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Yu Z, Li J, Deng Y, Li C, Ye M, Zhang Y, Huang Y, Wang X, Zhao X, Liu J, Liu Z, Yin X, Mei L, Hou Y, Hu Q, Huang Y, Wang R, Fu H, Qiu R, Xu J, Gong Z, Zhang D, Zhang X. Lung tumor discrimination by deep neural network model CanDo via DNA methylation in bronchial lavage. iScience 2024; 27:110079. [PMID: 38883836 PMCID: PMC11176796 DOI: 10.1016/j.isci.2024.110079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Bronchoscopic-assisted discrimination of lung tumors presents challenges, especially in cases with contraindications or inaccessible lesions. Through meta-analysis and validation using the HumanMethylation450 database, this study identified methylation markers for molecular discrimination in lung tumors and designed a sequencing panel. DNA samples from 118 bronchial washing fluid (BWF) specimens underwent enrichment via multiplex PCR before targeted methylation sequencing. The Recursive Feature Elimination Cross-Validation and deep neural network algorithm established the CanDo classification model, which incorporated 11 methylation features (including 8 specific to the TBR1 gene), demonstrating a sensitivity of 98.6% and specificity of 97.8%. In contrast, bronchoscopic rapid on-site evaluation (bronchoscopic-ROSE) had lower sensitivity (87.7%) and specificity (80%). Further validation in 33 individuals confirmed CanDo's discriminatory potential, particularly in challenging cases for bronchoscopic-ROSE due to pathological complexity. CanDo serves as a valuable complement to bronchoscopy for the discriminatory diagnosis and stratified management of lung tumors utilizing BWF specimens.
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Affiliation(s)
- Zezhong Yu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jieyi Li
- Jiaxing Key Laboratory of Precision Medicine and Companion Diagnostics, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing 314033, China
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Yi Deng
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chun Li
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Maosong Ye
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yuqing Huang
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Xintao Wang
- Jiaxing Key Laboratory of Precision Medicine and Companion Diagnostics, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing 314033, China
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Xiaokai Zhao
- Jiaxing Key Laboratory of Precision Medicine and Companion Diagnostics, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing 314033, China
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Jie Liu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zilong Liu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xia Yin
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijiang Mei
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yingyong Hou
- Department of Pathology Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qin Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yao Huang
- Department of Pulmonary, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210046, China
| | - Rongping Wang
- Department of Pulmonary, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210046, China
| | - Huiyu Fu
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Rumeng Qiu
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Jiahuan Xu
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
| | - Ziying Gong
- Jiaxing Key Laboratory of Precision Medicine and Companion Diagnostics, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing 314033, China
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
- Department of R&D, Shanghai Yunying Biopharmaceutical Technology Co., Ltd., Shanghai 201612, China
| | - Daoyun Zhang
- Jiaxing Key Laboratory of Precision Medicine and Companion Diagnostics, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing 314033, China
- Department of R&D, Zhejiang Yunying Medical Technology Co., Ltd., Jiaxing 314006, China
- Department of R&D, Shanghai Yunying Biopharmaceutical Technology Co., Ltd., Shanghai 201612, China
| | - Xin Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Pulmonary, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210046, China
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Yan S, Pan L, Chen J, Jiang H, Gong L, Jin F. Application of rapid on-site evaluation combined with flexible bronchoscopy in the diagnosis of lung lesions. Ann Diagn Pathol 2024; 69:152261. [PMID: 38262192 DOI: 10.1016/j.anndiagpath.2023.152261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Pathology is considered the gold standard for the diagnosis of lung lesions, but the pathological result is relatively lagging and cannot provide real-time guidance for the biopsy procedure. OBJECTIVE To investigate the potential application of rapid on-site evaluation (ROSE) during flexible bronchoscopy (FB) in the evaluation and diagnosis of lung lesions. PATIENTS AND METHODS Consecutive patients who underwent FB for the diagnosis of lung lesions between August 2022 and February 2023 were included in this retrospective study. 294 patients underwent FB with ROSE, while 304 patients underwent FB without ROSE. The final pathological results and the number of patients undergoing repeat biopsies were recorded in both groups. Specifically, we conducted separate statistical analysis for patients undergoing different biopsy methods, including the endobronchial biopsy (EBB), radial probe endobronchial ultrasound transbronchial lung biopsy with guide sheath (r-EBUS-GS-TBLB), and the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to study the detailed roles that ROSE plays under different biopsy methods. RESULTS The adequacy rate of biopsy specimens from the non-ROSE group was significantly lower than that of the ROSE group (259/281 = 92.17 % vs. 263/268 = 98.13 %, p = 0.001). Meanwhile, fewer patients underwent repeat biopsies in the ROSE group compared to the non-ROSE group (2/294 = 0.68 % vs. 10/304 = 3.29 %, p = 0.023). For the ROSE group, the consistency between ROSE diagnoses and final pathological diagnoses was 94.40 % (κ = 0.886), with 95.58 % for benign diseases and 93.55 % for malignant diseases. CONCLUSION The utility of ROSE during FB increases the adequacy rate of biopsy specimens and thus decreases the need for repeat biopsies in patients with lung lesions to get a definite diagnosis. Moreover, the high consistency between ROSE diagnoses and final pathological diagnoses suggests that ROSE is a reliable tool for optimizing the diagnosis of lung lesions.
