What is the yield of EBUS-TBNA for re-evaluation of previously treated non-small-cell lung cancer?

BACKGROUND: Locoregional recurrence in lung cancer still remains an important problem. We aimed to indicate the effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for reevaluation in previously treated nonsmall cell lung cancer (NSCLC). METHODS: : NSCLC patients who underwent EBUS for rebiopsy of suspicious recurrent or progressive lesions between January 2010 and June 2017 were reviewed. Patients were categorized into two groups based on the previous treatment modalities: Group 1 (G1) consisted of patients who had been treated with chemoradiotherapy, and Group 2 (G2) consisted of patients who had undergone radical surgery. RESULTS: Of 115 patients, 100 patients enrolled in the study. Of 26 patients with 35 lymph nodes in G1, malignant cells were identified in thirteen patients (50%). Anthracosis was detected in the remaining. Malignancy was detected in 28 patients (37.8%) in G2. Thirty-threepatients were diagnosed as benign (24 anthracosis; 8 lymphocytes, and 1 granulomatous); 8 were not sampled, and inadequate material was obtained in five. The sensitivity, specificity, negative and positive predictive value, and overall diagnostic accuracy of EBUS-TBNA for rebiopsy in G1 were 84.8%, 100%, 89.1%, 100%, and 93.2%, respectively. These values were all perfect in G2. DISCUSSION: EBUS-TBNA could be preferred as a feasible and efficient procedure for rebiopsy in previously treated NSCLC patients.

Cigarette Smoking, and Blood Monocyte Count Correlate with Chronic Lung Injuries and Mortality.

Background: Cigarette smoking (CS)-related monocytosis contributes to the development of chronic lung injuries via complex mechanisms. We aim to determine correlations between measures of CS and monocytes, their capacities to predict chronic lung diseases, and their associations with mortality. Methods: A single-center retrospective study of patients undergoing surgical resection for suspected lung nodules/masses was performed. CS was quantified as cigarettes smoked per day (CPD), duration of smoking, composite pack years (CPY), current smoking status, and smoking cessation years. A multivariate logistic regression analysis was performed. Results: Of 382 eligible patients, 88% were ever smokers. In this group, 45% were current smokers with mean CPD of 27.2±40.0. CPY and duration of smoking showed positive linear correlations with percentage monocyte count. Physiologically, CPY was associated with progressive obstruction, hyperinflation, and reduced diffusion capacity (DLCO). Across the quartiles of smoking, there was an accumulation of radiologic and histologic abnormalities. Anthracosis and emphysema were associated with CPD, while lung cancer, respiratory bronchiolitis (RB), emphysema, and honeycombing were statistically related to duration of smoking. Analysis using consecutive CPY showed associations with lung cancer (≥10 and <30), fibrosis (≥20 and <40), RB (≥50), anthracosis and emphysema (≥10 and onwards). Percentage monocytes correlated with organizing pneumonia (OP), fibrosis, and emphysema. The greater CPY increased mortality across the groups. Significant predictors of mortality included percentage monocyte, anemia, GERD, and reduced DLCO. Conclusion: Indices of CS and greater monocyte numbers were associated with endpoints of chronic lung disease suggesting a participation in pathogenesis. Application of these easily available metrics may support a chronology of CS-induced chronic lung injuries. While a relative lesser amount of smoking can be associated with lung cancer and fibrosis, greater CPY increases the risk for emphysema. Monocytosis predicted lung fibrosis and mortality. Duration of smoking may serve as a better marker of monocytosis and associated chronic lung diseases.

Esophageal anthracosis occurred after treatment of esophageal tuberculosis secondary to mediastinal tuberculous lymphadenitis: a rare case report.

