title: Multimodality bronchoscopic imaging of recurrent respiratory papillomatosis.
abstract: OBJECTIVE
  Recurrent respiratory papillomatosis (RRP) of the central airways requires removal to potentially reduce recurrence and risk for malignant transformation. Analogous to the principles of treatment for early lung cancer, a precise determination of the extent of cartilage invasion could help guide therapeutic decisions and monitor response to treatment. The purpose of this study was to determine whether a bronchoscopy platform comprised of white light bronchoscopy (WLB), endobronchial ultrasound (EBUS), and optical coherence tomography (OCT) could identify layered microstructure of RRP and underlying cartilage.
  
  
  METHODS
  Case study.
  
  
  METHODS
  A bronchoscopy platform consisting of commercially available WLB, EBUS using a 7.5 MHz convex probe (BF-UC 160F; Olympus Optical Co. Ltd, Tokyo, Japan), and a time-domain OCT with front imaging and inside actuation (Niris Imaging System; Imalux Corp., Cleveland, OH) was used in a patient with tracheal stenosis from RRP. Findings are compared with results of histology and the characteristics of imaging modalities are discussed.
  
  
  RESULTS
  WLB revealed tracheal pedunculated lesions. EBUS showed a 1-cm hypoechogenic density corresponding to the papilloma, visualized above a hyperechogenic density corresponding to tracheal cartilage. There was no sonographic evidence of cartilage disruption or adjacent lymphadenopathy. OCT revealed a layer of heterogeneous light backscattering suggesting the mucosal papilloma, and a layer of high-degree scattering, corresponding to the central fibrovascular core noted on histology.
  
  
  CONCLUSIONS
  Layered microstructures of RRP and underlying airway cartilage can be identified using a combination of acoustic and optical bronchoscopic imaging modalities with different resolution and depth of penetration characteristics.
authors.affiliation: Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, California, USA. hcolt@uci.edu
authors.forename: Henri G
authors.initials: HG
authors.lastname: Colt
authors.forename: Septimiu D
authors.initials: SD
authors.lastname: Murgu
authors.forename: Bockhyun
authors.initials: B
authors.lastname: Jung
authors.forename: Yeh-Chan
authors.initials: YC
authors.lastname: Ahn
authors.forename: Matt
authors.initials: M
authors.lastname: Brenner
mesh_terms: D001999:Bronchoscopy; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D010212:Papilloma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D014134:Tracheal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014135:Tracheal Stenosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery