1
|
Dotson T, Bellinger C, Su J, Hansen K, Parks GE, Cappellari JO, Craddock L, Clark H, Howard C, Petty WJ, Prakash B, Watabe K, Chan M, Hovda J, Miller LD, Ruiz J. Feasibility of lung cancer RNA acquisition from a single transbronchial or transthoracic needle pass (FASTT trial). Lung Cancer 2018; 127:6-11. [PMID: 30642553 DOI: 10.1016/j.lungcan.2018.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/03/2018] [Accepted: 11/19/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION RNA isolation from tumor tissue is used for biomarker analyses and validation. Limited diagnostic material from small volume biopsies combined with an increasing demand for standard histologic, molecular characterization, and next generation sequencing applications often leads to limited material for research. We sought to evaluate small volume sampling of lung cancer tissue collected from a single needle pass during a diagnostic procedure and determine if it can provide RNA of acceptable quantity and quality. METHODS We enrolled 140 patients with probable primary bronchogenic carcinoma and collected RNA from a dedicated FNA aspiration. Total RNA (ηg), RNA integrity number (RIN), and %Mass in base pairs were evaluated from each patient sample. A customized nanoString nCounter® 95-gene panel was used to profile the expression patterns of feature NSCLC genes. We compared gene expression patterns that distinguish lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) in our cohort with a corresponding Cancer Genome Atlas (TCGA) NSCLC datasets. RESULTS Of the 149 patients consented. RNA-extraction was performed in 101 eligible patients. A satisfactory total RNA mass and RIN was quantified for all samples with a similar distribution among cellular subtypes. Mean %-Mass over 300 base pairs was noted for all specimens and 96% of samples met criteria to perform genetic evaluation with our commercialized gene expression assay. The FNA-derived transcriptomic results showed excellent consistency with the TCGA counterparts, and the differential expression pattern of LUAD vs LUSC subtypes were highly similar. DISCUSSION In this study, RNA retrieval from a single-pass FNA regardless of procedural approach showed equivalence and suitability for gene expression assessments. RNA extraction from small volume samples has the potential to provide valuable material for genetic profiling.
Collapse
Affiliation(s)
- Travis Dotson
- Department of Medicine, Pulmonary & Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Christina Bellinger
- Department of Medicine, Pulmonary & Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jing Su
- Department of Biostatistics Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kris Hansen
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Graham E Parks
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - James O Cappellari
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Lou Craddock
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Hollins Clark
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Clifford Howard
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Jeffrey Petty
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Bharat Prakash
- Department of Medicine, Pulmonary & Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Michael Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jonathan Hovda
- Department of Medicine, Pulmonary & Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Lance D Miller
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jimmy Ruiz
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States; W.G. (Bill) Hefner VA Medical Center, Salisbury, NC, United States.
| |
Collapse
|
2
|
Wang S, Ye Q, Tu J, Song Y. The location, histologic type, and stage of lung cancer are associated with bleeding during endobronchial biopsy. Cancer Manag Res 2018; 10:1251-1257. [PMID: 29844704 PMCID: PMC5962311 DOI: 10.2147/cmar.s164315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Several risk factors have been proposed for bleeding during bronchoscopy, including immunosuppression, thrombocytopenia, pulmonary arterial hypertension, and mechanical ventilation. However, research on bronchoscopic biopsy-induced bleeding in the population of lung cancer without these “proposed risk factors” remains lacking. Patients and methods A total of 531 lung cancer patients with endobronchial biopsy (EBB) were enrolled in this retrospective observational study. Patients were divided into biopsy-induced bleeding group (n=162) and non-bleeding group (n=369). Using multiple logistic regression, independent risk factors for EBB bleeding were identified. Results The location, histologic type, and stage of lung cancer were independently associated with EBB bleeding, as assessed by multiple logistic regression (p<0.05) in patients with lung cancer. Moreover, during EBB, the risk of bleeding of endobronchial lesions located in the central airways was significantly higher when compared to that in peripheral bronchi (odds ratio [OR], 2.211; 95% CI, 1.276–3.830; p=0.005). In addition, squamous cell carcinoma and small-cell lung carcinoma were more susceptible to bleeding during biopsy when compared with adenocarcinoma (OR, 3.107, 2.389; 95% CI, 1.832–5.271, 1.271–4.489; p=0.000, p=0.007, respectively). Patients with advanced lung cancer were more prone to EBB bleeding compared to patients in the early stages of disease (OR, 1.583; 95% CI, 1.065–2.354; p=0.023). Conclusion Lesions located in the central airways, histologic types of squamous cell carcinoma and small-cell lung carcinoma, and stages of advanced lung cancer were the independent risk factors for hemorrhage in EBB.
