19/79) for ENBD cytology. In 19 patients who showed positive ENBD cytology, other methods were performed in 11. Aspirated bile cytology, brush cytology, and forceps biopsy, were performed in 7, 5, and 6 patients, and the results were negative in 3 (43%), 2 (40%), and 1 (17%) patient, respectively. Three patients showed positive results only on ENBD cytology. Conclusions: Although the sensitivity of ENBD cytology was inferior to that of the other methods used, ENBD cytology may contribute to the improvement of the total diagnostic sensitivity for malignancy. [ABSTRACT FROM AUTHOR]

Thoracic SMARCA4‐deficient undifferentiated tumors (SMARCA4‐UT) have a poor prognosis and are often diagnosed at an inoperable advanced stage. Herein, we report a case of SMARCA4‐UT diagnosed by endobronchial ultrasound‐guided transbronchial cryobiopsy (EBUS‐cryo). The patient was a 42‐year‐old man with a history of smoking. Chest computed tomography revealed a right upper lobe nodule and an enlarged #11s lymph node. Core tissues could not be obtained by EBUS‐guided transbronchial needle aspiration (EBUS‐TBNA) for diagnosis and mediastinal staging; hence, EBUS‐guided intranodal forceps biopsy (EBUS‐IFB) was performed. However, a detailed diagnosis beyond poorly differentiated carcinoma could not be obtained. Subsequent EBUS‐cryo provided sufficient specimens for immunohistochemical and molecular evaluation and SMARCA4‐UT was definitively diagnosed. Thus, EBUS‐cryo could be of additional diagnostic value for uncommon tumors, such as SMARCA4‐UT, conjointly with EBUS‐IFB as well as EBUS‐TBNA. [ABSTRACT FROM AUTHOR]

Background and Aim Recently, the digital single-operator cholangioscope ( SPY-DS) has become available. This system may allow diagnosis by direct visualization and allow performance of various therapeutic procedures. The aim of the present study was to prospectively evaluate the clinical utility of DSOCS for diagnostic and therapeutic procedures for biliary disease. Methods Technical success was defined as successful visualization of target lesions in the biliary tract and carrying out forceps biopsy as a diagnostic procedure, and successfully carrying out treatment such as guidewire insertion for the area of interest, electrohydraulic lithotripsy ( EHL), or migrated stent removal. Also, the present study aimed at investigating diagnostic yield of the cholangioscopic findings and biopsy specimens. Results A total of 55 consecutive patients were prospectively enrolled in this study; a diagnostic procedure was done in 33 patients, and a therapeutic procedure was done in 22 patients. Overall accuracy of visual findings was 93%, with a sensitivity of 83%, a specificity of 89%, positive predictive value ( PPV) of 83%, and negative predictive value ( NPV) of 100%. However, the overall accuracy of forceps biopsy was 89%, with a sensitivity, specificity, and PPV of 100%, and NPV of 90%. Overall technical success rate of therapeutic procedures such as selective guidewire insertion, EHL or migrated stent removal was 91% (20/22). Finally, adverse events were seen in two cases in the diagnostic group, but were not seen in the therapeutic group. Conclusion Although additional cases and a randomized, controlled study with another cholangioscope are needed, diagnostic and therapeutic procedures using SPY- DS appear to be feasible and safe. [ABSTRACT FROM AUTHOR]

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an aggressive subtype of inflammatory myofibroblastic tumour which rarely affects the chest cavity. We, for the first time, report a case of mediastinal EIMS with the EML4-ALK fusion. A young woman presented to our hospital with cough, chest tightness and shortness of breath. Computed tomography (CT) showed a mixed attenuation soft-tissue mass in the right middle and upper mediastinum. Negative results were obtained from bronchoscopy forceps biopsy and endobronchial ultrasound-guided transbronchial fine needle aspiration. CT-guided percutaneous biopsy was finally performed. However, due to the rapidly progressed EIMS that compressed the trachea and right main bronchus, the patient died of respiratory failure 1 day before diagnosis. EIMS progresses rapidly, and an early diagnosis is important. For mediastinal EIMS, CT-guided percutaneous biopsy may be useful. Next-generation sequencing of blood may be instructive to EIMS patients who are intolerant to invasive biopsy. [ABSTRACT FROM AUTHOR]