BACKGROUND: Anthracosis is a disease generally considered to be in the lungs resulting from exposure to industrial dust in the workplace. Esophageal anthracosis is a fairly rare phenomenon and shows a strong correlation with tuberculosis. Moreover, esophageal involvement in tuberculosis is also rare. We here present an extremely rare case in which follow-up gastroesophageal endoscopy revealed a mass with a sunken, black area in the center and raised ring-like pattern in the surrounding mucosa resembling malignant melanoma. Uncovering the patient's tuberculosis history finally avoided a misdiagnosis or overtreatment. CASE PRESENTATION: A 67-year-old male patient was admitted to the hospital due to "repeated chest pain for 1 month". Endoscopic ultrasonography and contrast-enhanced CT scans revealed a mass adjacent to the esophageal wall with unclear boundaries. Aspiration biopsy confirmed that esophageal tuberculosis was caused by nearby mediastinal tuberculous lymphadenitis. After a standard anti-tuberculosis treatment regimen, the patient achieved a favorable prognosis. The follow-up gastroesophageal endoscopy showed a sunken black lesion with elevated peripheral mucosa replacing the original tuberculous mass, which was thought to be anthracosis, a disease that rarely occurs in the esophagus. CONCLUSION: The diagnosis of tuberculosis should be taken into consideration when a submucosal mass appears in the middle part of the esophagus. Endoscopic ultrasonography can effectively contribute to a definite diagnosis. Moreover, this is the first case of esophageal anthracosis observed only 1 year after the treatment of tuberculosis, indicating esophageal anthracosis can be a short-term disease. The traction of the reduction of tubercular mediastinal lymph nodes after anti-tuberculosis treatment may create a circumstance for pigmentation or dust deposition.

An unusual finding in gastroesophageal surgery: gastric anthracosis.

We present the case of a patient with an unusual finding of gastric anthracosis during oncological surgery for gastric adenocarcinoma.

First Case Report Of Anca-Associated Vasculitis And Anthracosis Coexistence.

Anthracosis is a type of mild pneumoconiosis secondary to harmless carbon dust deposits. Although anthracosis was previously associated with inhaled coal particles, such as coal workers' pneumoconiosis, this hypothesis was later abandoned; pathology has been associated with inhaled dust particles. Our paper is the first case report of ANCA-associated vasculitis and anthracosis coexistence. In addition, it aims to highlight that histopathologically proven anthracotic granulomatous nodules can show high FDG uptake in PET/CT contrary to expectation. We present a case of a 73-year-old male with p-ANCA-associated vasculitis and anthracotic lung nodules accompanied by radiological and clinical findings. The patient got diagnosis with p-ANCA-associated vasculitis with serological and rheumatological tests. Atypically, the clinical findings of the patient were weak (No dyspnoea, cough or additional pulmonary complaints). Nodules were present on X-ray graphics and nodules' contours were irregular on CT. On PET/CT, SUV values of the nodules were high [12 kBq/mL]. Histopathological specimens showed multiple lung granulomas including anthracosis particles. Until performing the biopsy, we could not exclude the possibility of malignancy. Conclusion: When lung involvement of vasculitis is superimposed by anthracosis, it can create granulomas with high SUV values. The relationship between anthracosis and parenchymal lung diseases is a current topic and many recently published papers are present on this subject. To the best of our knowledge, our paper is the first paper showing the relationship between parenchymal involvement of vasculitis and anthracosis in the literature. Environmental pollution and dust particles are the known reasons for anthracosis particles in the nodules. It is open to future research on whether air pollution triggers new atypical cases or not.

F-18 FDG PET/CT findings of intrathoracic lymphadenopathy in EBUS-TBNA-proven anthracosis.

Introduction: Anthracosis is a kind of pneumoconiosis that may cause parenchymal and bronchiolar injury and mediastinal lymphadenopathy. In this study, we aimed to investigate F-18 fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) findings of patients who had anthracosis diagnosis with endobronchial ultrasonography (EBUS). Materials and Methods: The patients who underwent EBUS-transbronchial needle aspiration (TBNA) and were diagnosed with anthracosis in a five year period were included in the study. The diagnosis was confirmed by surgery/ radiological stability. Demographic characteristics such as age, sex, smoking status, and occupational and environmental exposures were recorded. The characteristics: diameter (short axis), shape, central hilar structure, necrosis sign, echogenicity, and margins measured by EBUS, and maximum standardized uptake value (SUV max value) by PET/CT of the lymph node stations were evaluated. Result: One hundred thirty-three patients with 239 lymph node stations were investigated. Biomass exposure was detected in nearly half of the patients (n= 55, 41.4%) and occupational exposure was detected in 32 (24.1%) patients. Eighty-six (64.7%) patients had more than 20 packs/years of smoking history. Most of the lymph nodes (80.8%) have a higher PET/CT SUV max value than 2.5. The mean diameter of the lymph nodes measured by thorax CT (16.2 ± 6.5 mm) and EBUS (12.7 ± 5.6 mm) did not show any difference according to PET/CT SUV max value of ≥2.5 or not (p> 0.05). Subcarinal lymph nodes were significantly larger than the other lymph node stations. The lymph nodes with necrosis sign (p= 0.028), absence of central hilar structure (p= 0.013), and heterogeneous echogenicity (p= 0.008) were statistically significantly related to higher SUV max value. Conclusions: Anthracosis should be considered as a cause of false-positive PET/CT results for mediastinal lymph nodes, especially in patients with a history of occupational and environmental exposure including biomass and smoking.