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Affiliation(s)
- Shuang Yan
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
| | - Lei Pan
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Jian Chen
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Hua Jiang
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Li Gong
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, PR China
| | - Faguang Jin
- Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
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Graham AJ, Robinson MT, Kahler J, Azadi JR, Maleki Z. Rapid on-site evaluation (ROSE) of image-guided FNA specimens improves subsequent core biopsy adequacy in clinical trial patients: The impact of preanalytical factors and its correlation with survival. Cancer Cytopathol 2024; 132:30-40. [PMID: 37768842 DOI: 10.1002/cncy.22764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/09/2023] [Accepted: 08/02/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Sufficient tumor collection has become of utmost importance in therapeutic experimental protocols. Rapid on-site evaluation (ROSE) ensures adequate sampling for quantification of biomarkers, molecular analyses, and other ancillary studies. The objectives of this study were to evaluate the role of ROSE in trial-associated fine-needle aspiration (FNA) and to analyze predictors of adequacy and cumulative survival from in-house FNA cases used in clinical trials. METHODS Clinical trial FNA biopsies performed at a large academic institution were analyzed over 10 months using a comprehensive chart review of the electronic medical records. SPSS version 28 was used for statistical analysis. RESULTS Three hundred twenty-five FNAs were collected for 57 clinical trials. In total, 225 individual patients had an average of 1.4 FNA procedures each as a result of a multidepartmental collaborative effort. ROSE was performed for all patients, and adequacy was evaluated by cytotechnologists. Seventy-eight percent of samples were considered adequate, 14% were considered less than optimal, and 8% were considered inadequate, with the latter two categories designated together as less than adequate. The imaging modalities were mainly ultrasound-guided (n = 267; 82%) and computed tomography-guided (n = 58; 18%). There was a statistically significant association between adequate sampling and ultrasound-guided biopsies (83%) compared with computed tomography-guided biopsies (59%; p < .01). The effect of body mass index (BMI) on mortality was also a significant finding. The authors observed a survival benefit in patients who had elevated BMIs (range, 25.0-34.9 kg/m2 ) compared with those who were underweight (BMI, <18.5 kg/m2 ) or class III obese (BMI, >35.0 kg/m2 ; p < .01). Therefore, the best predictors of adequacy and mortality were imaging modality and BMI, respectively. CONCLUSIONS Ultrasound-guided modalities are recommended for obtaining adequate FNA sampling for clinical trials. In addition, patients with cancer who had slightly elevated BMIs (25.0-34.0 kg/m2 ) had increased overall survival in this cohort.
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Affiliation(s)
- Ashleigh J Graham
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mahalia T Robinson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Kahler
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Javad R Azadi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Vu LH, Yu Lee-Mateus A, Edell ES, Hartley C, Vierkant RA, Fernandez-Bussy S, Reisenauer J. Accuracy of Preliminary Pathology for Robotic Bronchoscopic Biopsy. Ann Thorac Surg 2023; 116:1028-1034. [PMID: 36470566 DOI: 10.1016/j.athoracsur.2022.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diagnosis and treatment of peripheral pulmonary lesions (PPLs) currently require at least 2 procedures. An all-in-1 approach would require diagnosing malignancy with preliminary cytology results. This study investigated the concordance between preliminary cytology and final pathology results in biopsies of PPLs obtained by shape-sensing robotic-assisted bronchoscopy (ssRAB). METHODS This study was a retrospective, consecutive, single-arm, single-center study of 110 ssRABs for PPLs. Concordance was defined as agreement between preliminary cytology and final pathology results. Accuracy, sensitivity, specificity, positive and negative predictive values, and safety outcomes were examined. RESULTS The concordance was 89% for needle biopsies, 85% for forceps biopsies, and 92% overall, with substantial agreement. There was no significant association of concordance with patients' demographics or lesion characteristics. Preliminary cytology resulted in a malignant diagnosis in 70%, a nonmalignant diagnosis in 4%, and a nondiagnostic result in 26%, with accuracy of 86% and sensitivity of 84%. The total complication rate was 3.6%, with a pneumothorax rate of 1.8%. CONCLUSIONS This study compared the concordance of preliminary pathology results with final pathology results for ssRAB biopsies in PPLs. The results showed that preliminary samples have a high concordance with final pathology results and may enable management of PPLs with a single anesthetic procedure including biopsy, staging, and treatment.
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Affiliation(s)
- Linh H Vu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alejandra Yu Lee-Mateus
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Sebastian Fernandez-Bussy
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Janani Reisenauer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Steinfort DP, Evison M, Witt A, Tsaknis G, Kheir F, Manners D, Madan K, Sidhu C, Fantin A, Korevaar DA, Van Der Heijden EHFM. Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement. Respirology 2023; 28:722-743. [PMID: 37463832 DOI: 10.1111/resp.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Since their introduction, both linear and radial endobronchial ultrasound (EBUS) have become an integral component of the practice of Pulmonology and Thoracic Oncology. The quality of health care can be measured by comparing the performance of an individual or a health service with an ideal threshold or benchmark. The taskforce sought to evaluate quality indicators in EBUS bronchoscopy based on clinical relevance/importance and on the basis that observed significant variation in outcomes indicates potential for improvement in health care outcomes. METHODS A comprehensive literature review informed the composition of a comprehensive list of candidate quality indicators in EBUS. A multiple-round modified Delphi consensus process was subsequently performed with the aim of reaching consensus over a final list of quality indicators and performance targets for these indicators. Standard reporting items were developed, with a strong preference for items where evidence demonstrates a relationship with quality indicator outcomes. RESULTS Twelve quality Indicators are proposed, with performance targets supported by evidence from the literature. Standardized reporting items for both radial and linear EBUS are recommended, with evidence supporting their utility in assessing procedural outcomes presented. CONCLUSION This statement is intended to provide a framework for individual proceduralists to assess the quality of EBUS they provide their patients through the identification of clinically relevant, feasible quality measures. Emphasis is placed on outcome measures, with a preference for consistent terminology to allow communication and benchmarking between centres.
