Refinements and innovations in biopsy and analysis techniques for pleural and lung disease

[摘要] 1.1. BackgroundTumors arising from the lung, pleura, or chest wall are a frequent problem in clinicalpulmonary medicine. Most lesions are either infectious, neoplastic or granulomatous innature, but a variety of other differential diagnoses must be considered. An accurate diagnosisis important because the available treatments differ substantially, and because any delay willimpair the prognosis in potentially curable patients with lung carcinoma. The investigationsinvolve the disciplines of radiology, pulmonology, surgery, microbiology, and anatomicalpathology and consume a respectable amount of resources. The aim of the work covered inthis thesis was to optimize the available diagnostic methods for the routine use in a healthcare setting with limited resources.1.2. MethodsThe general idea of this work was to identify conventional sampling methods that could bedeveloped further to become more useful for the diagnosis of chest tumors in a low resourcehealth care setting. The key method was research performed: a) to revise and expand theindication for a sampling method, b) to technically improve the sampling process, and c) tooptimize sample transport, preparation and analysis in collaboration with the analyticallaboratory.1.3. ResultsA list of invasive diagnostic procedures, imaging methods and analytical processes weredeveloped, evaluated and integrated into clinical practice. A) transbronchial needleaspiration, B) transthoracic cutting needle biopsy, C) transthoracic fine needle aspiration, D)transthoracic ultrasound, and E) rapid on-site evaluation of needle aspirates by acytopathologist. Five studies pertaining to this thesis were published in international peerreviewedjournals:â ¢ Safety and yield of ultrasound-assisted transthoracic biopsy performed bypulmonologists (Respiration 2004;71:519-22) This paper established that ultrasound-assisted transthoracic biopsy performed bypulmonologists is feasible, safe, practical, low-cost and has a high yield.â ¢ Utility of rapid on-site evaluation of transbronchial needle aspirates (Respiration2005;72:182-8)This paper demonstrated the economical advantages of on-site evaluation of transbronchialspecimens in a low-resource setting.â ¢ Transbronchial needle aspirates: comparison of two preparation methods (Chest2005;127:2015-8)This paper demonstrated that preparing smears on-site has a far better yield than poolingsamples into a vial. This means that the yield is improved over the current standard at noadditional cost.â ¢ Transbronchial needle aspirates: how many passes per target site? (EuropeanRespiratory Journal 2007;29:112-6)This paper investigated the most economical and effective approach to serial sampling withtransbronchial needle aspiration during flexible bronchoscopy.â ¢ Ultrasound assisted transthoracic biopsy: fine needle aspiration or cutting needlebiopsy? (European Respiratory Journal 2007;29:357-62)This paper compared two common methods of sampling and demonstrates that the lessexpensive method is sufficient in the majority of cases.1.4. ConclusionThis work has impacted on current practice in multiple ways. Conventional methods havebeen optimized by improving technical factors and with the integration of interdisciplinarycollaboration. The initiated research is ongoing with the aim to achieve continued technicaland economical improvements in the diagnosis of chest tumors.

[发布机构] Stellenbosch University