EVIS X1™ Respiratory Imaging Atlas
TXI™ Technology

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EVIS X1 Respiratory Atlas
EVIS X1™ Respiratory Imaging Atlas TXI™ Technology

Table of Contents

Fumihiro Asano, MD, PhD

Department of Pulmonary Medicine,

Gifu Prefectural General Medical Center

Disclaimer:

TXI™, RDI™, and NBI™ Technologies are not intended to replace histopathological sampling as a means of diagnosis
The positions and statements made herein by Dr. Asano, are based on Dr. Asano’s experiences, thoughts and opinions. As with any product, results may vary, and the techniques, instruments, and settings can vary from facility to facility. The content hereof should not be considered as a substitute for carefully reading all applicable labeling, including the Instructions for Use. Please thoroughly review the relevant user manual(s) for instructions, risks, warnings, and cautions. Techniques, instruments, and setting can vary from facility to facility. It is the clinician’s decision and responsibility in each clinical situation to decide which products, modes, medications, applications, and settings to use.
The BF-1TH1200 used in this case is not available in the US market at this time nor is there an established time for its release. The safety and effectiveness of this product and or the use of these products has not yet been established in the United States market.
The EVIS X1™ endoscopy system is not designed for cardiac applications. Other combinations of equipment may cause ventricular fibrillation or seriously affect the cardiac function of the patient. Improper use of endoscopes may result in patient injury, infection, bleeding, and/or perforation. Complete indications, contraindications, warnings, and cautions are available in the Instructions for Use (IFU)
Dr Asano, the authoring physician(s) of this presentation, are/ is a paid consultant(s) to Olympus Corporation

Procedure information

Scope: BF-1TH1200
Case:Right lung tumor
Location: Between the right intermediate trunk and the right upper lobe bronchus
Patient information: Female, 70 years old
Medical history:While she was receiving treatment for emphysema at a local clinic, chest X-ray revealed a right lung mass and pleural effusion. She was then referred to our institution.

1. Tumor in the right intermediate trunk
(WLI)

The upper left side marks the entrance of the right upper lobe. A nodular tumor with surface irregularities is visible in the right intermediate bronchus. Additionally, the surface of the tumor is uneven and displays a spiral tumor vessel (red dots).

2. Tumor in the right intermediate trunk
(TXI™ Technology)

When using the TXI™ technology mode, the longitudinal folds can be depicted with greater definition than with WLI, up until just before the tumor. The red dots on the tumor surface are also depicted clearly, while the intermediate trunk is obstructed by the tumor.

3. Tumor in the right intermediate trunk
(NBI™ Technology)

By utilizing the NBI™ technology feature, the capillaries on the surface of the tumor become distinctly visible. There is a suspected enlargement of the area located between the upper lobe bronchus and intermediate bronchus. No abnormal vessels are observed on the mucosa at the upper lobe side.

4. Tumor in the right intermediate trunk
(RDI™ Technology)

The RDI™ technology mode reveals no evidence of active bleeding from the tumor.

5. Lesion in the right upper lobe bronchus
(WLI)

A flat lesion with a white coating is observed at the entrance of the right upper lobe B². Transparency of the epithelium is lost in the same area, and the vessels under the epithelium cannot be observed.

6. Lesion in the right upper lobe bronchus
(TXI™ Technology)

TXI™ technology imaging reveals that the bridging fold, where the longitudinal folds are raised near the lesion, is more prominently enhanced compared to WLI. It is possible that the lesion has infiltrated into inner layer of bronchial wall to submucosa and some parts of the lesion might have infiltrated into epithelial layers.

Case Video

Pathological Findings

The tumor located in the intermediate trunk was biopsied endoscopically and diagnosed as squamous cell carcinoma with keratinization.
The tumor cells tested positive for p40 but negative for TTF-1.

Overall Comment

This case is a lung squamous cell carcinoma originating from beyond the intermediate bronchus, with suspected infiltration into the upper lobe bronchus wall from lymph node metastasis in the hilum. TXI™ technology has the advantage of observing not only abnormal findings such as red dots and bridging fold, but also the intricate vascular network of normal areas in greater detail compared to WLI. This makes it easier to comprehend the extent of the lesion’s infiltration.

Case 13: Tumor in the right upper lobe Case 15 : Tumor in the right upper lobe

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