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Affiliation(s)
- Daniel P Steinfort
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashleigh Witt
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Georgios Tsaknis
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, Kettering General Hospital, UK
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Manners
- St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alberto Fantin
- Department of Pulmonology, University Hospital of Udine (ASUFC), Udine, Italy
| | - Daniel A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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Oki M, Saka H, Kogure Y, Niwa H, Yamada A, Torii A, Kitagawa C. Ultrathin bronchoscopic cryobiopsy of peripheral pulmonary lesions. Respirology 2023; 28:143-151. [PMID: 36066209 DOI: 10.1111/resp.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Ultrathin bronchoscopy aids in the diagnosis of peripheral pulmonary lesions. However, both the working channel and the specimens are small. A 1.1-mm ultrathin cryoprobe that can enter the working channel of the ultrathin bronchoscope is now available, which may overcome the limitations of small specimen size. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrathin bronchoscopic cryobiopsy using an ultrathin cryoprobe for diagnosing peripheral pulmonary lesions. METHODS Patients with peripheral pulmonary lesions ≤30 mm in diameter were prospectively enrolled in the study. All patients underwent forceps biopsy followed by cryobiopsy using a 3.0-mm ultrathin bronchoscope under radial probe endobronchial ultrasound guidance, virtual bronchoscopic navigation and fluoroscopic guidance. The primary endpoint was the feasibility of cryobiopsy. RESULTS In total, 50 patients with peripheral pulmonary lesions were enrolled in the study; the median longest diameter on computed tomography was 17.9 mm. Cryobiopsy was performed successfully in 49 patients (98%). Forceps biopsy, cryobiopsy and the combination of these two methods provided a specific diagnosis in 54% (27/50), 62% (31/50) and 74% (37/50) of patients, respectively. The median size of specimens obtained via cryobiopsy was significantly larger than the median size obtained via forceps biopsy (7.0 vs. 1.3 mm2 , respectively, p < 0.001). Mild bleeding during cryobiopsy occurred in 47 patients (94%). No moderate/severe bleeding or pneumothorax occurred. CONCLUSION Ultrathin bronchoscopic cryobiopsy is feasible, effective and sufficiently safe for the diagnosis of peripheral pulmonary lesions.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideyuki Niwa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Arisa Yamada
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Atsushi Torii
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Liang Y, Jiang X, Ma L, Li Y, Ma H, Wang Z. Diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath combined with rapid on-site evaluation system for peripheral pulmonary infectious diseases. Minerva Surg 2023; 78:37-44. [PMID: 35837872 DOI: 10.23736/s2724-5691.22.09597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath (EBUS-GS) combined with rapid on-site evaluation (ROSE) system for peripheral pulmonary infectious diseases. METHODS The clinical data of 196 patients visiting our hospital, who had peripheral pulmonary lesions (PPLs) indicated by spiral computed tomography (CT) of the chest and were finally diagnosed as infectious PPLs, were retrospectively collected. Then the patients were divided into ultrathin bronchoscope + ROSE group, EBUS-GS + ROSE group and ultrathin bronchoscope + EBUS-GS + ROSE group based on different diagnostic techniques. Moreover, the general conditions, diagnostic results and specific operation parameters of the patients were recorded, and the diagnostic rate, sensitivity and complications were compared. RESULTS In ultrathin bronchoscope + EBUS-GS + ROSE group, the time of localizing lesions and operation time were the shortest, and the grade of bronchi reached by the bronchoscope was the highest. The differences were significant between any two groups (P<0.05). Patients with bacterial pneumonia, and patients with pulmonary tuberculosis and nontuberculous mycobacterial disease, ultrathin bronchoscope + EBUS-GS + ROSE group exhibited the highest definite diagnosis rate of bronchoscope and diagnostic sensitivity of ROSE system, with significant differences from those of the other two groups (P<0.05). The incidence rates of complications were low in all groups, and there were no significant differences between any two groups (P>0.05). CONCLUSIONS Ultrathin bronchoscope and EBUS-GS combined with ROSE system can prominently decrease the time of localizing lesions and operation time, remarkably improve the diagnostic accuracy and sensitivity and result in fewer complications.
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Affiliation(s)
- Yongxue Liang
- Second Ward of Respiratory and Critical Care Medicine, Yan'an Hospital of Kunming City, Kunming, China
| | - Xia Jiang
- Second Ward of Respiratory and Critical Care Medicine, Yan'an Hospital of Kunming City, Kunming, China
| | - Liwen Ma
- Second Ward of Respiratory and Critical Care Medicine, Yan'an Hospital of Kunming City, Kunming, China
| | - Yi Li
- Second Ward of Respiratory and Critical Care Medicine, Yan'an Hospital of Kunming City, Kunming, China
| | - Han Ma
- Second Ward of Respiratory and Critical Care Medicine, Yan'an Hospital of Kunming City, Kunming, China
| | - Zhongping Wang
- Second Ward of Respiratory and Critical Care Medicine, Yan'an Hospital of Kunming City, Kunming, China -
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Zheng X, Zhong C, Xie F, Li S, Wang G, Zhang L, Sun J. Virtual bronchoscopic navigation and endobronchial ultrasound with a guide sheath without fluoroscopy for diagnosing peripheral pulmonary lesions with a bronchus leading to or adjacent to the lesion: A randomized non‐inferiority trial. Respirology 2022; 28:389-398. [PMID: 36356596 DOI: 10.1111/resp.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Transbronchial sampling of peripheral pulmonary lesions (PPLs) is routinely performed under fluoroscopy. However, advanced ancillary techniques have become available, such as virtual bronchoscopic navigation (VBN) and radial endobronchial ultrasound with a guide sheath (rEBUS-GS). This study was performed to determine whether the diagnostic utility of VBN and rEBUS with a GS is similar with or without fluoroscopy. METHODS This multicenter non-inferiority trial randomized patients to a VBN-rEBUS-GS with or without fluoroscopy group at three centres. The primary endpoint was the diagnostic yield. The secondary endpoints were the time for rEBUS, GS, and the total operation. Complications were also recorded. RESULTS Four hundred and ninety-six subjects were assessed and 426 subjects were included in the analysis (212 in non-fluoroscopy-guided-group and 214 in fluoroscopy-guided-group). The diagnostic yield in the non-fluoroscopy-guided-group (84.0%) was not inferior to that in the fluoroscopy-guided-group (84.6%), with a diagnostic difference of -0.6% (95% CI: -6.4%, 5.2%). Multivariable analysis confirmed that bronchus sign and lesion nature were valuable diagnostic predictors in non-fluoroscopy-guided-group. The non-fluoroscopy-guided-group had shorter rEBUS, GS, and total operation time. No severe complications occurred in either group. CONCLUSION Transbronchial diagnosis of PPLs suspicious of malignancy and presence of a bronchus leading to or adjacent to lesions using VBN-rEBUS-GS without fluoroscopy is a safe and effective method that is non-inferior to VBN-rEBUS-GS with fluoroscopy. Bronchus leading to lesions and malignant nature are associated with high diagnostic yield in VBN-rEBUS-GS without fluoroscopy for the diagnosis of PPLs.
