Bronchoscopy was performed after inducing general anesthesia (propofol and remifentanil) by anesthesiologists or local anesthesia (lidocaine) by pulmonologists. R-EBUS was performed with an endoscopic ultrasonographic system (EU-ME2; Olympus, Tokyo, Japan), equipped with a 20-MHz mechanical radial type probe (UM-S20-17S or UM-S20-20R; Olympus). The R-EBUS probe was combined with or without other guidance equipment. When the bronchoscopist considered that the R-EBUS probe had reached the lesion, it was used to scan the lesion from its proximal to its distal end. A 10-second video was recorded, and a typical R-EBUS image was saved. The long and short axes of the lesion were measured at its maximum cross-section. After locating the PPL on the R-EBUS image, the probe was withdrawn. Brush or/and biopsy forceps were introduced through the working channel or guide sheath, and cytological and pathological specimens were obtained (13 (link)). No fewer than five biopsy specimens visible to the naked eye were obtained. We also obtained microbiological specimens if the bronchoscopist thought they were necessary.
Eu me2
Manufactured by Olympus
Sourced in Japan, Germany
The EU-ME2 is a laboratory microscope designed for general microscopy applications. It features binocular eyepieces, LED illumination, and a range of magnification options. The EU-ME2 provides clear and detailed images for various observational tasks.
Automatically generated - may contain errors
Lab products found in correlation
Gf uct260, by Olympus (16 mentions)
Eu me1, by Olympus (10 mentions)
Gf uct180, by Olympus (6 mentions)
Bf uc260fw, by Olympus (5 mentions)
Gf um2000, by Olympus (5 mentions)
Um 3r, by Olympus (4 mentions)
Um s20 17s, by Olympus (3 mentions)
Um 2r, by Olympus (3 mentions)
Gf ue260, by Olympus (3 mentions)
Sp 900, by Fujifilm (3 mentions)
Gf uc240p al5, by Olympus (3 mentions)
Vizishot na 201sx 4022, by Olympus (3 mentions)
Gf ue260 al5, by Olympus (3 mentions)
Um s20 20r, by Olympus (2 mentions)
Gf uc140, by Olympus (2 mentions)
Prosound f75, by Hitachi (2 mentions)
Prosound α10, by Hitachi (2 mentions)
Eu m2000, by Olympus (2 mentions)
Gf ue290, by Olympus (2 mentions)
Eg 580ut, by Fujifilm (2 mentions)
45 protocols using eu me2
1
Radial EBUS-Guided Biopsy of Peripheral Lung Lesions
2
EUS-EG Evaluation of Pancreatic Tumor Vascular Integrity
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Patients who meet inclusion and exclusion criteria are eligible to perform an EUS-EG.
EUS-EG is performed the day before surgery by the same experienced endoscopist to evaluate the integrity of Inoue’s level III. Technical considerations include a radial EUS scope, GF-UE 160-AL5 Olympus, an Olympus EUS processor, and EU-ME2. The procedure was carried out at the clinic under monitored sedation.
EUS-EG protocol includes an assessment of pancreatic tumour and their relationship with vessels: For vessels: (a) grade of vessel contact: < 90/90–180, 180–270, > 270; (b) deformity (irregularity): yes/no; (c) lumen reduction: no, < 50%, > 50%, occlusion; (d) thrombus in the vessel: yes/no; (e) length of stenosis in mmm. For Inoue’s level III evaluation, a hyperechogenic line between the vessel wall and tumour suggests the integrity of Inoue’s level. Additionally, the presence of green lines on elastography around vessels indicated the integrity of the vascular wall.
3
EBUS-TBNA and TBB Procedure
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Bronchoscopy was performed according to the CHEST guidelines 9 (link) prior to the study. Briefly, a dedicated flexible bronchoscope (BF-UC260FW; Olympus, Tokyo, Japan) equipped with an endoscopic ultrasound processor (EU-ME2; Olympus, Tokyo, Japan) was used to perform EBUS-TBNA. First, TBB specimens were obtained using the EBUS equipment with a guide sheath method (EBUS-GS) and disposable biopsy forceps (FB-231D; Olympus, Tokyo, Japan) 28 (link). Thereafter, EBUS-TBNA was performed using a 22-gauge needle (NA-U401SX-4022; Olympus, Tokyo, Japan). The tissue specimens collected by performing EBUS-TBNA and TBB were immediately fixed in 10% neutral buffered formalin for 24 h and embedded in paraffin. The tissue blocks were then sliced into 4‒5-μm-thick sections at the time of diagnosis and used for the determination of the expression of PD-L1 expression.
4
Endoscopic Characterization of Pancreatic Cysts
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All EUS procedures were performed under anesthesiologist-directed sedation using linear echoendoscopes (Olympus® GF-UCT180 and Olympus® GF-UC140) coupled with an Olympus® EU-ME2 ultrasound processor under anesthesiologist-directed sedation. Cyst type was determined based on surgical specimen, intracystic biopsy forceps samples (Moray® micro forceps, STERIS) or cyst fluid cytology combined with carcinoembryonic antigen (CEA) and glucose fluid levels. PCLs were considered mucinous if cytology revealed mucinous epithelial cells or, in their absence, CEA fluid levels >192 ng/mL and glucose levels <50 mg/dL. Patients with cystic neuroendocrine tumors and solid pseudopapillary neoplasms were excluded.
