We reviewed the advances in photodynamic therapy (PDT) for lung cancer and the clinical results in Japan. In March 1980, PDT was first applied bronchoscopically for central-type early-stage lung cancer (ESLC) at Tokyo Medical University using an argon dye laser combined with a tumor-specific photosensitizer, hematoporphyrin derivative, the profimer sodium (PFS) prototype. Subsequently, a phase II study on PFS was conducted, and the complete remission (CR) was 84.7%. The data showed excellent PDT efficacy. However, it is not widely employed partly because of the laser system's high cost, bulky size, and the adverse effects resulting from skin photosensitization. To resolve these issues, second generation PDT using taraporfin sodium (TPS) and a compact-size diode laser was developed. We compared the clinical results and adverse events of two phase II studies on PFS and TPS. Regarding efficacy, the CR of the phase II study on TPS was obtained at 84.6%, almost equivalent to the data (84.8%) of the previous phase II clinical study on PFS. Meanwhile, PDT using TPS showed a very low score on the skin photosensitivity test. Although patients using PFS showed skin reactivity for more than one month, photosensitivity attenuated until two weeks in most patients (84.8%) that use TPS. In clinical PDT, most adverse events were skin photosensitivity. However, bronchial stenosis, a rare complication resulting from excessive laser irradiation, was observed. Currently, due to its efficiency and low skin photosensitivity, the second generation PDT using TPS and diode laser has been a standard modality of PDT for central-type ESLC in Japan.

Background: Thoracoscopy under local anesthesia is widely performed for the diagnosis of malignancies and infectious diseases. With the aging of the population, it is increasingly performed in elderly patients, but there are still few reports on its efficacy and safety. We aimed to determine whether there were any differences in the efficacy or safety of thoracoscopy under local anesthesia between elderly (75≤) and nonelderly patients (75>).

Methods: Patients who underwent thoracoscopy under local anesthesia at our hospital between January 2018 and April 2023 were reviewed retrospectively. We examined the background factors of the patients, the purpose of the examination, diseases to be examined, examination time, anesthetic methods, diagnostic and treatment success rates, and adverse events.

Results: A total of 62 patients were reviewed. Of this, 32 were elderly and 30 were nonelderly. There were more men with a history of smoking and significantly more elderly patients had hypertension.

Forty-three patients (69.4%) were treated for diagnostic purposes, 16 (25.8%) for pyothorax, 1 (1.6%) for pneumothorax, and 1 (1.6%) for diagnosis and treatment. There were no significant differences in anesthetic drugs, examination time, pathology diagnosis rate, or success rate in treating pyothorax/pneumothorax. The diagnostic rate of malignancy was 93.8%, while that of benign disease was 41.7%. There was no significant difference in the overall success rate of pathological diagnosis and treatment between elderly and nonelderly patients (78.1% vs. 93.3%, p = 0.148). Adverse events were hypoxemia, pain, and hypertension, in that order, with pain being significantly more common in the elderly, but no other significant differences as well as serious adverse events were observed.

Conclusions: The efficacy and safety of thoracoscopy under local anesthesia were similar in elderly patients as in nonelderly patients in this retrospective single-center study.

Background: Bronchoscopy is a mandatory tool used to diagnose endobronchial tuberculosis (EBTB); however, it is not routinely performed on all patients with pulmonary tuberculosis (PTB) because of the risk of exposure to airborne Mycobacterium tuberculosis. Early diagnosis of EBTB is essential for watchful waiting and treatment planning of residual bronchostenosis. Therefore, physicians need to determine the incidence of EBTB according to the implementation rate of bronchoscopy in each region and identify patients with PTB requiring bronchoscopy on initial evaluation. We evaluated the implementation rate of bronchoscopy among patients with PTB and assessed the incidence and risk factors of concomitant EBTB.

Materials and Methods: Overall, 335 patients diagnosed with PTB between May 2013 and April 2020 were included. The implementation rate of bronchoscopy in patients with PTB was determined. Additionally, the incidence of EBTB and their clinical characteristics were also evaluated.

Results: The implementation rate of bronchoscopy in patients with PTB was 26.9% (n = 90/335). The incidence of EBTB in all patients with PTB was 7.5% (n = 25/335) and of those who underwent bronchoscopy was 27.8% (n = 25/90). Among the 25 patients with EBTB, although 19 (76%) were suspected to have EBTB before bronchoscopy, six (24%) were incidentally diagnosed using bronchoscopy. A positive acid-fast bacilli (AFB) sputum smear [odds ratio (OR) 10.11, 95% confidence interval (CI) 3.20-31.95] and the presence of airway stenosis on computed tomography (CT) images (OR 4.58, 95% CI 1.41-14.88) were identified as independent risk factors of concomitant EBTB in patients with PTB.

Conclusions: The incidence of EBTB may be underestimated because of the low implementation rate of bronchoscopy. Physicians should consider bronchoscopy to diagnose the presence of concomitant EBTB in patients with PTB with either or both a positive AFB sputum smear and the presence of airway stenosis on CT images.

Background: This study aimed to evaluate the efficacy and safety of a newly modified oxygen mask to contain droplets and aerosols during bronchoscopy. The coronavirus disease-2019 (COVID-19) pandemic has generated attention to the importance of infection control, especially in aerosol-generating procedures, such as bronchoscopy. A modified mask was designed to allow bronchoscope insertion, oxygen administration, and aspiration of oral secretions while preventing droplet and aerosol dispersion.