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Affiliation(s)
- Xiaoxuan Zheng
- Department of Respiratory Endoscopy and Department of Respiratory and Critical Care Medicine Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai Engineering Research Center of Respiratory Endoscopy Shanghai China
| | - Changhao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China
| | - Fangfang Xie
- Department of Respiratory Endoscopy and Department of Respiratory and Critical Care Medicine Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai Engineering Research Center of Respiratory Endoscopy Shanghai China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China
| | - Guiqi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Lei Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Department of Respiratory and Critical Care Medicine Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai Engineering Research Center of Respiratory Endoscopy Shanghai China
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Qi JC, Liao L, Zhao Z, Zeng H, Wang T, Hu M, Wang L, Wu Z, Ye Y, Ou Y, Cai Z, Wu Q, Xu Q, Zhang W, Huang W, Li H, Lin L. Impact of rapid on-site evaluation combined with endobronchial ultrasound and virtual bronchoscopic navigation in diagnosing peripheral lung lesions. BMC Pulm Med 2022; 22:117. [PMID: 35361163 PMCID: PMC8969361 DOI: 10.1186/s12890-022-01917-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). METHODS Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in expected consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, based on the calculation of expected diagnostic yield of R-EBUS biopsy and drop out, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. RESULTS In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, respectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, respectively, and the average expense was 643.44 ± 706.56 US.$ (4093.15 ± 4494.67 yuan ¥). In the controls, the positive rate of brushing and biopsy were 44%, 74%, respectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, respectively. And the average expense during diagnosis was 1009.27 ± 713.89 US.$ (6420.28 ± 4541.33 yuan ¥). There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤ 2 cm in diameter was significant. CONCLUSION In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.
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Affiliation(s)
- Jia-Chao Qi
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Liping Liao
- Department of Ultrasonic Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Zhiwei Zhao
- Department of Otolaryngology, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - HuiXue Zeng
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Tiezhu Wang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Miaofen Hu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - LiJv Wang
- Department of Pathology, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Zhi Wu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Yuming Ye
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Yangwu Ou
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Zhiming Cai
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Qiyin Wu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Qiaozhen Xu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Weiliang Zhang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Wensen Huang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China
| | - Hao Li
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China.
| | - Li Lin
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People's Republic of China.
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10
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PD-L1 copy number loss in NSCLC associates with reduced PD-L1 tumour staining and a cold immunophenotype. J Thorac Oncol 2022; 17:675-687. [DOI: 10.1016/j.jtho.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022]
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11
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Liu W, Xu C, Li L, Yuan Q, Wang W, Zou J. The Value of Computed Tomography-Guided Percutaneous Lung Biopsy Combined With Rapid On-Site Evaluation in Diagnosis of Peripheral Pulmonary Nodules. Technol Cancer Res Treat 2022; 21:15330338221118718. [PMID: 35930585 PMCID: PMC9358554 DOI: 10.1177/15330338221118718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the value of computed tomography-guided percutaneous lung biopsy (CT-PLB) combined with rapid on-site evaluation (ROSE) in the diagnosis of peripheral pulmonary lesions (PPLs). Methods: A total of 108 patients who diagnosed with PPLs by chest CT examination were prospectively collected and randomly divided into ROSE group (n = 56) and No-ROSE group (n = 52). Both groups received CT-PLB and pathological examination. The smear submitted for ROSE was stained using Diff Quik dye. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), number of punctures, puncture time and incidence of complications were compared between the two groups. Results: The accuracy, sensitivity, specificity, PPV, and NPV of the ROSE group were 89.29%, 87.50%, 91.67%, 93.33%, and 84.62%, respectively. The number of punctures in the ROSE group was significantly lower than that in the No-ROSE group (P < .05). The incidence of pneumothorax and hemoptysis in the ROSE group were lower than those in the No-ROSE group, but there was no statistical difference between the two groups (P > .05). ROSE has good concordance with routine pathological examination in the diagnosis of unidentified PPLs (Kappa = 0.786, P < .01). Conclusions: CT-PLB combined with ROSE is a safe and effective method for the diagnosis of PPLs.
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Affiliation(s)
- Wei Liu
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunhua Xu
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Li Li
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Qi Yuan
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Wei Wang
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,206608Nanjing Chest Hospital, Nanjing, Jiangsu, China
| | - Jue Zou
- 56647Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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12
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Steinfort DP, Rangamuwa K. A glimpse of the future?-bronchoscopic ablation of peripheral early stage lung cancer. Transl Lung Cancer Res 2021; 10:3861-3864. [PMID: 34858776 PMCID: PMC8577971 DOI: 10.21037/tlcr-21-763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kanishka Rangamuwa
- Department of Respiratory, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
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13
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Tao Y, Cai Y, Fu H, Song L, Xie L, Wang K. Automated interpretation and analysis of bronchoalveolar lavage fluid. Int J Med Inform 2021; 157:104638. [PMID: 34775213 DOI: 10.1016/j.ijmedinf.2021.104638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cytological analysis of bronchoalveolar lavage fluid (BALF) plays an essential role in the differential diagnosis of respiratory diseases. In recent years, deep learning has demonstrated excellent performance in image processing and object recognition. OBJECTIVES We aim to apply deep learning to the automated interpretation and analysis of BALF. METHOD Visual images were acquired using an automated biological microscopy platform. We propose a three-step algorithm to automatically interpret BALF cytology based on a convolutional neural network (CNN). The clinical value was evaluated at the patient level. RESULTS Our model successfully detected most cells in BALF specimens and achieved a sensitivity, precision, and F1 score of over 0.9 for most cell types. In two tests in the clinical context, the algorithm outperformed experienced practitioners. CONCLUSION The program can automatically provide the cytological background of BALF and augment clinical decision-making for clinicians.
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Affiliation(s)
- Yi Tao
- Center of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100193, China; Medical School of Chinese PLA, Beijing 100083, China
| | - Yu Cai
- Shanghai Howsome Biotech Co., Ltd., Shanghai 201108, China
| | - Han Fu
- Center of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100193, China
| | - Licheng Song
- Center of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100193, China
| | - Lixin Xie
- Center of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100193, China.
| | - Kaifei Wang
- Center of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100193, China.
