In EBUS-GS TBB, we used video bronchoscopes (BFp-260F, 4.0-mm outer diameter and BF1T-260, 5.9-mm outer diameter; Olympus, Tokyo, Japan) with an ultrasound scanner (EU-ME-1; Olympus) for the EBUS-GS biopsies. We used guide sheath kits with two sizes (K-201 and K-203 unit; Olympus). Each guide sheath kit consisted of a guide sheath, forceps, and a cytology brush. To detect the target lesion, we used radial endobronchial ultrasound probes (UM-S20-17S, 1.7-mm outer diameter and UM-S20-20R, 2.0-mm outer diameter; Olympus). In the CTBB group, we used several types of bronchoscopes for biopsy (BF260, BF6C260, BFp260F, and BF1T260; Olympus), disposable biopsy forceps (FB-231D; Olympus), and disposable cytology brushes (BC-202D-2010; Olympus).
Fb 231d
Manufactured by Olympus
Sourced in Japan
The FB-231D is a laboratory equipment designed for general laboratory use. It serves as a basic centrifuge for separating materials of different densities within a liquid sample.
Automatically generated - may contain errors
Lab products found in correlation
Um s20 20r, by Olympus (4 mentions)
Bf 260, by Olympus (3 mentions)
Bc 202d 2010, by Olympus (3 mentions)
Um s20 17s, by Olympus (3 mentions)
Bf 1t260, by Olympus (2 mentions)
K 201, by Olympus (2 mentions)
Bf p260f, by Olympus (2 mentions)
Cryo2, by Erbe (2 mentions)
Fb 233d, by Olympus (2 mentions)
Bf 6c260, by Olympus (1 mentions)
Eu me1, by Olympus (1 mentions)
Bf 1tq290, by Olympus (1 mentions)
Sg 201 c, by Olympus (1 mentions)
Eb 580s, by Fujifilm (1 mentions)
Eb 580t, by Fujifilm (1 mentions)
Bf 1t290, by Olympus (1 mentions)
K 203, by Olympus (1 mentions)
Radial jaw 4, by Boston Scientific (1 mentions)
Eu me2, by Olympus (1 mentions)
Bf uc260fw, by Olympus (1 mentions)
11 protocols using fb 231d
1
EBUS-GS and CTBB Biopsy Techniques
2
Cryobiopsy for Peripheral Lung Lesions
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All procedures were performed under moderate-to-deep sedation using midazolam, fentanyl, and/or propofol without general anesthesia. After sedation, a bronchoscope was introduced orally (or through an endobronchial tube in patients who were intubated), and 1% lidocaine hydrochloride solution was administered through the working channel for local anesthesia. The decision whether to use radial EBUS or a guide sheath (GS) was determined according to the location of the lesion and the type of bronchoscope. For directly observed central lesions, a 1.8 mm forceps biopsy was performed, followed by cryobiopsy through the working channel. For peripheral pulmonary lesions, radial EBUS and a GS were used to approach the target lesion, and a 1.5 mm forceps biopsy was then performed, followed by cryobiopsy using a 1.1 mm cryoprobe through the GS [26 (link)].
We located the target lesions with radial EBUS and obtained lung tissues with biopsy forceps more than three times. Next, we obtained lung tissues via cryobiopsy. Cryobiopsy yielded spherical specimens that surrounded the metal tip; the amount of tissue esd usually more than 10 times than that obtained via a forceps biopsy specimen (standard oval forceps, FB-231D; Olympus, Shinjuku Ward, Japan) when using a 1.9 mm cryoprobe (CRYO2; Erbe Elektromedizin GmbH, Tübingen, Germany) [24 (link)].
We located the target lesions with radial EBUS and obtained lung tissues with biopsy forceps more than three times. Next, we obtained lung tissues via cryobiopsy. Cryobiopsy yielded spherical specimens that surrounded the metal tip; the amount of tissue esd usually more than 10 times than that obtained via a forceps biopsy specimen (standard oval forceps, FB-231D; Olympus, Shinjuku Ward, Japan) when using a 1.9 mm cryoprobe (CRYO2; Erbe Elektromedizin GmbH, Tübingen, Germany) [24 (link)].
