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Observational Study
. 2023 Jan;14(2):186-194.
doi: 10.1111/1759-7714.14731. Epub 2022 Nov 22.

Usefulness of endocytoscopy in evaluating transbronchial biopsy specimens

Takae Okuno  1 , Noriaki Kurimoto  1 , Akari Tanino  1 , Megumi Hamaguchi  1 , Takamasa Hotta  1 , Ryosuke Tanino  1 , Misato Kobayashi  1 , Yohei Shiratsuki  1 , Shunichi Hamaguchi  1 , Takeshi Isobe  1 , Yukari Tsubata  1
Affiliations
Observational Study

Usefulness of endocytoscopy in evaluating transbronchial biopsy specimens

Takae Okuno et al. Thorac Cancer. 2023 Jan.

Abstract

Background: Endocytoscopy (ECS) provides a magnification of approximately 450× for real-time observation of lesion nuclei. Using ECS, we aimed to evaluate whether sufficient samples for diagnosis can be obtained during bronchoscopy. We also investigated whether ECS can enable two-class diagnosis of malignant or non-malignant transbronchial biopsy specimens in real-time during bronchoscopy.

Methods: This was a single-facility, prospective, observational, ex vivo study. Forty cases with localized peripheral pulmonary lesions underwent transbronchial biopsy with endobronchial ultrasonography using a guide sheath. Each biopsy specimen was immediately observed and evaluated endocytoscopically after the collection by the bronchoscopic procedure.

Results: Thirty-seven cases were enrolled. The diagnostic accuracy achieved by ECS was 91.9% (34/37). The agreement rate between the endocytoscopic evaluation and pathological diagnosis of each specimen (170 specimens) was 65.3% (111/170). The median time required for endocytoscopic evaluation per specimen was 70 s. When we judged a specimen to be malignant a second time on ECS evaluations of five specimens in one case, pathologically malignant specimens were collected in 26 of 27 cases (96.3%).

Conclusions: ECS with methylene blue staining may aid in the two-class diagnosis of malignant or non-malignant transbronchial biopsy specimens during bronchoscopy. This may reduce the number of tissue biopsies.

Keywords: biopsybronchoscopyendocytoscopy.

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Conflict of interest statement

Takae Okuno has no conflicts of interest. Noriaki Kurimoto received personal fees from Olympus Corporation. Noriaki Kurimoto received personal fees from Eli Lilly Japan K.K., and Chugai Pharmaceutical outside the submitted work. Akari Tanino has no conflicts of interest. Megumi Hamaguchi has no conflicts of interest. Takamasa Hotta has no conflicts of interest. Ryosuke Tanino has no conflicts of interest. Misato Kobayashi has no conflicts of interest. Yohei Shiratsuki has no conflicts of interest. Shunichi Hamaguchi has no conflicts of interest. Takeshi Isobe received grants from KONICA MINOLTA, IQVIA Services JAPAN K.K. and Insmed outside the submitted work. Takeshi Isobe received personal fees from DAIICHI SANKYO COMPANY, AstraZeneca K.K., and Nippon Boehringer Ingelheim outside the submitted work. Yukari Tsubata received grants from ONO PHARMACEUTICAL and Pfizer Health Research Foundation., outside the submitted work. Yukari Tsubata received personal fees from DAIICHI SANKYO COMPANY, AstraZeneca K.K., and Chugai Pharmaceutical, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Endocytoscopy (ECS). (a) An endocytoscope consisting of a flexible catheter‐type endoscope 380 cm long and 3.2 mm in diameter (Source: courtesy of Olympus medical systems). (b) The light emitted from the tip of the endocytoscope is scattered in the tissue, and the tissue can be observed with the objective lens using scattered light. The ECS system provides a magnification of 450‐fold on a 14‐inch monitor, observation field of 300 × 300 μm, observation depth of 0–30 μm, and horizontal resolution of 4.2 μm.
FIGURE 2
FIGURE 2
Endocytoscopy‐for‐biopsy (ECB) classification. ECB 1: endocytoscopy (ECS) indicates homogeneity of nuclei and regularity of nuclear arrangement. ECB 2: ECS indicates either heterogeneity of nuclei or irregularity of nuclear arrangement. This image shows irregularity of nuclear arrangement. ECB 3: ECS indicates both heterogeneity of nuclei (white arrow, yellow arrow) and irregularity of nuclear arrangement (circle on broken line). ECB 1 and ECB 2 specimens are classified as non‐malignant, whereas ECB 3 specimens are classified as malignant.
FIGURE 3
FIGURE 3
Flow chart of study enrollment. Forty cases were enrolled, and three inappropriate cases were excluded. Of the 37 cases evaluated, 27 were malignant, and 10 were pathologically non‐malignant on bronchoscopic specimens. A total of 185 specimens were obtained from 37 cases. Among them, 170 specimens were evaluated following the exclusion of 15 inappropriate specimens. ECS, endocytoscopy
FIGURE 4
FIGURE 4
Representative cases. (a) Chest computed tomography (CT) image showing an adenocarcinoma in the left upper lobe. (b) Endocytoscopy (ECS) image showing swelling of the nuclei (arrow), heterogeneity in the size and shape of nuclei, irregular arrangement of nuclei, and abnormal proliferation and accumulation of nuclei (circle on broken line). (c) Pathological findings (hematoxylin and eosin staining [H&E]) closely resemble the ECS findings. (d) Chest CT image showing a squamous cell carcinoma in the left lower lobe. (e) ECS imaging showing swelling of nuclei, heterogeneity in the size and shape of nuclei, and irregular arrangement of nuclei. Elongated deformed nuclei can be observed. (f) Pathological findings (H&E staining) closely resemble the ECS findings.
FIGURE 5
FIGURE 5
Cumulative diagnostic yield of sequential biopsies from lesions pathologically diagnosed as malignant. A total of 95% of the cumulative diagnostic yield was reached by the fourth biopsy specimen.
FIGURE 6
FIGURE 6
Correlation between collection of malignant tissue and the number of specimens evaluated as malignant based on ECS. When ECS revealed malignancy a second time of five biopsies in a malignant case, pathologically proven malignant specimens were collected in 26 of 27 cases (96.3%). ECS, endocytoscopy.
See this image and copyright information in PMC

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