J Cancer 2022; 13(4):1307-1312. doi:10.7150/jca.67113 This issue

Research Paper

Radial Endobronchial Ultrasound for Lung Cancer Diagnosis: Tips and Tricks

Paul Zarogoulidis1,2✉*, Haidong Huang3*, Wei Chen4*, Dimitris Petridis5, Dimitris Matthaios6, Wolfgang Hohenforst-Schmidt7, Christos Tolis8, Kosmas Tsakiridis9, Sofia Baka10, Christos Arnaoutoglou11, Maria Saroglou12, Stavros Tryfon12, Aris Ioannidis13, Lutz Freitag14, Christoforos Kosmidis1, Chong Bai3✉

1. 3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.
2. Pulmonary Oncology Department, “Bioclinic” Private Hospital, Thessaloniki, Greece.
3. Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China.
4. Department of Respiratory and Critical Care Medicine, The Huaian Clinical College of Xuzhou Medical University, Huai'an, Jiangsu, China.
5. Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
6. Oncology Department, General Hospital of Rhodes, Rhodes, Greece.
7. Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany.
8. Oncology Department, “Oncoderm” Private Oncology Clinic, Ioannina, Greece.
9. Thoracic Oncology Department, “Interbalkan” European Medical Center, Thessaloniki, Greece.
10. Oncology Department, “Interbalkan” European Medical Center, Thessaloniki, Greece.
11. 1st Department of Obstetrics & Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Periferiakos Str., 56429, Thessaloniki, Greece.
12. Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
13. Surgery Department, Genesis Private Hospital, Thessaloniki, Greece.
14. Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
*These authors contributed equally.

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Citation:
Zarogoulidis P, Huang H, Chen W, Petridis D, Matthaios D, Hohenforst-Schmidt W, Tolis C, Tsakiridis K, Baka S, Arnaoutoglou C, Saroglou M, Tryfon S, Ioannidis A, Freitag L, Kosmidis C, Bai C. Radial Endobronchial Ultrasound for Lung Cancer Diagnosis: Tips and Tricks. J Cancer 2022; 13(4):1307-1312. doi:10.7150/jca.67113. Available from https://www.jcancer.org/v13p1307.htm

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Abstract

Graphic abstract

Introduction: Endoscopic techniques have been upgraded in the recent 10 years. We can use the radial endobronchial ultrasound to reach distal nodules in the periphery of the lungs, but also we can use it in order to make biopsies in lesions without endobronchial findings.

Patients and Methods: We included in our study 248 patients with pulmonary nodules up to 4 cm. We use a radial endobronchial system from FUJI, a PENTAX bronchoscope and a C-ARM. We recorded the cancer type, biopsy method, time of each procedure, cell blocks and slices from cell blocks.

Results: Two thirds of patients belonged to males (61.7%), forceps was the main tissue extraction technique (118, 47.6%) and tumors sized 1 to 2 cm were the most encountered (96, 38.7%). Samples with tissue content were present in 175 patients (70.6%) and one cell block dominated in the samples (109, 43.9%). Less than 20 minutes were needed to complete the operative procedure for the half patients (127, 51.2%), the C-Arm implementation concerned 117 persons (47.2%) and the majority of tumors was located in the central area of the lungs (178, 71.8%). Less time was necessary for central lesions and larger biopsy samples were acquired without the extensive use of C-ARM.

Conclusion: The larger the nodule ≥2cm and in periphery the less we use the C-ARM and the time of the procedure is between 20-40 minutes. Moreover; we have more tissue sample and cell block slices.

Keywords: radial ebus, lung cancer, 22G needle, forceps, brush, C-Arm, nsclc, sclc, metastasis, elastography