Collapse
Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China.,Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Qian Ye
- Department of Medical Records Quality Management, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China
| | - Junwei Tu
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Impact of a Non-small Cell Lung Cancer Educational Program for Interdisciplinary Teams. Chest 2017; 153:876-887. [PMID: 29246769 DOI: 10.1016/j.chest.2017.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Successful implementation of non-small cell lung cancer (NSCLC) evidence-based guideline recommendations requires effective educational programs that target all clinicians from interdisciplinary teams. This study describes and evaluates the Engaging an Interdisciplinary Team for NSCLC (GAIN 3.0) experiential learning-based educational curriculum. METHODS GAIN 3.0 was designed to enhance interdisciplinary collaboration for effective NSCLC diagnosis, assessment, and treatment. The program used a flipped classroom model that included an e-learning component prior to a live 6-hour interactive program. The interactive program included hands-on simulations, small group workshops, gamification, and case discussions. Participants included academic and community members of multidisciplinary lung cancer teams. Assessments included an online baseline survey, a pretest and posttest, a program evaluation, a long-term survey (LTS), and on-site faculty evaluation of participants. RESULTS Of 416 attendees to 13 live GAIN 3.0 programs (nine in the United States and four in Europe), 304 (73%) completed the pretest and 187 (45%) completed the posttest. Out of a perfect score of 12 points, program participants had a mean test score of 6.3 ± 2.1 on the pretest (52%) and 7.8 ± 2.1 on the posttest (65%) (P = .03). There was an overall knowledge increase of 13% from pretest to posttest. Most LTS respondents (65%) rated the GAIN 3.0 live programs as "high impact." On the LTS, the areas with the greatest gains in participants who had very high confidence were communication across disciplines, use of a team-based approach, and personalized treatment. CONCLUSIONS GAIN 3.0 was a highly successful interdisciplinary activity that improved participants' knowledge, competence, and likely the clinical care provided to patients with NSCLC.
Collapse
|
4
|
Lim C, Sekhon HS, Cutz JC, Hwang DM, Kamel-Reid S, Carter RF, Santos GDC, Waddell T, Binnie M, Patel M, Paul N, Chung T, Brade A, El-Maraghi R, Sit C, Tsao MS, Leighl NB. Improving molecular testing and personalized medicine in non-small-cell lung cancer in Ontario. ACTA ACUST UNITED AC 2017; 24:103-110. [PMID: 28490924 DOI: 10.3747/co.24.3495] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although molecular testing has become standard in managing advanced nonsquamous non-small-cell lung cancer (nsclc), most patients undergo minimally invasive procedures, and the diagnostic tumour specimens available for testing are usually limited. A knowledge translation initiative to educate diagnostic specialists about sampling techniques and laboratory processes was undertaken to improve the uptake and application of molecular testing in advanced lung cancer. METHODS A multidisciplinary panel of physician experts including pathologists, respirologists, interventional thoracic radiologists, thoracic surgeons, medical oncologists, and radiation oncologists developed a specialty-specific education program, adapting international clinical guidelines to the local Ontario context. Expert recommendations from the program are reported here. RESULTS Panel experts agreed that specialists procuring samples for lung cancer diagnosis should choose biopsy techniques that maximize tumour cellularity, and that conservation strategies to maximize tissue for molecular testing should be used in tissue processing. The timeliness of molecular reporting can be improved by pathologist-initiated reflex testing upon confirmation of nonsquamous nsclc and by prompt transportation of specimens to designated molecular diagnostic centres. To coordinate timely molecular testing and optimal treatment, collaboration and communication between all clinicians involved in diagnosing patients with advanced lung cancer are mandatory. CONCLUSIONS Knowledge transfer to diagnostic lung cancer specialists could potentially improve molecular testing and treatment for advanced lung cancer patients.