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14
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Torous VF, Lopez SH, Xu C, Sweeney BJ, Pitman MB. Performance of Rapid On-Site Evaluation in Breast Fine-Needle Aspiration Biopsies: Identifying Areas of Diagnostic Challenge. Acta Cytol 2021; 66:1-13. [PMID: 34816801 DOI: 10.1159/000518579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is a well-established method for sampling breast lesions with high accuracy and positive predictive value. Despite its decline in recent years relative to the use of core needle biopsies, there are several advantages to FNA which include cost-effectiveness, low complication rate, and the ability to perform rapid on-site evaluation (ROSE). The aim of this study was to evaluate breast FNAs with ROSE to identify diagnostic challenges during ROSE. MATERIALS AND METHODS We identified all breast FNAs with ROSE performed at Massachusetts General Hospital from January 2014 to December 2019. From the electronic medical record, clinical, radiological, and follow-up pathology results were recorded. Comparison between the rapid and final cytological diagnosis was made. All discrepancies were documented with major discrepancy defined as a malignant rapid interpretation not confirmed on final diagnosis or a negative rapid interpretation upgraded to suspicious or positive on final diagnosis. RESULTS The study cohort consisted of 483 breast FNAs with ROSE. The rapid and final cytological interpretations showed good correlation, with only 6 (1.2%) major discrepancies. Problematic areas included low-grade, lobular, and fibroepithelial lesions with low cellularity being a contributory factor to misclassification. CONCLUSIONS FNA remains a highly accurate method for the evaluation of breast lesions with ROSE.
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Affiliation(s)
- Vanda F Torous
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christine Xu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda J Sweeney
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Martha B Pitman
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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15
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Zhang L, Wang G. Subpleural ground glass opacities diagnosed by bronchoscopic brush cytology with manual mapping navigation: A case report. Medicine (Baltimore) 2021; 100:e25515. [PMID: 33879688 PMCID: PMC8078355 DOI: 10.1097/md.0000000000025515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/25/2021] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Ground-glass opacity nodules (GGNs) are a computed tomography (CT) finding suggestive of lung cancer. Conventional bronchoscopy with brush cytology is a simple diagnostic modality but has a low diagnostic yield for peripheral lesions, especially peripheral GGNs. Therefore, maximizing the detection rate of bronchoscopic brushings should be a key objective. We report a case of a subpleural ground glass opacity (GGO) with a cytological diagnosis of adenocarcinoma by bronchoscopic brushing guided by manual mapping navigation. PATIENT CONCERNS A 46-year-old man was hospitalized for GGO in the right lung. Follow-up CT revealed a subpleural nodule sized 1.2 cm × 0.9 cm in the superior segment of the right lower lobe. DIAGNOSES CT findings of the patient's nodule were suggestive of malignancy. INTERVENTIONS The patient underwent conventional bronchoscopy combined with brushing guided by manual mapping navigation, with subsequent cytological diagnosis of adenocarcinoma. The patient then underwent right lower lobectomy with mediastinal lymph node dissection. OUTCOMES There were no postoperative complications. Postoperative pathological examination showed lung adenocarcinoma with lepidic and acinar growth without visceral pleural invasion (pT1aN0M0, IA1). LESSONS Exfoliated cells present in peripheral GGNs are rarely detected on brush sampling. However, use of a manual mapping navigation system may help increase the sensitivity of conventional bronchoscopic brushing for the diagnosis of peripheral pulmonary lesions.
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16
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Steinfort DP, Christie M, Antippa P, Rangamuwa K, Padera R, Müller MR, Irving LB, Valipour A. Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study. Respiration 2021; 100:432-442. [PMID: 33730740 DOI: 10.1159/000514109] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic thermal vapour ablation (BTVA) is an established and approved modality for minimally invasive lung volume reduction in severe emphysema. Preclinical data suggest potential for BTVA in minimally invasive ablation of lung cancer lesions. OBJECTIVES The objective of this study is to establish the safety, feasibility, and ablative efficacy of BTVA for minimally invasive ablation of lung cancers. METHODS Single arm treat-and-resect clinical feasibility study of patients with biopsy-confirmed lung cancer. A novel BTVA for lung cancer (BTVA-C) system for minimally invasive treatment of peripheral pulmonary tumours was used to deliver 330 Cal thermal vapour energy via bronchoscopy to target lesion. Patients underwent planned lobectomy to complete oncologic care. Pre-surgical CT chest and post-resection histologic analysis were performed to evaluate ablative efficacy. RESULTS Six patients underwent BTVA-C, and 5 progressed to planned lobectomy. Median procedure duration was 12 min. No major procedure-related complications occurred. All 5 resected lesions were part-solid lung adenocarcinomas with median solid component size 1.32±0.36 cm. Large uniform ablation zones were seen in 4 patients where thermal dose exceeded 3 Cal/mL, with complete/near-complete necrosis of target lesions seen in 2 patients. Tumour positioned within ablation zones demonstrated necrosis in >99% of cross-sectional area examined. CONCLUSION BTVA of lung tumours is feasible and well tolerated, with preliminary evidence suggesting high potential for effective ablation of tumours. Thermal injury is well demarcated, and uniform tissue necrosis is observed within ablation zones receiving sufficient thermal dose per volume of lung. Treatment of smaller volumes and ensuring adequate thermal dose may be important for ablative efficacy.
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Affiliation(s)
- Daniel P Steinfort
- Department Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia, .,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia,
| | - Michael Christie
- Department of Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kanishka Rangamuwa
- Department Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Robert Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Rolf Müller
- Department of Thoracic Surgery, North Clinic Vienna, Karl-Landsteiner-Institute of Thoracic Oncology, Sigmund-Freud-University Medical Faculty, Vienna, Austria
| | - Louis B Irving
- Department Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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17
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Diagnostic Value of Rapid On-Site Evaluation for CT-Guided Percutaneous Fine Needle Aspiration in the Diagnosis of Pulmonary Occupying Lesions. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9842768. [PMID: 33282959 PMCID: PMC7685792 DOI: 10.1155/2020/9842768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/11/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
Objective Rapid on-site evaluation (ROSE) is an effective and efficient auxiliary examination, but its value for CT-guided percutaneous fine-needle aspiration (FNA) in the diagnosis of pulmonary occupying lesions is unclear. This study is aimed at evaluating the clinical utility of ROSE for CT-guided percutaneous FNA. Methods We reviewed 234 patients from September 2018 to April 2019. The result using ROSE was compared with the final pathological diagnosis of CT-guided percutaneous FNA, and we also compared the complications between the ROSE group and the NO-ROSE group. The final pathological diagnosis results served as the gold standard. We also analyzed the diagnostic rate of FNA and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of malignancy. The correlation between diverse pathological types of lung cancer was also taken into consideration. Results In total, 132 patients underwent CT-guided percutaneous FNA with ROSE (ROSE group), and 102 did not (NO-ROSE group). The diagnostic rate, sensitivity, specificity, PPV, and NPV of the ROSE group were 91.6%, 89.1%, 94.1%, 93.4%, and 90.1%, respectively. The complication rates of the ROSE group and the NO-ROSE group were 8.33% and 16.67%, respectively. This difference was not statistically significant (P > 0.05). In subsets of adenocarcinoma (AC) and small cell lung cancer (SCLC) patients, the ROSE result was highly consistent with the final pathological result. Conclusion CT-guided percutaneous FNA combined with ROSE has a high diagnostic rate, sensitivity, and specificity for pulmonary occupying lesions and an acceptable rate of complications. This method is worthy of wide use given its high efficiency and safety.