Thoracoscopy under local anaesthesia is recommended for malignant tumours with negative pleural effusion cytology. Cryobiopsy from the visceral pleura by thoracoscopy under local anaesthesia can provide more diagnostic options for patients with thoracentesis‐negative malignant effusions. Here we present the first case in which this technique was used. The patient had a pleural metastasis that could not be diagnosed even with rapid cytology of the parietal pleura biopsy. Indications, technical pitfalls, and safety tips are discussed. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound (EBUS)‐guided tissue acquisition (TA) performed by transbronchial needle aspiration (TBNA) is the main diagnostic procedure in mediastinal and hilar lymph node (LN) biopsy. EBUS‐guided intranodal forceps biopsy (EBUS‐IFB) and EBUS‐guided cryobiopsy can achieve higher diagnostic yield of lymphomas, uncommon tumors, and benign diseases. However, these techniques require the creation of a tract to insert biopsy devices, which may result in critical complications. Here, we report a rare case of airway stenosis (AS) that occurred after EBUS‐TA for mediastinal LN biopsy. An 80‐year‐old man had multiple pulmonary nodules and an enlarged mediastinal LN. EBUS‐TBNA and EBUS‐IFB were performed for histological diagnosis. Cutaneous adnexal carcinoma (CAC) was diagnosed. The patient underwent chemotherapy. Four months later, he was hospitalized for AS due to a tracheal tumor with dyspnea. Chest computed tomography and bronchoscopy revealed that the tracheal tumor was caused by invasion from the biopsied LN into the tracheal lumen by tract seeding (TS) caused by EBUS‐TA. Cryotherapy was performed. The tracheal tumor was pathologically consistent with CAC and is currently under control with radiotherapy. TS‐associated EBUS‐TA is rare but may increase in frequency with aggressive tissue sampling techniques. Bronchoscopists should perform EBUS‐TA with awareness of the potentially serious complications. [ABSTRACT FROM AUTHOR]

Endoscopic management for perihilar cholangiocarcinoma (PHCC) is evolving toward more accurate diagnosis and safer drainage. In imaging, it is important to diagnose the entire lesion using multidetector‐row computed tomography to determine resectability and optimal surgical planning, followed by local diagnosis using endoscopic retrograde cholangiopancreatography. Video peroral cholangioscopy and probe‐based confocal laser endomicroscopy have been newly introduced as diagnostic imaging methods and are being applied clinically. In transpapillary forceps biopsy for PHCC diagnosis, the location in the bile duct (for mapping biopsy) and the number of biopsy samples should be determined depending on resectability, the morphological type, and future surgical planning. Preoperative drainage has shifted from percutaneous transhepatic biliary drainage to endoscopic nasobiliary drainage given the possibility of seeding metastasis. In addition, considering potential patient discomfort from a nasal tube, the usefulness of the placement of a plastic stent above the papilla (inside stent) as a bridging therapy for surgery has been reported. For drainage of unresectable PHCC, the improved prognosis due to advances in chemotherapy has necessitated a strategy that accounts for reintervention. Thus, in addition to uncovered self‐expandable metallic stents (SEMS), exchangeable slim fully covered SEMS and inside stents have started to be used. In addition to the conventional transpapillary approach, an endoscopic ultrasonography‐guided approach has been introduced, and a combination of both methods has also been proposed. To improve the quality of life and prognosis of PHCC patients, endoscopists need to understand and be able to use the various methods of endoscopic management for PHCC. [ABSTRACT FROM AUTHOR]

Background and Aim Various methods for endoscopic transpapillary sampling have been developed. However, the factors affecting the accuracy of these methods for bile duct cancer are unknown. The aim of the present study was to determine the factors affecting the accuracy of endoscopic transpapillary sampling methods. Methods We reviewed the results from 101 patients with bile duct cancer who underwent transpapillary sampling by aspiration bile cytology, brushing cytology, and fluoroscopic forceps biopsy. The final diagnosis of bile duct cancer was made on the basis of pathological evaluation of specimens obtained at surgery and the clinical course over at least 1 year in patients not operated on. We carried out subgroup analyses for the factors affecting the accuracy of each transpapillary sampling method. Results Aspiration bile cytology was carried out 238 times in 77 patients, brushing cytology was carried out 67 times in 60patients, and fluoroscopic forceps biopsy was carried out 64 times in 53 patients. Accuracies of aspiration bile cytology were significantly higher for longer (≥15 mm) biliary cancerous lesions than for shorter (<15 mm) lesions (30% vs 18%, respectively, P = 0.049). Accuracies of brushing cytology and fluoroscopic forceps biopsy were significantly higher for non-flat than for flat-type biliary cancerous lesions (brushing: 58% vs 38%, respectively, P = 0.032; forceps biopsy: 60% vs 33%, respectively, P = 0.043). Conclusion Endoscopic transpapillary sampling methods are more accurate for longer or elevated (non-flat) biliary cancerous lesions than for shorter or flat lesions. [ABSTRACT FROM AUTHOR]

