Annual Report 2020
Department of Endoscopy, Respiratory Endoscopy Division
Takaaki Tsuchida, Yuji Matsumoto, Tatsuya Imabayashi
Introduction
We performed more than 1,100 bronchoscopies between April 2020 and March 2021 (Table 1). We are one of the facilities with the highest number of bronchoscopies in Japan. Almost all cases of peripheral and central pulmonary lesions are diagnosed on an outpatient basis, and sedation is used in combination with bronchoscopy to reduce patient suffering.
A special feature of our hospital is the use of endobronchial ultrasound (EBUS-TBNA, radial EBUS) for almost all examinations; for small peripheral lesions, virtual bronchoscopy and virtual fluoroscopy using workstations and other instruments are employed to simulate the lesion before the examination. Efforts have been made to shorten the length of the procedure.
Guided biopsies are combined with rapid onsite cytology. Cryobiopsies have been used to diagnose ground grass nodules or to obtain large specimens especially for next-generation sequencing.
Stenting for airway stenosis and tumor ablation have also been performed. We actively performed thoracoscopy under local anesthesia for cases of unexplained pleural effusion and pleural thickening.
The Team and What We Do
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. A total of 376 cases of EBUS-TBNA (EBUS-guided transbronchial needle aspiration) were performed as a less invasive procedure to improve diagnoses for patients with mediastinal or hilar lymph node swelling. Transbronchial biopsies with virtual navigation were performed in most of the peripheral pulmonary lesions.
Endobronchial stenosis patients were treated with airway stent placement, debulking with a cryoprobe and/or endobronchial electrocautery ablation. Medical thoracoscopies under local anesthesia in the endoscopic examination room were performed with unknown pleural effusion and/or pleural thickening.
Research activities
1) We started a clinical trial of photodynamic therapy for peripheral small lung cancer.
Table 1. Type of procedure and number of patients
2) We demonstrated the usefulness of a 25G needle for transbronchial ultrasound-guided biopsy, and showed that a sufficient amount of specimen can be obtained with a 25G needle.
3) We developed a technique for thoracoscopy under local anesthesia in cases without pleural effusion. By expanding the indications for local anesthesia thoracoscopy, we have demonstrated the new possibility of minimally invasive biopsy techniques.
4) We demonstrated the usefulness of transbronchial biopsy in rebiopsy.
5) We were the first to introduce a new single-use thinner cryoprobe in Japan, and have shown that it can provide sufficient diagnostic accuracy for small lesions.
Clinical trials
The world’s first multicenter trial of photodynamic therapy for peripheral type lung cancer was started.
Education
Since the flexible bronchoscope was developed at our hospital for the first time in the world, there are many residents and overseas doctors who wish to receive training at our hospital, and we actively accept them. This year, however, due to the spread of COVID-19, the number of overseas doctors was limited. On the other hand, we gave many residents opportunities to write papers and present at conferences.
Future Prospects
1) We will launch the world’s first multicenter clinical trial of photodynamic therapy for peripheral small lung cancer.
2) We are developing a new method of diagnosing malignant tumors using tabletop electron microscopy.
3) We are working on the development of diagnosis and treatment methods that employ minimally invasive technology called bronchoscopy.
4) We are conducting research on multidimensional information analysis of lung cancer pathogenesis using pathological information, ultra-high definition CT images, and medical information, and investigating the potential diagnostic capability of ultra-high definition CT images for lung cancer.
5) We are leading a prospective observational study using a multicenter database on respiratory endoscopy in Japan.
List of papers published in 2020
Journal
1. Usuda J, Inoue T, Tsuchida T, Ohtani K, Maehara S, Ikeda N, Ohsaki Y, Sasaki T, Oka K. Clinical trial of photodynamic therapy for peripheral-type lung cancers using a new laser device in a pilot study. Photodiagnosis Photodyn Ther.2021:Epub 2020.
2. Tateishi A, Matsumoto Y, Tanaka M, Nakai T, Sasada S, Aoshima M, Tsuchida T. The utility of transbronchial rebiopsy for peripheral pulmonary lesions in patients with advanced non-squamous non-small cell lung cancer. BMC Pulm Med.2020:238 2020:238.
3. Imabayashi T, Matsumoto Y, Tanaka M, Nakai T, Tsuchida T. Pleural staging using local anesthetic thoracoscopy in dry pleural dissemination and minimal pleural effusion. Thorac Cancer. 2021:1195-1202.
4. Uchimura K, Imabayashi T, Matsumoto Y, Tsuchida T. Intravascular Lymphoma Diagnosed by "Hot Lung" Sign. Intern Med. 2021:Epub
5. Aoki H, Uchimura K, Imabayashi T, Matsumoto Y, Higashiyama M, Watanabe SI, Tsuchida T. Nodular-type central squamous cell lung carcinoma cured by intraluminal bronchoscopic treatment: A case report. Thorac Cancer. 2021 12(17):2411-2414
6. Matsumoto Y, Nakai T, Tanaka M, Imabayashi T, Tsuchida T, Ohe Y. Diagnostic Outcomes and Safety of Cryobiopsy Added to Conventional Sampling Methods: An Observational Study. Chest. 2021[Online ahead of print]
7. Nishida T, Matsumoto Y, Sasada S, Tanaka M, Nakai T, Fukai R, Ohe Y, Watanabe SI, Motoi N. Feasibility study of cryobiopsy for practical pathological diagnosis of primary lung cancer including immunohistochemical assessment. Jpn J Clin Oncol. 2021;51:271-278.
8. Okubo Y, Matsumoto Y, Tanaka M, Imabayashi T, Uezono Y, Watanabe SI, Tsuchida T. Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer. J Thorac Dis. 2021;13:3033-3041.
9. Nogawa H, Matsumoto Y, Tanaka M, Tsuchida T. Diagnostic usefulness of bronchoscopy for peripheral pulmonary lesions in patients with idiopathic pulmonary fibrosis. J Thorac Dis. 2021 [Accepted]