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18
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Lam S, Bryant H, Donahoe L, Domingo A, Earle C, Finley C, Gonzalez AV, Hergott C, Hung RJ, Ireland AM, Lovas M, Manos D, Mayo J, Maziak DE, McInnis M, Myers R, Nicholson E, Politis C, Schmidt H, Sekhon HS, Soprovich M, Stewart A, Tammemagi M, Taylor JL, Tsao MS, Warkentin MT, Yasufuku K. Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2020.1819175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Bryant
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ashleigh Domingo
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Craig Earle
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christian Finley
- Department of Thoracic Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Anne V. Gonzalez
- Division of Respiratory Medicine, McGill University, Montreal, Quebec, Canada
| | - Christopher Hergott
- Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rayjean J. Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Anne Marie Ireland
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Michael Lovas
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Mayo
- Department of Radiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna E. Maziak
- Surgical Oncology Division of Thoracic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Renelle Myers
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Nicholson
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christopher Politis
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harman S. Sekhon
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marie Soprovich
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Archie Stewart
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Jana L. Taylor
- Department of Radiology, McGill University, Montreal, Quebec, Canada
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University Health Network and Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew T. Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Weng X, Zhi L, An X, Xu M, Zhang H, Long K, Gao P. Diagnostic value of rapid on-site evaluation in interventional pulmonology: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21168. [PMID: 32702873 PMCID: PMC7373600 DOI: 10.1097/md.0000000000021168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) is a kind of rapid evaluation of specimen satisfaction, preliminary diagnosis and priority strategy, the diagnostic accuracy of ROSE in the field of pulmonary intervention shows wide variation. The aim of the study was to further clarify the accuracy and diagnostic efficacy of ROSE in interventional pulmonology. METHODS This review summarizes and meta-analyzes studies of ROSE in interventional pulmonology, the ROSE diagnoses would be compared with the final pathologic diagnoses. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, Web of science, CNKI, and WANFANG DATA. The methodologic quality of studies has been assessed using the Quality of Diagnostic Studies (QUADAS-2) instrument. This review is conducted using standard methods for systematic reviews of diagnostic accuracy studies. STATA SE 12.0 is used for data synthesis and analysis. RESULTS This review evaluates the accuracy and diagnostic efficacy of ROSE in interventional pulmonology, and the process factors that may influence the ROSE diagnosis are analyzed, such as Smear method, profession of smear technician, staining method, Profession of stain technician, Profession of reading slides, invasive procedure, Anesthesia method and etc. CONCLUSION:: This review will stimulate proper evaluation of ROSE and provide assistance for clinical practice.
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Affiliation(s)
- Xiangwen Weng
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
| | - Lijia Zhi
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Xing An
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
- Respiratory department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Meixin Xu
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
| | - Hua Zhang
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine
| | - Kunlan Long
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Peiyang Gao
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine
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20
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Steinfort DP, Herth FJF. Bronchoscopic treatments for early-stage peripheral lung cancer: Are we ready for prime time? Respirology 2020; 25:944-952. [PMID: 32643221 DOI: 10.1111/resp.13903] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/29/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide and surgical lobectomy remains the preferred therapy for patients with early-stage NSCLC. Medical comorbidities and advanced age preclude resection in many patients and minimally invasive ablative therapies are needed for treatment. Stereotactic ablative radiation is established as an effective modality in this patient group, although may be contraindicated in some patients with prior radiation exposure, comorbidities or centrally positioned tumours. Percutaneous ablative methods are available, although are frequently associated with significant complications. Numerous endoscopic ablative techniques are under evaluation. With a more favourable safety profile and the ability to provide diagnosis and staging information potentially within a single procedure, there is a strong rationale for development of bronchoscopic ablative modalities. In the following article, the authors aim to explore the role bronchoscopic ablation may play in treatment of peripheral lung tumours, and to describe a pathway to establishing these modalities as part of routine care. The current status of several bronchoscopic ablative options is discussed in detail.
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany
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21
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Li C, Xie W, Cao J, Feng J. Detailed procedure and clinical application overview of rapid on-site evaluation in diagnostic interventional pulmonology. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:35. [PMID: 32582341 PMCID: PMC7306229 DOI: 10.4103/jrms.jrms_21_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 11/27/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022]
Abstract
Diagnostic interventional pulmonology is widely accepted as a minimally invasive, highly accurate procedure for diagnosing lung cancer, more drug-resistant pathogen infections of lower respiratory tract, and critical respiratory diseases. The efficiency of interventional diagnostics depends on quite a few factors, including size and the anatomic location of lymph nodes, number of biopsy sites and complications rate, characteristics of the lesion, and underlying disease. Specifically, the application of rapid on-site evaluation (ROSE) may avoid additional sampling without compromising diagnostic yield with a preliminary evaluation for adequate diagnostic material and thus reduce the complication rate. In this review article we aimed at elaborate the technical details, clinical roles, and technological progress of ROSE in diagnostic interventional pulmonology, highlighting the importance of ROSE in diagnostic interventional pulmonology. We finally pointed out that it will be a tendency for a pulmonologist, to undergo a short yet intensive training and perform ROSE in diagnostic interventional pulmonology.