5
Contrast-Enhanced Endoscopic Ultrasound Imaging of Pancreatic Tumors
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CE-EUS was performed using a convex-type echoendoscope (GF-UCT260; Olympus, Tokyo, Japan) and ultrasound processors (ProSound F75 or ProSound α10; Hitachi-Aloka Medical, Tokyo, Japan, or EU-ME2; Olympus, Tokyo, Japan). The setting of the ultrasound processor was changed to dual imaging with the extended pure harmonic detection mode on the right side and standard B-mode on the left side (Figure 1 ). The gain and range levels were adjusted so that the entire tumor could be visualized with appropriate contrast. Microbubbles were composed of perfluorobutane, created to a median diameter of 2–3 μm (Sonazoid: Daiichi-Sankyo, Tokyo, Japan; GE Healthcare, Milwaukee, WI, USA), and were used as the ultrasound contrast agent. A video image of the screen was recorded while observing the pancreatic tumor for 90 seconds after intravenous administration of the contrast agent.
6
Bronchoscopic Examination using EBUS
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For bronchoscopic examinations, endobronchial ultrasonography (EBUS) (Endoscopic Ultrasound Center; EU-ME2, Olympus, Tokyo, Japan) was routinely used in combination with a flexible thin bronchoscope, BF-P260F/P290, or normal bronchoscope, BF-1T260/1TQ290/1TH1200, with a guide sheath kit (Olympus, Tokyo, Japan). EBUS-TBNA was undertaken using a flexible fiberscope (BF-UC260F, Olympus, Tokyo, Japan), and performed 2 to 3 times with a 22-gauge needle. CT/ultrasound-guided core needle biopsy was performed 3 times with a semi-automatic aspiration device (Temno Evolution, Care Fusion Japan, Tokyo, Japan). The needle size was 20 gauge, and the length of the needle was 11 or 15 cm.
7
Ultrasonic Miniprobe Endoscopic Imaging
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8
Comparative EUS Characteristics of AIP and PC
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Two hundred and seventeen patients with AIP (90 FAIP patients and 127 DAIP patients) and 197 patients with pancreatic head cancer, who consecutively underwent EUS before the initiation of steroid therapy at our center from January 2013 to December 2018, were retrospectively included in the present study. The diagnosis of AIP met the revised Mayo clinic criteria (revised HISORt criteria) including features of histology, imaging, serology, other organs involvement, and response to steroid therapy.[15 (link)] The diagnosis of pancreatic duct adenocarcinoma was confirmed by surgical pathology or by cytology/histology after EUS-guided fine-needle aspiration or biopsy. The EUS examination was performed by experienced endosonographers with a radial or linear echoendoscope (GF-UM2000, GF-UCT260 or GF-UE260, Olympus, Tokyo, Japan) and ultrasonic processing system (EU-M2000, EU-ME1 or EU-ME2, Olympus, Tokyo, Japan; or ProSound α5, Aloka, Tokyo, Japan). EUS characteristics of the patients with AIP were compared with those of the PC patients. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (6th revision, 2008) and was approved by the Ethics Committee of our institution.
9
Endoscopic Ultrasound-Guided Cyst Analysis
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All EUS procedures were performed by two experienced endosonographers (F.V.B. and P.M.R.), each possessing more than a decade of experience in EUS practice and having completed over 1000 procedures. The procedures were carried out using Olympus® GF-UCT180 and Olympus® GF-UC140 curvilinear echoendoscopes, coupled with the Olympus® EU-ME2 ultrasound processor. All interventions were performed under anesthesiologist-guided for sedation. Cystic lesions were punctured using 19-gauge or 22-gauge FNA needles (Expect™ Slimline, Boston Scientific Corp., Marlborough, Massachusetts, USA) either through the stomach for lesions situated in the body or tail, or via the duodenum for lesions located in the head of the pancreas. For patients with more than one cystic lesion, only the larger was considered for analysis.
Glucose was measured using both an on-site and a laboratory approach. On-site glucose measurement was performed using a conventional glucometer (GlucoMen® Aero 2K, A. Menarini, Firenze, Italy), with a range between 20-600 mg/dL. All samples with glucose levels < 10 mg/dL were recorded and analyzed as 19 mg/dL. In patients with an appropriate cyst fluid volume, the values of CEA levels were determined.
Glucose was measured using both an on-site and a laboratory approach. On-site glucose measurement was performed using a conventional glucometer (GlucoMen® Aero 2K, A. Menarini, Firenze, Italy), with a range between 20-600 mg/dL. All samples with glucose levels < 10 mg/dL were recorded and analyzed as 19 mg/dL. In patients with an appropriate cyst fluid volume, the values of CEA levels were determined.
10
Radial EBUS-Guided Transbronchial Biopsy
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The bronchoscopic procedure used in this study was rEBUS-TBB for sampling peripheral pulmonary nodules. Most of the procedures were performed under local anaesthesia (lidocaine); however, some patients underwent mild-to-moderate sedation using intravenous fentanyl and midazolam, based on the judgement of the bronchoscopist. Conventional bronchoscopy (BF-P260F, BF-P290 or BF-1T; Olympus, Tokyo, Japan) was used to examine the trachea and bronchi, after which rEBUS images were obtained using an endoscopic ultrasound device (Olympus EU-ME2 at NTUH-HC and NTUH-BIO; Olympus EU-M30S at NTUH-TPE or Fujifilm SP-900 at NTUH-BIO) with a 20 MHz radial ultrasonic probe (Olympus UM-S20-17S or UM-S20-20R at NTUH-HC, NTUH-TPE and NTUH-BIO or Fujifilm PB-2020M at NTUH-BIO). The position of the rEBUS probe was reported to be within or adjacent to the target lesion. Once the lesion was identified, the radial probe was withdrawn from the working channel, to allow the insertion of biopsy forceps for TBB. In some instances, bronchial brushing and/or washing were performed. Specimens obtained in the TBB were prepared for pathological and cytological examination by a qualified pathologist.
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