Collapse
Affiliation(s)
- C Lim
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto
| | - H S Sekhon
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa
| | - J C Cutz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton
| | - D M Hwang
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - S Kamel-Reid
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto.,Molecular Diagnostics Laboratory, University Health Network, Toronto
| | - R F Carter
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton.,LifeLabs Genetics, Toronto
| | - G da Cunha Santos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto
| | - M Binnie
- Division of Respirology, University of Toronto, Toronto
| | - M Patel
- Division of Respirology, Trillium Health Partners, Mississauga
| | - N Paul
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto
| | - T Chung
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto
| | - A Brade
- Department of Radiation Oncology, University of Toronto, Toronto
| | - R El-Maraghi
- Simcoe Muskoka Regional Cancer Centre, Barrie; and
| | - C Sit
- Lung Cancer Canada, Toronto, ON
| | - M S Tsao
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - N B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto
| |
Collapse
|
5
|
Girard P, Caliandro R, Seguin-Givelet A, Lenoir S, Gossot D, Validire P, Stern JB. Sensitivity of Cytology Specimens From Bronchial Aspirate or Washing During Bronchoscopy in the Diagnosis of Lung Malignancies: An Update. Clin Lung Cancer 2016; 18:512-518. [PMID: 28007409 DOI: 10.1016/j.cllc.2016.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/08/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Routine collection of cytology specimens from bronchial aspirate or washing is thought to increase the sensitivity of bronchoscopy for diagnosing malignant lung lesions. However, the added value of this practice has not been reappraised in a context of changing epidemiology. PATIENTS AND METHODS In a retrospective monocenter study, all cytology specimens from bronchial aspirate or washing collected between May 2011 and December 2014 and the corresponding patients' files were reviewed. The final diagnosis of malignancy was based on all available pathologic information. RESULTS Bronchoscopy was performed in 2750 patients, and bronchial cytology specimens were collected during 667 procedures, including 474 aspirate or washing cytology specimens collected during conventional (n = 366) or ultrasound-guided (EBUS) (n = 108) bronchoscopy in 455 patients with malignant lung lesion(s). The predominant histologic types were lung adenocarcinoma (43.9%) and squamous cell carcinoma (25.2%), and 271 tumors (59.6%) were endoscopically visible. At least 1 endoscopic sample (bronchial cytology and/or biopsies and/or endobronchial ultrasound-guided samples) was positive for malignancy during 329 (69.4%) of the 474 endoscopies, including 79 samples obtained in nonvisible lesions. Only 67 bronchial cytology specimens proved positive (sensitivity, 14.7%; 95% confidence interval, 11.8%-18.3%), and only 1 specimen (0.2%) produced a diagnosis not made by other samples during the same procedure. CONCLUSION In contrast with older studies, the added value of collecting cytology specimens from bronchial aspirate or washing during bronchoscopy in this series proved negligible, reflecting mainly the increasing prevalence of adenocarcinomas. Abandoning this technique could be considered in centers with similar expertise and patient populations.