3
Flexible Bronchoscopy with EBUS and Cryo Biopsy
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The procedures used in this study were described previously [14 (link)]. A flexible fiber bronchoscope (BF-1TQ290; Olympus, Tokyo, Japan), 20-MHz radial EBUS probe (UM-S20-20R; Olympus), guide sheath (SG-201C; Olympus), brush (BC-202D-2010; Olympus), forceps (FB-231D; Olympus), and 1.9 mm cryo probe (CRYO2; ERBE, Tuebingen, Germany) were employed [14 (link)]. Thrombin (Liquid Thrombin MOCHIDA Softbottle 10,000; Mochida Pharmaceutical, Tokyo, Japan) and balloon catheter (B5-2C; Olympus) were prepared in case of mild or severe bleeding [14 (link)]. Local anesthesia with 1% lidocaine for nebulizing, 2% lidocaine bolus to the bronchus, intravenous injection of 2–2.5 mg of midazolam, and intra-muscular injection of 35 mg pethidine hydrochloride for conscious sedation were used during the procedures [9 (link), 14 (link)]. The blood pressure, oxygen saturation, pulse rate, and electrocardiography of all patients were monitored in this study [9 (link), 14 (link)].
4
Flexible Bronchoscopy with Endobronchial Balloon
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Bronchoscopy was performed with a flexible bronchoscope of an EB-580T, EB-580S (Fujifilm, Tokyo, Japan), BF-1T290, BF1T-260, or BF-260 (Olympus, Tokyo, Japan). Patients underwent intravenous deep anaesthesia with pethidine, midazolam, or fentanyl, and 2% lidocaine was administered intratracheally. A flexible endotracheal tube (SACETT suction above cuff endotracheal tube 8.0–8.5 mm; Smiths Medical International Ltd., Minneapolis, MN, USA) was inserted for airway control. An endobronchial balloon (Fogarty® catheter, E-080-4F; Edwards Life-sciences, Irvine, CA, USA) was used for bronchial blockade and for haemostasis in all patients. If necessary, forceps (FB-15C-1, FB-231D; Olympus, Tokyo, Japan) and a guide sheath (K-201, K-203; Olympus, Tokyo, Japan) were used. A 1.4-mm 20-MHz radial probe (PB2020-M; Fujifilm or UM-S20-17S; Olympus) was also used in some patients for visualisation of lesions and blood vessels during determination of biopsy sites. All anticoagulant drugs were discontinued prior to the procedure as per guidelines [12 (link)].
5
Comprehensive Lung Tissue Sampling Protocol
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Tissue sampling procedures included transbronchial lung biopsy (TBLB) using endobronchial ultrasonography with a guide sheath (EBUS‐GS), endobronchial biopsy (EBB) using direct‐vision forceps, endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA), and computed tomography (CT)‐guided biopsy from primary or metastatic sites. During the sampling with the TBLB, large biopsy forceps (large EBUS‐GS; FB‐231D; Olympus Medical Systems) were used at least five times. During the sampling using EBUS‐TBNA, the biopsies were performed at least three times, whenever possible.
6
Bronchial Sampling Methods for Research
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Bronchoabsorption exudate - Lung lining fluid was collected using Accuwick Ultra membrane (Pall, USA) which is a specialised fibrous hydroxylated polyester absorptive matrix paper. A pre-cut Accuwick strip was guided through the K-203 guide sheath within the bronchoscope using Olympus forceps (FB-231D, oval, fenestrated swing jaw biopsy forceps, working length 1150 mm, and an outer diameter of 2.0 mm). Strips were left to absorb bronchial secretions for up to 2 min before they were withdrawn back through the bronchoscope.
Bronchial lavage - BAL collection was performed using 4 x 60 mL aliquots (240mL in total) of 0.9 % saline (Nebusal 7 %) pre-warmed. Each aliquot was immediately recovered by gentle negative pressure using a suction pump or directly into a syringe and collected into a container cooled in ice.
Bronchial brushing - Utilizing an endobronchial disposable Olympus cytology brush (BC-202D-2010, 2 mm brush diameter, 10 mm brush length, working length 1150 mm) bronchial brushings were obtained for microarray analysis. A bronchial brush was guided through the K-203 guide sheath within the bronchoscope. Once in position, the brush was gently rotated to collect mucosal cells. The brush was then removed through the guide sheath.
Bronchial lavage - BAL collection was performed using 4 x 60 mL aliquots (240mL in total) of 0.9 % saline (Nebusal 7 %) pre-warmed. Each aliquot was immediately recovered by gentle negative pressure using a suction pump or directly into a syringe and collected into a container cooled in ice.
Bronchial brushing - Utilizing an endobronchial disposable Olympus cytology brush (BC-202D-2010, 2 mm brush diameter, 10 mm brush length, working length 1150 mm) bronchial brushings were obtained for microarray analysis. A bronchial brush was guided through the K-203 guide sheath within the bronchoscope. Once in position, the brush was gently rotated to collect mucosal cells. The brush was then removed through the guide sheath.