A pilot study on the lung morphology of shelter dogs in relation to air pollution in Trinidad.

OBJECTIVE: To identify and characterize the gross and histological lesions associated with air pollution in the lungs of dogs from various locations in Trinidad. ANIMALS: 56 fresh lungs were obtained from already euthanized adult dogs collected from different locations in Trinidad at the Trinidad and Tobago Society for the Prevention of Cruelty to Animals. PROCEDURES: Lung specimens were examined grossly and tissue samples were taken for routine histologic examination. RESULTS: Histological examination showed that 51.8% of the dogs had evidence of anthracosis. Dogs with anthracosis had greater median lesion scores compared to dogs without anthracosis (P = .022). There was no association between the presence of anthracosis and any other lesion in this study (P > .05). CLINICAL RELEVANCE: There was evidence that dogs with anthracosis had a greater degree of nonspecific lung histologic lesions. Using the dog as a sentinel model for human exposure in Trinidad, our findings indicate that environmental air pollution may also have an effect on the respiratory health of the human population. It is important for the public to be aware of air pollution, and the government of Trinidad and Tobago should develop an intervention protocol along with veterinary and human medical epidemiologists to reduce air pollution in the country.

Inflammation and fibrosis in the coal dust-exposed lung described by confocal Raman spectroscopy.

Background: Coal workers' pneumoconiosis (CWP) is an occupational disease that severely damages the life and health of miners. However, little is known about the molecular and cellular mechanisms changes associated with lung inflammation and fibrosis induced by coal dust. As a non-destructive technique for measuring biological tissue, confocal Raman spectroscopy provides accurate molecular fingerprints of label-free tissues and cells. Here, the progression of lung inflammation and fibrosis in a murine model of CWP was evaluated using confocal Raman spectroscopy. Methods: A mouse model of CWP was constructed and biochemical analysis in lungs exposed to coal dust after 1 month (CWP-1M) and 3 months (CWP-3M) vs control tissues (NS) were used by confocal Raman spectroscopy. H&E, immunohistochemical and collagen staining were used to evaluate the histopathology alterations in the lung tissues. Results: The CWP murine model was successfully constructed, and the mouse lung tissues showed progression of inflammation and fibrosis, accompanied by changes in NF-κB, p53, Bax, and Ki67. Meanwhile, significant differences in Raman bands were observed among the different groups, particularly changes at 1,248, 1,448, 1,572, and 746 cm-1. These changes were consistent with collagen, Ki67, and Bax levels in the CWP and NS groups. Conclusion: Confocal Raman spectroscopy represented a novel approach to the identification of the biochemical changes in CWP lungs and provides potential biomarkers of inflammation and fibrosis.

Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection.

BACKGROUND: Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality. METHODS: Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis. RESULTS: In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84-9.25]). CONCLUSIONS: In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population.

Altered lymphatic structure and function in pleural anthracosis: negative role in skip N2 metastasis.