Collapse
Affiliation(s)
- Philippe Girard
- Département Thoracique, L'institut Mutualiste Montsouris, Paris, France.
| | | | - Agathe Seguin-Givelet
- Département Thoracique, L'institut Mutualiste Montsouris, Paris, France; Faculté de Médecine SMBH, Université Paris 13, Université Sorbonne Paris Cité, Bobigny, France
| | - Stéphane Lenoir
- Département d'Imagerie Médicale, l'Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Département Thoracique, L'institut Mutualiste Montsouris, Paris, France
| | - Pierre Validire
- Département d'Anatomie Pathologique, l'Institut Mutualiste Montsouris, Paris, France
| | | |
Collapse
|
6
|
Berg J, Fjellbirkeland L, Suhrke P, Jebsen P, Lund-Iversen M, Kleinberg L, Helgeland L, Brustugun OT, Helland Å. EGFR mutation testing of lung cancer patients - Experiences from Vestfold Hospital Trust. Acta Oncol 2015; 55:149-55. [PMID: 26313507 DOI: 10.3109/0284186x.2015.1062537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with advanced stage lung cancer and somatic mutations in the epithelial growth factor receptor (EGFR) gene are currently treated with tyrosine-kinase inhibitors. The Norwegian Lung Cancer Group (NLCG) recommended EGFR testing of all patients with non-small cell lung carcinoma (NSCLC) from June 2010. From March 2013, testing of squamous cell carcinomas was terminated. We have analysed how these recommendation were followed at a medium-sized Norwegian hospital and we present data on mutation frequency, retesting and possible explanations for missing test results. MATERIAL AND METHODS All pathology reports for patients diagnosed with NSCLC at Vestfold Hospital Trust were examined for the period June 2010 to December 2013. Mutation analyses were done at the Department of Pathology, Oslo University Hospital. RESULTS Material was sent for EGFR analysis for 256 of the 304 eligible patients diagnosed in the period. Material from 48 patients was never sent for EGFR testing, of which five samples consisted of too few tumour cells. For the rest, no obvious reason for omitting EGFR mutation analyses was identified. During the first six months of our study period, material from 25 of 66 NSCLC patients (38%) was not tested, whereas only six of the 118 patients (5%) in 2013 were not tested. For 34 patients, the first tissue specimen contained too few tumour cells and a new sample was sent for EGFR analyses for 11 of these. EGFR mutation was detected in 7.1% of the analysed NSCLC and in 9.4% of adenocarcinomas. DISCUSSION Especially for patients with advanced stages of NSCLC, EGFR mutation status is necessary for treatment stratification. Our results show that the guidelines were followed increasingly over time for patients diagnosed with NSCLC at the Vestfold Hospital Trust. The establishment of interdisciplinary meetings has improved the diagnostic routines.
Collapse
Affiliation(s)
- Janna Berg
- a Department of Medicine , Vestfold Hospital Trust , Tønsberg , Norway
| | - Lars Fjellbirkeland
- b Department of Pulmonology , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Pål Suhrke
- c Department of Pathology , Vestfold Hospital Trust , Tønsberg , Norway
| | - Peter Jebsen
- d Department of Pathology , Oslo University Hospital , Oslo , Norway
| | | | - Lilach Kleinberg
- d Department of Pathology , Oslo University Hospital , Oslo , Norway
| | - Lars Helgeland
- e Department of Pathology , Haukeland Universitetssykehus , Haukeland , Norway
| | - Odd Terje Brustugun
- f Department of Genetics/Oncology , Oslo University Hospital , Oslo , Norway
| | - Åslaug Helland
- f Department of Genetics/Oncology , Oslo University Hospital , Oslo , Norway
| |
Collapse
|
7
|
Carter CA, Nations JA, Lazarus A. Molecular Targets in the Treatment of Non—Small-Cell Lung Cancer: Is There Hope on the Horizon? Postgrad Med 2015; 126:139-48. [DOI: 10.3810/pgm.2014.11.2842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
8
|
