Page 53 - ECBIP 2021_Program

MODERATED e-POSTER SESSION 03:
EBUS Bronchoscopy
PP18
Introduction: Endobronchial-ultrasound-guided-transbronchial-needle-aspiration (EBUS-TBNA) came to develop the sampling of mediastinal lymph nodes and mediastinal lung cancer staging. Nevertheless EBUS-TBNA may not be cost-effective in smaller units. Consequently, EBUS-TBNA is not widely available as flexible bronchoscopy (FB). Conventional TBNA (cTBNA) is a minimally invasive procedure with high yield for cancer diagnosis and lung cancer staging when sampling large lymph nodes in favorable locations. However, it remains as an underused procedure mainly due to vascular puncture risk.
We aimed to document cTBNA effectiveness in lung cancer suspicion.
Methods: Clinical files of all patients submitted to FB over 40 months of activity in our bronchoscopy unit were reviewed. Patients who underwent cTBNA due to lung cancer suspicion were selected. Only cTBNA performed in lymph node stations were selected. Demographic data, results and complications were analysed.
Results: During the study period 1101 FB were performed. Twenty-two patients were included and 25 cTBNA accounted (in two exams a double puncture was performed). Mean age was 70.5-year-old and 68.2% (n=15) were males. All exams were performed under conscious sedation with midazolam and/or fentanyl.The most frequently aimed lymph station was region 7 (68%; n=17), followed by 10R (16%, n=4). The mean number of punctured lymph station per procedure was 1.13. In 15 patients (68.2%) adequate material was obtained and cancer diagnosis was established in all of these. In 10 exams, bronchial biopsies (BB) were performed due to endobronchial tumor signs. However, in two exams only cTBNA findings were diagnostic. In one exam, bronchial biopsy defined the diagnosis of adenocarcinoma versus cTBNA finding of non-small cell carcinoma and in another only BB defined colonic adenocarcinoma versus cTBNA adenocarcinoma. Considering overall pathological cTBNA findings: adenocarcinoma – 9 (40.9%); non-small cell carcinoma – 2 (9.1%); squamous cell carcinoma – 1 (4.5%); prostatic adenocarcinoma – 1 (4.5%); neuroendocrine cell carcinoma – 2 (9.1%). N2 status was established in 10 patients (45.5%) and N3 in one. No major complications were observed. Minor bleeding occurred in 5 cases and simple resolution with instillation of cold saline solution, adrenaline or endobronchial aminocaproic acid was achieved. No exam interruptions were registered.
Conclusions: Advances in minimally invasive mediastinal staging have been applied in recent years. Nevertheless, FB and cTBNA remain useful and safe in the setting of lung cancer. cTBNA might also be useful even when endobronchial lesions are identified and biopsied. Overall complications are infrequent which encourages its execution in smaller bronchoscopy units.
PP19
Rapid on-site cytologic evaluation (ROSE) of EBUS-TBNA samples can reliably assess adequacy of cytologic material for diagnosis, staging and molecular analysis of lung cancer. A pulmonologist can be adequately trained to perform ROSE. Several randomized studies have shown that using ROSE can lead to reduction of transbronchial biopsies.
Aim: To compare the performance of an appropriately trained pulmonologist and the cytopathologist (gold standard) for assessing EBUS-TBNA sample adequacy and evaluate an algorithm of handling materials by assessment of their adequacy. We also aimed to assess the rate of avoidance of transbronchial biopsies given the information provided by ROSE.
Method: Patients presenting with mediastinal or hilar lymphadenopathy and/or central or peripheral lung lesions were prospectively recruited. After each station sampling by EBUS-TBNA certain slides were prepared for ROSE using the Diff Quik staining method and the remaining were kept in ethanol in order to be examined by the cytopathologist. The Diff Quik slides were evaluated for sample adequacy by a trained pulmonologist. In the presence of adequate material (i.e., malignant cells or lymphocytes on the slide as well as presence of adequate histology core biopsy) transbronchial biopsy was omitted, thus avoiding potential complications. Evaluation of all prepared slides (including Diff Quik stained) was afterwards performed by the cytopathologist and results of both assessments were compared to each other.
Results: 100 patients were recruited (60 males). 210 lymph node stations (4R, 4L, 7, 8, 10R, 10L, 11 R, 11L), as well as 11 central lung lesions were punctured by EBUS-TBNA. Concordance between pulmonologist and cytopathologist for EBUS TBNA sample adequacy (malignant cells or lymphocytes) was substantial (85%, Cohen kappa 0,71). In 70 patients the primary lung lesion was solitary while 6 had multiple lesions and in 24 only enlarged lymph nodes were present without parenchymal lesions. 52 patients had indication for transbronchial biopsy which was performed only in 24 (46%) due to decision taken on the basis of sample adequacy derived by ROSE. Sensitivity of pulmonologist for sample adequacy was 90%, specificity 81%, false positive rate 18% and false negative rate 9%.
Conclusion: A trained pulmonologist can reliably assess EBUS-TBNA sample adequacy without the presence of on site cyto-pathologist. Our particular algorithm reduced the need for transbronchial biopsies by 46% without compromising our diagnostic accuracy.
CONVENTIONAL TRANSBRONCHIAL NEEDLE ASPIRATION IN THE ERA OF EBUS-TBNA – A SINGLE CENTER EXPERIENCE
João Rodrigues, Mário Pinto, Ana Santos, Dionísio Maia, Rita Gerardo, Alexandra Mineiro, João Cardoso
Hospital De Santa Marta, Lisboa, Portugal
RAPID ON-SITE EVALUATION (ROSE) FOR EBUS TBNA BY TRAINED PULMONOLOGIST AND CYTOPATHOLOGIST. CAN THEY BE INTEGRATED?
Philip Emmanouil1, Vlasios Vitsas1, Nektarios Anagnostopoulos2, Loukas Kaklamanis1, Grigorios Stratakos2
1 Interventional Pulmonology Unit, Mediterraneo Hospital, Athens, Greece
2 Interventional Pulmonology Unit, 1st Department of Pulmonary Medicine, University of Athens , Athens, Greece
ECBIP 2021 53
6th European Congress
for Bronchology and Interventional Pulmonology
OCTOBER ECBIP 15 - 17
ATHENS - GREECE 2021
Book of Abstracts