Ampullary cancer detected upon re-examination in a patient initially diagnosed as cancer of unknown primary Ampullary cancers are rare cancers that account for 0.2% of all gastrointestinal cancers and primarily manifest as obstructive jaundice.8-10 In the present case, ampullary adenocarcinoma, initially diagnosed as CUP, was revealed by endoscopic forceps biopsy for the ampullary lesion progressing over time. Keywords: cancer of unknown primary site; conversion surgery; duodenal papillary carcinoma; endoscopic ultrasound EN cancer of unknown primary site conversion surgery duodenal papillary carcinoma endoscopic ultrasound 222 224 3 03/24/22 20220301 NES 220301 In patients with cancer of unknown primary (CUP), the efficiency of reexamination in the improvement of the prognosis has not been demonstrated yet. [Extracted from the article]

As the demand for advanced bronchoscopic procedures increases, prolonged sedation with adequate oxygenation has become essential. Traditionally, these procedures require an anesthesiologist to provide (positive‐pressure or jet) ventilator support. However, recent innovations have enabled advanced bronchoscopy under high‐flow endotracheal oxygenation and deep sedation without these requirements. Following oropharyngeal lidocaine anaesthesia, deep sedation was induced using fentanyl and remimazolam. Thereafter lidocaine was instilled into the larynx, trachea, and main bronchi using a flexible bronchoscope with a spray catheter. Finally, either an uncuffed endotracheal tube (Case 1) or a rigid bronchoscope (Case 2) was inserted, and advanced bronchoscopic procedures, such as cryobiopsy and stent insertion, were successfully performed without a ventilator or an anesthesiologist. Our novel technique is expected to facilitate the easier and adequate performance of advanced high‐level bronchoscopic procedures by pulmonologists, even in resource‐limited settings. [ABSTRACT FROM AUTHOR]

Summary: Background: Pre‐operative tissue diagnosis for suspected malignant biliary strictures remains challenging. Aim: To develop evidence‐based consensus statements on endoscopic tissue acquisition for biliary strictures. Methods: The initial draft of statements was prepared following a systematic literature review. A committee of 20 experts from Asia‐Pacific region then reviewed, discussed, and modified the statements. Two rounds of independent voting were conducted to reach a final version. Consensus was considered to be achieved when 80% or more of voting members voted “agree completely” or “agree with some reservation.” Results: Eleven statements achieved consensus. The choice of tissue sampling modalities for biliary strictures depends on the clinical setting, the location of lesion, and availability of expertise. Detailed radiological and endoscopic evaluation is useful to guide the selection of appropriate tissue acquisition technique. Standard intraductal biliary brushing and/or forceps biopsy is the first option when endoscopic biliary drainage is required with an overall (range) sensitivity and specificity of 45% (26%‐72%) and 99% (98%‐100%), and 48% (15%‐100%) and 99% (97%‐100%), respectively, in diagnosing malignant biliary strictures. Probe‐based confocal laser endomicroscopy and fluorescence in situ hybridisation using 4 fluorescent‐labelled probes targeting chromosomes 3, 7, 17 and 9p21 locus may be added to improve the diagnostic yield. Cholangioscopy‐guided biopsy and EUS‐guided tissue acquisition can be considered after prior negative conventional tissue sampling with an overall (range) sensitivity and specificity of 60% (38%‐88%) and 98% (83%‐100%), and 80% (46%‐100%) and 97% (92%‐100%), respectively, in diagnosing malignant biliary strictures. Conclusion: These consensus statements provide evidence‐based recommendations for endoscopic tissue acquisition of biliary strictures. [ABSTRACT FROM AUTHOR]