OBJECTIVES: The present study investigated whether or not pleural anthracosis is associated with changes in the pleural lymphatic structures or function, which would interfere with nodal skip metastasis. METHODS: This study comprised 2 different case series. In the first series, we observed pleural lymphatic drainage using near-infrared fluorescent endoscopy by the subpleural injection of indocyanine green immediately after thoracotomy for lung cancer. We also performed a histological assessment of the pleura. In the second series, we reviewed the nodal metastatic pattern (skip or non-skip metastasis) in pathological N2 lung cancer involving the pleura. These findings were compared with the severity of pleural anthracosis, which was quantified by thoracoscopic vision and a software-based imaging analysis. RESULTS: In the first series (n = 42), pleural lymphatic drainage was not visualized in 19 (45%) patients who had relatively severe anthracosis, while it was visualized in the remaining 23 (55%) patients who had relatively minimal anthracosis. Histologically, severe anthracosis was associated with pleural thickening accompanied by a decreased incidence of straight-running lymphatic vessels and, in turn, an increased incidence of short lymphatic vessels, which was suggested to be the result of pleural remodelling. In the second series (n = 53), a skip metastatic pattern was found in 24 (45%) patients who predominantly had less-severe anthracosis, while a non-skip metastatic pattern was found in 29 (55%) patients who predominantly had severe anthracosis. CONCLUSIONS: Pleural anthracosis was associated with pathological changes in the pleural lymphatics and decreased pleural lymphatic drainage, thereby interfering with nodal skip metastasis.

A systematic review and meta-analysis on international studies of prevalence, mortality and survival due to coal mine dust lung disease.

BACKGROUND: Coal mine dust lung disease comprises a group of occupational lung diseases including coal workers pneumoconiosis. In many countries, there is a lack of robust prevalence estimates for these diseases. Our objective was to perform a systematic review and meta-analysis of published contemporary estimates on prevalence, mortality, and survival for coal mine dust lung disease worldwide. METHODS: Systematic searches of PubMed, EMBASE and Web of Science databases for English language peer-reviewed articles published from 1/1/2000 to 30/03/2021 that presented quantitative estimates of prevalence, mortality, or survival for coal mine dust lung disease. Review was conducted per PRISMA guidelines. Articles were screened independently by two authors. Studies were critically assessed using Joanna Briggs Institute tools. Pooled prevalence estimates were obtained using random effects meta-analysis models. Heterogeneity was measured using the I2 statistics and publication bias using Egger's tests. RESULTS: Overall 40 studies were included, (31 prevalence, 8 mortality, 1 survival). Of the prevalence estimates, fifteen (12 from the United States) were retained for the meta-analysis. The overall pooled prevalence estimate for coal workers pneumoconiosis among underground miners was 3.7% (95% CI 3.0-4.5%) with high heterogeneity between studies. The pooled estimate of coal workers pneumoconiosis prevalence in the United States was higher in the 2000s than in the 1990s, consistent with published reports of increasing prevalence following decades of declining trends. Sub-group analyses also indicated higher prevalence among underground miners, and in Central Appalachia. The mortality studies were suggestive of reduced pneumoconiosis mortality rates over time, relative to the general population. CONCLUSION: The ongoing prevalence of occupational lung diseases among contemporary coal miners highlights the importance of respiratory surveillance and preventive efforts through effective dust control measures. Limited prevalence studies from countries other than the United States limits our understanding of the current disease burden in other coal-producing countries.

Scary black nodes.

Anthracosis is associated with smoking, air pollution, tuberculosis infection, and exposure to biomass. Anthracosis commonly involves bronchial trees and rarely lymph nodes. We report an unusual case of a 44-year-old female presented with painless supraclavicular swelling for 1 month. A fine-needle aspiration cytology examination was done from the swelling. The smears were markedly cellular and showed the presence of sheets, clusters, and singly scattered round to oval cells with mild anisonucleosis, fine to coarse chromatin, few with tiny nucleoli, and cytoplasm containing abundant black coarse pigment. At many places, the fibroblasts and lymphocytes were admixed with histiocytes containing pigment. The cell block made showed cell morphology similar to that described above for fine-needle aspiration smears. The immunohistochemistry on the cell block and special stains helped to ascertain the nature of pigment and cell type. The final diagnosis of the anthracofibrosis lymph node was made. Due to its rarity, its awareness is a must; otherwise, it can be mistaken for metastatic deposits from malignant melanoma and can result in unnecessary surgical intervention and morbidity. However, it shall be considered one of the differential diagnoses of neck nodes in nonsmoker females with a history of domestic wood smoke exposure.

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes.

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. MATERIAL AND METHOD: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ±â€Š2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ±â€Š7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. CONCLUSION: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.

Progression of coal workers' pneumoconiosis absent further exposure.

OBJECTIVES: The natural history of coal workers' pneumoconiosis (CWP) after cessation of exposure remains poorly understood. METHODS: We characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression. RESULTS: A total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR. CONCLUSIONS: This study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.