Materials and Methods: The mask was created by modifying a commercially available non-rebreathing oxygen mask. All the exhalation holes were sealed, and two new holes were drilled for the oxygen tube, bronchoscope, and suction tube. The holes were covered with rubber and provided with X-shaped slits to prevent aerosol and droplet dispersal. This study used a particle visualization system to visually assess the spread of particles during simulated coughing with and without a modified mask. The particles were quantified using a counting system. Mask safety was evaluated by monitoring a healthy volunteer's carbon dioxide levels, oxygen saturation, and heart rate. Additionally, these parameters were monitored in seven patients undergoing bronchoscopy.

Results: The modified masks significantly reduced droplet and aerosol dispersion. The modified mask successfully prevented aerosol leakage during bronchoscopy in a human model. The mask reduced droplet and aerosol dispersion by approximately 97% in a human participant. Safety assessments in the seven patients suggested that the mask was safe for use during bronchoscopy as it did not significantly affect the carbon dioxide levels or oxygen saturation.

Conclusions: This study demonstrated that the modified masks effectively minimized the spread of potentially infectious particles during bronchoscopy and were safe for patients. This is especially important considering the potential for asymptomatic individuals to transmit infectious diseases, such as COVID-19. This study advocates the universal use of such masks during bronchoscopy to protect healthcare workers and patients from airborne transmission.

A 64-year-old patient with a history of breast cancer was referred to our department after a computed tomography finding of a chest abnormality. We performed bronchoscopy, and the specimens obtained via forceps biopsy were nondiagnostic. Cryobiopsy was then performed using the "tube-wedging method." The process was straightforward and could be completed without complication. Pathological diagnosis of specimens obtained via cryobiopsy revealed metastatic breast cancer in the lungs.

Pulmonary cryptococcosis is a fungal infection with diverse images, particularly in immunocompromised individuals. We herein report a rare case of miliary pulmonary cryptococcosis exhibiting different changes in computed tomography (CT) images of the left and right lungs. The case was a 70-year-old patient with chronic lymphocytic leukemia (CLL) treated with ibrutinib, a Bruton tyrosine kinase inhibitor that suppresses humoral immunity. She was diagnosed with CLL in March 2019, and ibrutinib administration was initiated. After 4 months, she visited our hospital due to high fever and dry cough for the previous 2 weeks. Initial CT revealed bilateral miliary nodules surrounded by ground-glass opacity (GGO) and interlobular septal thickening, mainly distributed in the left lung. Bacterial pneumonia was suspected; thus, garenoxacin was prescribed. However, CT scan after treatment with garenoxacin revealed new consolidation superimposed on miliary nodules in the right lung. Contrarily, the GGO and interlobular septal thickening in the left lung were improved, but miliary nodules remained. Finally, cryptococci were detected in the lung specimen via bronchoscopy and those were also detected in cerebrospinal fluid, leading to the diagnosis of disseminated cryptococcosis. When performing bronchoscopy in patients treated with ibrutinib, cryptococcosis needs to be considered despite atypical chest CT findings.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established method for obtaining samples from mediastinal or hilar lymph nodes and mass lesions. This technique has greatly improved the diagnostic performance in lung cancer. However, its performance is limited in granulomatous and lymphoproliferative diseases. EBUS miniforceps biopsy (MFB) is a recently developed technique for performing biopsies of mediastinal lesions under continuous endobronchial ultrasound guidance. In this article, we describe a case of malignant lymphoma in a patient with successful chemotherapy treatment. The present case suggests that EBUS-MFB is an effective diagnostic tool.

A male in his early sixties complaining of dyspnea underwent chest computed tomography (CT), which revealed a tumor at the right lower lobe with swollen mediastinal lymph nodes. Biopsy by endobronchial ultrasound-guided transbronchial needle aspiration confirmed adenocarcinoma. Despite chemoradiotherapy, his symptoms worsened, and a chest CT scan performed 3 weeks after the start of treatment showed a right-sided pleural effusion. An indwelling pleural catheter (IPC) was placed under local anesthesia to relieve his symptoms. Cytologic assessment of the pleural fluid further confirmed adenocarcinoma. After three rounds of intrapleural cisplatin, the drainage fluid decreased, and IPC was removed. Although IPC is a global standard option for managing malignant pleural effusion, it has yet to be approved in Japan. We report this first case report of IPC placement in Japan.

Appropriate endobronchial path selection is important for the bronchoscopic diagnosis of peripheral pulmonary lesions (PPLs). Herein, we report a case of a successful ultrathin bronchoscopic biopsy of a small PPL using computed tomography (CT) in the lateral decubitus position. CT imaging and bronchoscopy were performed on a patient in the supine and lateral decubitus positions. CT images in the supine position showed a pseudo-obstruction of the left B¹⁰ in three-dimensional (3D) images of the bronchial tree and virtual bronchoscopic navigation (VBN). Conversely, CT images in the lateral decubitus position with "examination side up" showed the 3D bronchial tree image of the lower lobe, delineating the B¹⁰ bronchus along with the further subsegmental bronchi. In conclusion, using VBN and CT imaging can improve the optimal bronchial pathway determination for the transbronchial biopsy of a target lesion.

We describe a patient with antimelanoma differentiation-associated gene 5 (MDA5) antibody-positive interstitial pneumonia without cutaneous features. The lung specimen obtained from transbronchial lung biopsy revealed interstitial pneumonia. In addition, scattered white lesions were observed on the central bronchi. The pathology of the bronchial lesion was confirmed as squamous metaplasia. We successfully treated the patient with steroids and tacrolimus. The bronchial lesions were improved in parallel with the interstitial pneumonia. These bronchial lesions could be a manifestation of anti-MDA5 antibody-positive interstitial pneumonia.