Bronchobiliary fistula and lithoptysis after endoscopic retrograde cholangiopancreatography and liver biopsy in a patient with paroxysmal nocturnal hemoglobinuria.
Bronchobiliary fistula and lithoptysis after endoscopic retrograde cholangiopancreatography and liver biopsy in a patient with paroxysmal nocturnal hemoglobinuria.
复制标题
阵发性睡眠性血红蛋白尿患者进行内镜逆行胰胆管造影和肝活检后出现支气管胆瘘和碎石。
DOI：
10.1164/ajrccm.187.4.451a
复制
发表时间：
2013
影响因子：
24.7
通讯作者：
Choti,MichaelA
中科院分区：
文献类型：
--
作者：
Harnoss,JonathanM;Yung,Rex;Brodsky,RobertA;Hruban,RalphH;Boitnott,JohnK;Murphy,DavidJ;Yang,StephenC;Choti,MichaelA
We thank Drs. Maturu, Agarwal, and Rossi for their interest in our article (1). Drs. Maturu and Agarwal question the cost effectiveness of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) compared with standard bronchoscopy in the diagnosis of lung cancer. None of the patients included in our study had endobronchial disease, and we cannot agree with their statement that the vast majority of patients with lung cancer have abnormal endobronchial findings. Drs. Maturu and Agarwal also miss an important point regarding the utility of EBUS-TBNA in patients with lung cancer. Not only can EBUS-TBNA provide a lung cancer phenotype and genotype, but it also provides a highly accurate nodal stage, critical to determining the treatment options. EBUS-TBNA, therefore, provides considerable information in addition to that provided by bronchoscopy and may prevent the need for further investigations such as integrated positron emission tomography–computed tomography, endoscopic ultrasound–guided fine needle aspiration, and mediastinoscopy. We are currently investigating the clinical efficacy and cost effectiveness of EBUS-TBNA as an initial investigation after staging computed tomography scan in patients with suspected lung cancer (2).We agree with Dr. Rossi that the personalization of advanced non–small cell lung cancer (NSCLC) management has adjusted the spotlight onto tissue acquisition techniques and their interpretation. A paradox currently exists whereby patients with metastatic disease (in whom cancer phenotyping and genotyping is mandatory for best outcomes) have the smallest biopsies, whereas patients with considerably larger surgically resected specimens currently do not have systemic treatment tailored to their tumor. Dr. Rossi highlights the key role that the pathologist plays in