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Affiliation(s)
- Caili Li
- Department of Respiratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Xie
- Department of Respiratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Cao
- Department of Respiratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Feng
- Department of Respiratory, Tianjin Medical University General Hospital, Tianjin, China.,Department of Respiratory, Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
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22
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Steinfort DP, Herth FJF, Irving LB, Nguyen PT. Safe performance of diagnostic bronchoscopy/EBUS during the SARS-CoV-2 pandemic. Respirology 2020; 25:703-708. [PMID: 32403194 PMCID: PMC7273079 DOI: 10.1111/resp.13843] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 12/18/2022]
Abstract
The SARS‐CoV‐2 pandemic is unprecedented in our professional lives and much effort and resources will be devoted to care of patients (and HCW) affected by this illness. We must also continue to aim for the same standard of care for our non‐COVID respiratory patients, while minimizing risks of infection transmission to our colleagues. This commentary addresses the key paired issues of minimizing performance of diagnostic/staging bronchoscopy in patients with suspected/known lung cancer while maximizing the safety of the procedure with respect to HCW transmission of COVID‐19.
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany
| | - Louis B Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Phan T Nguyen
- Department of Thoracic Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
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23
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Jiang S, Xie F, Mao X, Ma H, Sun J. The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta-analysis. Thorac Cancer 2020; 11:1191-1201. [PMID: 32130761 PMCID: PMC7180606 DOI: 10.1111/1759-7714.13373] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 12/29/2022] Open
Abstract
Background To compare the diagnostic yield of peripheral pulmonary lesions (PPLs) with and without navigation system. Methods Studies dating from January 1990 to October 2019 were collected from databases. Diagnostic yield of navigation bronchoscopy and non‐navigation bronchoscopy was extracted from comparative studies. Subgroup analysis was adopted to test diagnostic yield variation by lesion size, lobe location of the lesion, distance from the hilum, bronchus sign and nature of the lesion. Results In total, 2131 patients from 10 studies were enrolled into the study. Diagnostic yield of navigation bronchoscopy was statistically higher than non‐navigation bronchoscopy for PPLs (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.32, 2.18, P < 0.001), particularly for PPLs in the peripheral third lung (OR 2.26, 95% CI 1.48, 3.44, P < 0.001) and for bronchus sign positive PPLs (OR 2.26, 95% CI 1.21, 4.26, P = 0.011). Navigation bronchoscopy had better performance than non‐navigation bronchoscopy when PPLs were ≤ 20 mm (OR 2.09, 95% CI 1.44, 3.03, P < 0.001). It also elevated diagnostic yield of malignant PPLs (OR 1.67, 95% CI 1.26, 2.22, P < 0.001) and PPLs in the bilateral upper lobes (OR 1.50, 95% CI 1.09, 2.08, P = 0.014). Conclusions Navigation bronchoscopy enhanced diagnostic yield when compared to non‐navigation bronchoscopy, particularly for PPLs in the peripheral third lung, PPLs being bronchus sign positive, PPLs ≤ 20 mm, malignant PPLs and PPLs in the bilateral upper lobes. Key points The current study provided systematic evaluation on the diagnostic value of navigation bronchoscopy by comparing it with non‐navigation bronchoscopy, and exploring the factors affecting the diagnostic yield.
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Affiliation(s)
- Simin Jiang
- Department of Respiratory medicine, Yongzhou central Hospital, Yongzhou, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xiaowei Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haifeng Ma
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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24
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Fetzer R, Duey M, Pena V, Wanzer D, Kirkpatrick J, Chau D, Sarode VR. Role of cytotechnologists in rapid onsite adequacy assessment of cytology materials for diagnostic workup and specimen allocation for ancillary testing using a standardized protocol. J Am Soc Cytopathol 2020; 9:67-75. [PMID: 31543473 DOI: 10.1016/j.jasc.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/23/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Data on the performance of cytotechnologists in assessing specimen adequacy of needle core biopsies (NCB) is scant and their role in specimen triaging for ancillary studies have not been well established. MATERIALS AND METHODS We retrospectively analyzed rapid onsite evaluation (ROSE) performed exclusively by cytotechnologists on 248 NCB and fine-needle aspiration (FNA) specimens. Overall adequacy and accuracy rates were determined by comparing to final diagnosis. We also reviewed the process of specimen allocation for ancillary testing to determine whether specimens were appropriately triaged at the time of ROSE. RESULTS Of the 248 cases, 222 (89.5%) were touch imprint and 26 (10.5%) were FNA smears. The overall adequacy rate was 73.4% (182 of 248). Concordance for "adequate" interpretation by ROSE with unequivocal malignant or benign diagnoses on final interpretation was 95.6%. The sensitivity, specificity, and accuracy of ROSE for a final "positive for malignancy" were 89.2% (95% CI 83.04% to 93.69%), 43.24% (95% CI 31.77% to 55.28%), and 73.87% (95% CI 67.57% to 55.28%), respectively. Cases with "positive for malignancy" on final diagnosis were "adequate" by ROSE in 89.1% (132 of 148) and "inadequate" in 10.8% (16 of 148), P < 0.0001. Ancillary tests were performed in 168 of 248 (67.7%); the majority were immunohistochemical stains for determining tumor subtype. Predictive biomarkers were performed successfully in 100% of metastatic breast cancers. CONCLUSIONS Cytotechnologists performed at a high level of competency in providing ROSE and allocating specimens for ancillary testing, which were performed successfully in the majority of cases. Implementation of a standardized protocol for tissue management/prioritization is of paramount importance to maximize tissue preservation and minimize wastage.
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Affiliation(s)
- Russel Fetzer
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Michelle Duey
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Valerie Pena
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Dana Wanzer
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - James Kirkpatrick
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Donnie Chau
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Venetia R Sarode
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas.
