Department of Endoscopy, Respiratory Endoscopy Division (the Endoscopy Center)

Takaaki Tsuchida, Yuji Matsumoto, Toshiyuki Nakai

Introduction

For respiratory diseases, we have focused on the accurate and less invasive diagnosis of miniature peripheral malignancies detected by computed tomography (CT), which can lead to earlier surgical treatment and a less invasive treatment 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 earlier detection of tracheobronchial malignancies.

Our 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 peripheral lung lesions. Two hundred thirty seven cases of EBUS-TBNA (EBUS-trans bronchial needle aspiration) were performed as a less invasive procedure to improve the diagnosis of 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/or endobronchial electrocautery ablation.

Medical thorachoscopy under local anesthesia in the endoscopic examination room was performed with unknown pleural effusion or pleural tumors.

Research activities

Our efforts have been focused on new diagnostic and therapeutic strategies including bronchoscopy, which involve CT-screening for lung cancer and lead to cure and less-invasive treatments for lung cancer. To achieve a more accurate endoscopic diagnosis for solitary peripheral lung nodules, we are using three-dimensional computed tomography (3D-CT) navigation, ultrsound-guided approach, electromagnetic navigation and onsite cytology.

We showed the utility of rapid on-site cytologic evaluation during EBUS-TBNA. We also showed the utility of bronchoscopic procedure for re-biopsy.

Clinical trials

We conducted a multicenter prospective study for the evaluation of photodynamic therapy for peripheral lung cancer.

A study for the evaluation of virtual bronchoscopical navigation with CT workstation is also ongoing with the multicenter.

Education

A flexible bronchoscope was developed for the first time in the world in the National Cancer Center Hospital (NCCH). There are many residents and overseas doctors wishing to train their skills at our hospital. We were given the opportunity of writing papers and conference presentations for many residents. Overseas training doctors came from many countries.

Future prospects

Table 1. Type of procedures and number of patients

A multicenter trial for the evaluation of a new type needle for EBUS-TBNA and a multicenter clinical trial for the evaluation of photodynamic therapy for peripheral lung cancer are expected to be carried out.