Department of Endoscopy, Respiratory Endoscopy Division

Takaaki Tsuchida, Yuji Matsumoto, Tatsuya Imabayashi, Keigo Uchimura

Introduction

More than 1,200 bronchoscopies were performed between April 2021 and March 2022 (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.

The special feature of our hospital is the use of endobronchial ultrasound (EBUS-TBNA, radial EBUS) for almost all examinations, and for small peripheral lesions, virtual bronchoscopy and virtual fluoroscopy using workstations and other instruments are used to simulate the lesion before the examination. Efforts were made to shorten the length of the procedure.

Guided biopsies were combined with rapid onsite cytology. Cryobiopsies were used to diagnose ground grass nodules or to obtain large specimens especially for next-generation sequencing.

Stenting for airway stenosis and tumor ablation were 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. Three hundred seventy-six cases of EBUS-TBNA (EBUS-guided transbronchial needle aspiration) were performed as a less invasive procedure to improve diagnosis 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 thoracoscopy under local anesthesia in the endoscopic examination room was performed with unknown pleural effusion and/or pleural thickening.

Research activities

1) We conducted a trial of photodynamic therapy for peripheral small lung cancer.

Table 1. Type of procedure and number of patients

2) The usefulness of cryobiopsy in respiratory endoscopy was demonstrated.

3) The usefulness of convex type ultrasound bronchoscopy-guided forceps biopsy was demonstrated.

4) The role of core tissue in next-generation sequencing analysis of ultrasound bronchoscopy- guided needle puncture aspiration biopsy specimens was demonstrated.

5) We demonstrated the safety of day treatment for photodynamic therapy.

Clinical trials

The world's first multicenter trial of photodynamic therapy for peripheral type lung cancer was performed.

Education

Since a 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 here, and we actively accept them. However, this year, due to the spread of COVID-19, the number of overseas doctors was limited. On the other hand, we have given many residents opportunities to write papers and present at conferences.

Future prospects

1) We will complete a multicenter trial of photodynamic therapy for small peripheral lung cancer.

2) We will conduct a randomized controlled trial to evaluate the efficacy of cryo-biopsy in bronchoscopic diagnosis of peripheral lung lesions.

3) We will develop a method to nondestructively understand tissue architecture using X-ray phase imaging.

4) We will investigate the usefulness of regular-diameter forceps for ultrasound bronchoscopy-guided intranodal forceps biopsy.

5) We will develop a new diagnostic method for malignant tumors using a tabletop electron microscope.

6) We will developing diagnostic and therapeutic procedures using the minimally invasive technique of bronchoscopy.

7) We will conduct research on multidimensional information analysis of lung cancer pathology and examine the potential diagnostic ability of ultra-high-resolution CT images for lung cancer.

8) We will lead a prospective observational study using a multicenter database on respiratory endoscopy in Japan.