7
Biopsy Techniques for NSCLC Diagnosis
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The study participants included 184 patients with NSCLC who were pathologically diagnosed with a biopsy sample between September 2019 and May 2020 at the Kanagawa Cancer Center Hospital, Yokohama, Japan. The biopsy procedures used included TBB with EBUS-GS, endobronchial biopsy (EBB) under direct-vision forceps, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We retrospectively reviewed the medical records of all the patients included in this study and analyzed the pathological features of their biopsy samples. We obtained ethical approval from the Kanagawa Cancer Center Hospital, Japan (2019EKI-48), and patient confidentiality was maintained. The TBB samples were obtained with small (small EBUS-GS; FB-233D; Olympus Medical Systems, Tokyo, Japan) or large forceps (large EBUS-GS; FB-231D; Olympus Medical Systems). The EBB samples were obtained with biopsy forceps (Radial Jaw 4; Boston Scientific Corporation, Natick, MA, USA). The EBUS-TBNA samples were obtained with 22-gauge (22G) aspiration needles (Expect™ Pulmonary E00558220, Boston Scientific Corporation).
8
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.
9
Endobronchial Ultrasound-Guided Navigational Biopsy
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All ENB procedures were performed using the SuperDimensionTM navigation system version 7.1 (Medtronic, Minneapolis, MN, USA). All additional procedural decisions, including choice of biopsy tools (forceps, needle, cytobrushes, bronchial lavage), order of biopsy tool use and use of fluoroscopy (confirmed with frontal images), were performed at the operator’s discretion. In all three centers, intravenous Midazolam and Fentanyl were used for sedation, and all procedures were performed using Olympus (190F) bronchoscopes, rEBUS probes were Olympus UMS20-20R and forceps were Olympus FB-231D.
The location of the lesions (central, middle, peripheral) were recorded based on the definition used in the NAVIGATE study [15 (link)], with peripheral lesions defined as lesions in the peripheral outer third of the lungs and the central lesions located in proximity to the hilum.
All operators used rEBUS as a standardized part of the ENB procedure whenever possible. There was no access to rapid onsite evaluation of cytological material (ROSE). All procedures were performed under conscious sedation and any adverse events related to the procedures were recorded. None of the pulmonologists had access to supervision by experienced ENB operators.
The location of the lesions (central, middle, peripheral) were recorded based on the definition used in the NAVIGATE study [15 (link)], with peripheral lesions defined as lesions in the peripheral outer third of the lungs and the central lesions located in proximity to the hilum.
All operators used rEBUS as a standardized part of the ENB procedure whenever possible. There was no access to rapid onsite evaluation of cytological material (ROSE). All procedures were performed under conscious sedation and any adverse events related to the procedures were recorded. None of the pulmonologists had access to supervision by experienced ENB operators.
10
Cryoprobe-guided Bronchoscopy Sampling Techniques
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According to the different guided bronchoscopy methods, samples harvested by a 1.1-mm cryoprobe (20402-401; Erbe, Tübingen, Germany) were retrieved as follows: (1) the cryoprobe was removed from the K-203 GS or EWC, keeping the standard bronchoscope and GS/EWC in situ to facilitate repeated biopsy and reduce bleeding; (2) the cryoprobe was removed en bloc with the K-201 GS, keeping the thin bronchoscope in situ to handle bleeding under direct vision; and (3) the cryoprobe and ultrathin bronchoscope were removed together. A CB-first biopsy sequence with a freezing time of 3–5 s was advised because GGO lesions are more prone to bleed than solid lesions during biopsy, which may impact CB effectiveness [14 (link)].
Conventional biopsy, including FB (FB-233D or FB-231D; Olympus) and brushing (BC-204D or BC-202D; Olympus), was also performed according to the fluoroscopic images. A 1.9-mm forceps was combined with a standard or thin bronchoscope when appropriate tissue was not obtained using a 1.5-mm forceps. All procedures were performed by two experienced experts (Junxiang Chen and Jiayuan Sun). Three CB samples and 5–10 FB samples were recommended for pathological examination. GS flushing was used in cases using GS during examination. Finally, bronchoscopy was performed again to investigate airway bleeding. Rapid on-site cytopathological evaluations were not conducted.
Conventional biopsy, including FB (FB-233D or FB-231D; Olympus) and brushing (BC-204D or BC-202D; Olympus), was also performed according to the fluoroscopic images. A 1.9-mm forceps was combined with a standard or thin bronchoscope when appropriate tissue was not obtained using a 1.5-mm forceps. All procedures were performed by two experienced experts (Junxiang Chen and Jiayuan Sun). Three CB samples and 5–10 FB samples were recommended for pathological examination. GS flushing was used in cases using GS during examination. Finally, bronchoscopy was performed again to investigate airway bleeding. Rapid on-site cytopathological evaluations were not conducted.
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