Ma QY, Chen J, Wang SH, Wu N, Hao ZH, Chen XF. Interleukin 17A genetic variations and susceptibility to non-small cell lung cancer. APMIS 2014; 123:194-8. [PMID: 25469655 DOI: 10.1111/apm.12341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 12/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related death, in which non-small cell lung cancer (NSCLC) is the most common type. Evidence have shown that interleukin 17 (IL-17) greatly involves in human immune responses. In this study, we investigated the effect of IL-17 on NSCLC by examining the association between IL-17A genetic polymorphisms and the susceptibility to NSCLC. IL-17A -420A/G and IL-17A -73G/A polymorphisms were detected in 330 NSCLC patients and 382 healthy controls. We found that subjects carrying -73GA genotype or AA genotype had 2.09-fold or 2.52-fold increased risk of NSCLC than those with -73GG genotype [odds ratio (OR) = 2.09, 95% confidence interval (CI), 1.46 - 2.98, p < 0.001; OR = 2.52, 95% CI, 1.30-4.88, p = 0.005, respectively). However, the IL-17A -420A/G did not reveal any correlation with the cancer. Further investigation showed that prevalence of IL-17A -73GA genotype and A allele were significantly increased in adenocarcinoma patients (OR = 1.75, 95% CI, 1.08-2.86, p = 0.024, OR = 1.57, 95% CI, 1.09-2.28, p = 0.016, respectively). We also evaluated the effect of the polymorphisms on gene expression, and identified that peripheral blood mononuclear cells with IL-17A -73GA and AA genotypes produced significantly higher level of IL-17 than the cells with IL-17A -73GG genotype. Our results suggest that IL-17A -73G/A genetic variations may upregulate IL-17 expression and are associated with increased susceptibility to NSCLC.
Collapse
Affiliation(s)
- Qin-Yun Ma
- Department of Thoracic Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | | | | | | | | | | |
Collapse
|
9
|
Zamani A. Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series. BMC Cancer 2014; 14:143. [PMID: 24581173 PMCID: PMC3944730 DOI: 10.1186/1471-2407-14-143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 02/23/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Significant bleeding may occur following endobronchial forceps biopsy or brushing of necrotic or hypervascular tumors in the airways. In some cases, methods such as endobronchial instillation of iced saline lavage and epinephrine may fail to control bleeding. The present study evaluated the efficacy and safety of a new bronchoscopic technique using intratumoral injection of tranexamic acid (IIT) for control of bleeding during forceps biopsy in patients with endobronchial tumors with a high risk of bleeding. METHODS The study was a prospective case series carried out in a single center. Bronchoscopic IIT was performed in those patients who had endoscopically visible tumoral lesions with persistent active bleeding following the first attempt at bronchoscopic sampling. Tranexamic acid (TEA) was injected through a 22-gauge Wang cytology needle into the lesion in nominal doses of 250-500 mg. After 2-3 minutes, multiple forceps biopsy specimens were obtained from the lesion. RESULTS Of the 57 consecutive patients included in the study, 20 patients (35.1%) underwent bronchoscopic IIT. The first attempt in 18 patients was endobronchial forceps biopsy (EBB), and because of a high risk of bleeding, the first attempt for the remaining two patients, who were on continuous dual antiplatelet therapy (aspirin and clopidogrel), employed endobronchial needle aspiration (EBNA) as a precautionary measure. Following IIT, subsequent specimens were obtained using EBB in all patients. Multiple forceps biopsy specimens (3-10) were obtained from the lesions (8 necrotic and 12 hypervascular) without incurring active bleeding. The following histopathologic diagnoses were made: squamous cell carcinoma (n = 14), adenocarcinoma (n = 2), small-cell lung cancer (n = 3), and malignant mesenchymal tumor (n = 1). No side effects of TEA were observed. CONCLUSIONS Bronchoscopic IIT is a useful and safe technique for controlling significant bleeding from a forceps biopsy procedure and can be considered as a pre-biopsy injection for lesions with a high risk of bleeding. TRIAL REGISTRATION ISRCTN23323895.
Collapse
Affiliation(s)
- Adil Zamani
- Department of Pulmonary Medicine, Meram Medical Faculty, Necmettin Erbakan University, Akyokus Mevkii, Meram 42080, Konya, Turkey.
| |
Collapse
|
10
|
|