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国立がん研究センター 中央病院

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Department of Endoscopy, Respiratory Endoscopy Division

Takehiro Izumo, Takaaki Tsuchida, Yuji Matsumoto

Introduction

For respiratory diseases, we have focused on the accurate and less-invasive diagnosis of minute peripheral malignancies detected by CT, which can lead to earlier surgical treatment and less-invasive treatments including bronchoscopic therapies. This is facilitated by a multi-purpose bronchoscopy system consisting of a flat-panel fluoroscope, as well as with the patient's cooperation and appropriate support by medical personnel. Endobronchial malignancies are diagnosed with videobronchoscopy, together with an endobronchial ultrasound system, and a high-resolution flat-panel fluoroscope. In addition, imaging diagnosis, including that with high-resolution CT, is also a routine activity for bronchoscopy, which leads to more accurate and safer diagnoses and the earlier detection of tracheobronchial malignancies.

Routine activities

Endobronchial ultrasonography (EBUS) is used not only to evaluate mediastinal or hilar malignant lesions but also to evaluate whether the biopsy devices can be directed to the peripheral lung lesions. One-hundred seventy six cases of EBUS-TBNA (EBUS-trans bronchial needle aspiration) were performed as a less invasive procedure to improve the diagnosis for patients with mediastinal or hilar lymph node swelling. The EBUS-GS (guide sheath) method was performed in most of the peripheral pulmonary lesions.

Endobronchial stenosis patients were treated with airway stent placement, photodynamic therapy and endobronchial electrocautery ablation. Medical thoracoscopy under local anesthesia in the operation suite was performed with unknown pleural effusion or a pleural tumor.

A weekly conference with CT imaging analysis and confirmation of the pathology results was held. Furthermore, we attended all clinical conferences in the Department of Thoracic Surgery, Pathology and Clinical Laboratories and Radiation Oncology to discuss and decide upon treatment strategies.

Research activities

Endobronchial ultrasound elastography is a new technique for describing the stiffness of tissue during endobronchial ultrasound-guided transbronchial needle aspiration.

We tried to improve the accuracy of GGO (ground grass opacity), which had been impossible to visualize using a routine chest radiography or X-ray fluoroscopy. Radial endobronchial ultrasound (R-EBUS) is a useful tool for precise localization of peripheral pulmonary lesions, but there have been no detailed reports about the use of R-EBUS images for GGO. R-EBUS images of GGO were identified based on the internal structure of the lesion and classified into two groups. Blizzard showed an enlarged, diffuse hyperintense acoustic shadow. Mixed blizzard showed a combination of blizzard and some diffuse heterogeneity with several hyperechoic dots and vessels.

Clinical trials

We conducted a multicenter prospective study for evaluation of photodynamic therapy for peripheral lung cancer. A study with CT workstation is ongoing with the multicenter.

Education

A flexible bronchoscope was developed for the first time in the world in this hospital. There are many resident and overseas doctors wishing to train at our hospital. I was given the opportunity of writing papers and conference presentations for many residents. Overseas training doctors came from many countries.

Future prospects

A multicenter trial of bronchoscopic therapy for peripheral lung cancer and a new diagnostic procedure such as electromagnetic navigation bronchoscopy are expected to be carried out.


Table 1. Type of procedure and number of patients

List of papers published in 2015

Journal

  1. Izumo T, Sasada S, Chavez C, Matsumoto Y, Tsuchida T. Radial endobronchial ultrasound images for ground-glass opacity pulmonary lesions. Eur Respir J, 45:1661-1668, 2015
  2. Izumo T, Sasada S, Chavez C, Matsumoto Y, Hayama M, Tsuchida T. The diagnostic value of histology and cytology samples during endobronchial ultrasound with a guide sheath. Jpn J Clin Oncol, 45:362-366, 2015
  3. Chavez C, Sasada S, Izumo T, Watanabe J, Katsurada M, Matsumoto Y, Tsuchida T. Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations. J Thorac Dis, 7:596-602, 2015
  4. Hayama M, Izumo T, Matsumoto Y, Chavez C, Tsuchida T, Sasada S. Complications with Endobronchial Ultrasound with a Guide Sheath for the Diagnosis of Peripheral Pulmonary Lesions. Respiration, 90:129-135, 2015
  5. Mimori T, Kobayashi S, Tanaka A, Sasada S, Yoshida A, Izumo T, Sasaki N, Tsuchida T, Tsuta K. Novel use for an EGFR mutation-specific antibody in discriminating lung adenocarcinoma from reactive pneumocyte hyperplasia. Histopathology, 66:816-823, 2015