Page 56 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED e-POSTER SESSION 03:
EBUS Bronchoscopy
THE UTILITY OF RAPID ON-SITE EVALUATION IN THE DIAGNOSIS OF LUNG CANCER DURING ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION
Despoina Malle1, Iraklis Titopoulos2, Eleftheria Konstantinou2
1 Acpath Laboratory of Clinical Cytology,Thessaloniki, Greece
2 Interventional Pulmonary Unit, European Interbalkan Medical Center, Thessaloniki, Greece
PP22
Mediastinal lymphadenopathy presents a diagnostic challenge. Rapid on-site evaluation (ROSE) is a rapid, real-time examination method. The aim of this study was to evaluate the impact of ROSE on adequate specimen sampling, rapid results and high diagnostic rate in patients who experienced EBUS-TBNA. We present the experience of the Interventional Pulmonology Unit of the European Interbalkan Medical Center, Athens Medical Group. A total of 243 patients, 128 males and 115 females, mean age 66,3 years, were included. All pts underwent EBUS-TBNA with ROSE using a 22-gauge needle. A number of 336 mediastinal lymph nodes, mainly at LN7 (N=182) and LN4R (N=87) station, as well as 42 mediastinal or hilar masses were totally sampled. All the aspirated materials were smeared onto glass slides, air dried and stained with Diff Quick for cytological evaluation. The remaining materials were rinsed into cytolyt solutions for processing with Thin Prep technique or preparing cell blocks. The histological biopsies were fixed in 10% formalin. Cytological and histological results were correlated for the evaluation of the accuracy of ROSE. We evaluated the diagnostic capacity of ROSE, by considering the histopathological examination as the diagnostic “gold standard”. The results showed: 1) final pathological examination revealed malignancy in 164 pts (67,48%), 2) from the total of 164 cases of malignancy, 149 (91%) cases were identified as a primary lung tumour.3)The most common malignancy was adenocarcinoma (40,2%) followed by small cell carcinoma (26,21%) and squamous cell carcinoma (10,97%). 4) 15 cases (9%) were identified as malignant tumor of extrapulmonary origin. Sensitivity of ROSE was 98,8% and specificity 98,75%, with negative predictive value (NPV) 97,53% and very high positive predictive value (PPV) 99,39%. On site evaluation was in agreement with definitive pathological diagnosis in 98,78% of cases. Repetition of the procedure was limited at 1,2% of cases. We conclude that ROSE improves significantly the diagnostic accuracy of EBUS-TBNA by ensuring adequate and representative samples.According to the literature the most important factor in determining the results of ROSE remains the cytopathologist’s and bronchoscopist’s experience.
PP23
Introduction: Transbronchial cryobiopsies (TBCB) are effective tools for diagnosing interstitial lung diseases. TBCB have been used for biopsying peripheral pulmonary lesions (PPL) as well. Obtaining large tissue samples is increasingly important for the diagnosis of PPLs, because large tissue specimens are essential for further immunohistochemical evaluation. The utility of the ultrathin bronchoscope, that can be advanced far peripheral, is limited because of the available biopsy instruments and tissue samples due to the small diameter of the working channel. The ultrathin cryoprobe (Firma Erbe, ED 1.1mm, Tübingen, Deutschland) compatible with the ultrathin bronchoscope is now available and used to investigate endobronchial ultrasound (EBUS)-guided transbronchial biopsy in PPLs.
Methods: Patients with peripheral pulmonary lung lesions less than 4cm in size were prospectively enrolled to receive transbronchial cryobiopsy.The lung lesions were reached with an ultrathin bronchoscope (BF-MP109F,
ED 3mm, Firma Olympus, Tokio, Japan) under EBUS guidance. Cryobiopsies were
performed using a flexible ultrathin cryoprobe to evaluate its feasibility and safety and
determine histologic diagnostic yield. In addition, the sample sizes received from the ultrathin cryoprobe were quantified in size and compared with biopsies obtained by a forceps (FB 19-C 120cm, Olympus, Tokio, Japan) and a cryoprobe (OD 1.9mm, 90cm, Erbe, Tübingen, Deutschland) from peripheral lung lesions composed from a historic collective.
Results: In all 35 patients (female:15/35,male:20/35,mean age 67,1 years) combining an ultrathin bronchoscope with the ultrathin cryoprobe to obtain EBUS-guided tissue samples delivered specimens that were suitable for histologic examination. The overall diagnostic yield was 71.4%. It rose with each of the first three biopsies (57.1%, 68.6%, 71.2%), but did not further increase with a fourth biopsy.The size of the samples obtained by the ultrathin cryoprobe was significantly lager (11.9 ±4,3mm2) than that of the samples obtained by the larger cryoprobe (9.1 ±2.9mm2; p=0.003) and by the forceps (3.9 ± 1.6mm2; p<0.001) in the historic cohort. No major complications occurred in this study. Mild bleeding occured in 4 cases and moderate bleeding in 6 cases,which required suction and further intervention (swap insertion),respectively. In one patient a small pneumothorax, which did not require thoracic drainage, occured. Conclusions: Performing EBUS-guided transbronchial cryobiopsies with the ultrathin cryoprobe for peripheral lung lesions is feasible and safe. The ultrathin cryoprobe gains sufficient tissue samples, that are significantly larger in size than forceps biopsies and cryobiopsies obtained with a larger probe.
EBUS-GUIDED TRANSBRONCHIAL CRYOBIOPSY IN PATIENTS WITH A PERIPHERAL PULMONARY LESION USING THE ULTRATHIN CRYOPROBE – A FEASIBILITY STUDY Franziska Hasselbring1, Mark Kriegsmann2, Felix Herth1, Ralf Eberhardt1,3
1 Department of Pneumology and Critical Care Medicine,Thoraxklinik, University of Heidelberg,Translational Lung Research Center Heidelberg (TLCR-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany 2 Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
3 Department of Pneumology and Intensive Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
56 6th European Congress for Bronchology and Interventional Pulmonology