Simultaneous use of FDG-18 and 68Ga-citrate PET/CT for the differential diagnosis of sarcoidosis and malignant disease.

A 67-year-old male presented with cutaneous rash, lassitude and fatigue of three weeks. Personal history included psoriasis and sarcoidosis. Physical examination revealed macular rash on the anterior chest wall. Laboratory results were within normal limits. Chest X-ray showed normal findings. Pulmonary function tests demonstrated a mild obstructive pattern and a mild decrease in DLCO/VA. Thorax CT revealed two nodules in the right upper and middle lobe. 68Ga-citrate PET/CT did not demonstrate any active inflammatory reaction associated with sarcoidosis while 18F-FDG PET/CT revealed increased FDG uptake in the right middle lobe, upper division bronchus and in the left lower abdominal quadrant. Histopathologic examination of the colon biopsy was compatible with adenocarcinoma and bronchoscopic biopsy of the lung lesions revealed nonspecific granulomatous inflammation. BAL cytology was normal while BAL culture did not grow any pathologic organisms. Simultaneous use of 18F-FDG and 68Ga-citrate PET/CT was the hallmark for the final diagnosis in our patient. While FDG/PET has detected the pulmonary and colonic malignant foci in our patient, 68Ga-citrate PET/CT excluded the presence of active granulomatous inflammation of sarcoidosis. Simultaneous utility of these two imaging modalities in patients with sarcoidosis is of great importance in terms of guiding the clinician towards the accurate diagnostic pathway which is the hallmark for final diagnosis, especially in the presence of concomitant malignant disease.

The utility of elastography during EBUS-TBNA in a population with a high prevalence of anthracosis.

BACKGROUND: Ultrasound elastography, is a pioneer sonographic modality that is conducted during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in order to increase the accuracy of sampling location. The current study aims to evaluate the usefulness of elastography during EBUS-TBNA in a population with a high prevalence of anthracosis. METHODS: This prospective single-blinded study was performed on 69 lymph nodes (LNs) of patients with mediastinal lymphadenopathy undergoing EBUS-TBNA and EBUS-elastography from October 2017 to July 2018. The stiffness level of the tissue was translated into a color to demonstrate the hardness of tissue. Blue and total areas of each section were measured to calculate the hardness of each LN. RESULTS: Sixty-nine LNs were evaluated by elastography. Twenty percent of LNs were malignant. There was a statistical difference between malignant and non-malignant nodes based on color dominancy (P = 0.032). However, with the exclusion of anthracosis nodes from the analysis, the difference was more significant (P < 0.001). Moreover, when the blue dominancy was used as the predictor of malignancy or anthracosis, the results showed a significant correlation (P < 001). CONCLUSION: The usefulness of elastography in selecting the hardest area of tissue that is appropriate for diagnosing diseases has been proven previously. Since in countries with a high prevalence of anthracosis, blue color achieved using elastography predicts either malignancy or anthracosis so, cases with blue dominancy of LNs in elastography and the white color in the EBUS-TBNA indicate anthracosis-caused calcification should be reconsidered.

Colletotrichum Species Associated with Japanese Plum (Prunus salicina) Anthracnose in South Korea.

A total of 24 Colletotrichum isolates were isolated from diseased Japanese plum (Prunus salicina) fruits showing chlorotic regions with whitish-brown sunken necrotic lesions and phylogenetic relationships among the collected Colletotrichum isolates were determined. A subset of 11 isolates was chosen for further taxonomic study based on morphology and molecular characteristics identified using the internal transcribed spacer (ITS) and beta-tubulin (TUB2) genes. Isolates in the C. acutatum complex were analyzed using partial sequencing of five gene regions (ITS, GAPDH, ACT, TUB2, and CHS), and C. gloeosporioides sensu lato (s.l.) isolates were analyzed using seven gene regions (ITS, TUB2, GAPDH, ACT, CAL, CHS-1, and ApMat). Morphological assessments in combination with phylogenetic analysis delineated four species of Colletotrichum including C. gloeosporioides sensu stricto (s.s.), C. nymphaeae, C. foriniae, and C. siamense; these data identify Colletotrichum fioriniae and C. siamense two new species associated with plum anthracnose in South Korea. Finally, the pathogenicity of these four species in the development of plum anthracnose in South Korea was confirmed by inoculations of plum fruit.