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25
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Wu W, Cao Z, Zhang W, Zhang L, Hou L, Wu C. Comparison of the SuperARMS and ARMS for detecting EGFR mutations in liquid-based cytology specimens from NSCLC patients. Diagn Pathol 2020; 15:9. [PMID: 32005253 PMCID: PMC6995041 DOI: 10.1186/s13000-019-0910-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Non-surgical cytological specimens are adequate not only for accurate histological subtyping but also for molecular profiling. A modified amplification refractory mutation system polymerase chain reaction (ARMS PCR), known as SuperARMS PCR, was improved by optimizing the primers designation, which provides a higher sensitivity and specificity approach for free plasma DNA detection. It is unclear whether SuperARMS PCR detects epidermal growth factor receptor (EGFR) mutations in cytology samples. The aim of this study was to compare the EGFR mutations detected by ARMS PCR and SuperARMS PCR in cytology samples derived from advanced non-small cell lung cancer (NSCLC) patients. METHODS From March 2016 to March 2018, a total of 234 cytological samples were obtained from primary or metastatic lesions of NSCLC, including 144 fine-needle aspirations (FNAs), 36 endobroncheal ultrasonography (EBUS) FNAs, 36 transbronchial needle aspirations (TBNAs) and 18 pleural effusion (PLEs). EGFR mutations were simultaneously detected using an ADx-ARMS EGFR kit (Amoy Diagnostics CO., ltd., Xiamen, China) and an ADx-SuperARMS EGFR kit (Amoy Diagnostics CO., ltd., Xiamen, China). Digital droplet PCR (ddPCR) and next-generation sequencing (NGS) were further used to verify the EGFR mutant inconsistent samples. RESULTS All of the 234 patients with advanced or recurrent NSCLC were diagnosed and assessed by two cytopathologists, and their EGFR mutation statuses were successfully detected by ARMS and SuperARMS. Importantly, the SuperARMS and ARMS methods showed a highly concordant result of 94.0% (220/234) (95%CI: 85.0, 95.0%). The positive rate of the SuperARMS was higher than the ARMS in the cytology samples for EGFR detection (46.2% vs. 40.2%). The specific EGFR mutation sites in 16 samples (6.8%) were not completely consistent between the SuperARMS and ARMS. A total of 14 patients showed EGFR mutations when detected by SuperARMS, but by ARMS there were EGFR wild-type. Two patients were detected as having one more EGFR mutation site by SuperARMS than by ARMS. ddPCR and NGS were used to further confirm the EGFR mutations in these inconsistent samples. Eight samples had the same mutation results as the SuperARMS, and 6 samples were not verified because the remaining DNA was insufficient. A total of 78 EGFR mutation patients received Tyrosine Kinase Inhibitor (TKI) treatment. The overall objective response rate (ORR) was 88.5% (69/78) for EGFR TKI treatment. CONCLUSION SuperARMS showed a high sensitivity and specificity for EGFR detection and thus, is expected to become a routine test in the clinic to be used as a widely available, easy-to-operate and sensitive method for EGFR mutation detection in liquid-based cytology samples.
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Affiliation(s)
| | | | - Wei Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 200433, Shanghai, People's Republic of China
| | - Liping Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 200433, Shanghai, People's Republic of China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 200433, Shanghai, People's Republic of China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 200433, Shanghai, People's Republic of China.
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26
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Lin CK, Jan IS, Yu KL, Chang LY, Fan HJ, Wen YF, Ho CC. Rapid on-site cytologic evaluation by pulmonologist improved diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy. J Formos Med Assoc 2020; 119:1684-1692. [PMID: 31964550 DOI: 10.1016/j.jfma.2020.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/01/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE Rapid on-site cytologic evaluation (ROSE) has been shown to improve the diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB). However, ROSE by a cytopathologist or cytotechnologist is not always available during the procedure. The purposes of this study were to verify that a pulmonologist, after receiving training in cytology, could accurately assess an EBUS-TBB specimen on-site, and to evaluate the contribution of ROSE to EBUS-TBB. METHODS A retrospective chart review of patients who underwent EBUS-TBB for diagnosis of peripheral pulmonary lesions (PPLs) from January 2014 to June 2017 was performed. PPLs without a malignant diagnosis were excluded. The ROSE result determined by a pulmonologist was compared to the formal imprint cytologic report and pathologic report. The diagnostic accuracy of EBUS-TBB was also compared between those with and without ROSE. RESULTS Two hundred ninety-three patients who underwent 336 EBUS-TBB procedures for PPL diagnosis and were found to have proven malignancy were enrolled. Eighty-six procedures were performed with ROSE. With the formal imprint cytologic diagnosis as the standard, ROSE had 96.9% sensitivity, 68.2% specificity, 89.9% positive predictive value (PPV), 88.2% negative predictive value (NPV), and 89.5% diagnostic accuracy. With the formal pathologic result as the standard, ROSE had 88.2% sensitivity, 80% specificity, 97.1% PPV, 47.1% NPV, and 87.2% diagnostic accuracy, respectively. The diagnostic accuracy was significantly higher when ROSE was performed during EBUS-TBB (88.4% vs 68.0%, P < 0.001). CONCLUSION A trained pulmonologist can interpret adequately cytologic smears on-site and effectively improve the accuracy of EBUS-TBB in the diagnosis of PPLs.
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Affiliation(s)
- Ching-Kai Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kai-Lun Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Lih-Yu Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Hung-Jen Fan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu County, Taiwan
| | - Yueh-Feng Wen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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27
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Wan T, Li Y, Hu Q, Deng H, Li D. Diagnostic value of rapid on-site evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions. Cytopathology 2019; 31:16-21. [PMID: 31571282 DOI: 10.1111/cyt.12776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the applied value of rapid on-site evaluation during endobronchial ultrasound (EBUS) with a guide sheath for peripheral pulmonary lesions (PPLs). METHODS Consecutive patients who underwent EBUS with a guide sheath for PPLs at our hospital from December 2015 to June 2017 in this retrospective study. The samples obtained from each operation were made rapid on-site evaluation at the same time. The results of rapid on-site evaluation were compared with the pathological diagnosis. RESULTS A total of 127 PPLs in 124 patients were included in the study. 70 lesions were malignancy in the final pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of rapid on-site evaluation for malignancy during EBUS with a guide sheath for PPLs was 88.6%, 98.2%, 98.4%, 87.5% and 92.9%, respectively. CONCLUSIONS Rapid on-site evaluation during EBUS with a guide sheath has a high diagnostic value for malignant PPLs.
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Affiliation(s)
- Tao Wan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qianfang Hu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongli Deng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dairong Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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28
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The Utility of Rapid On-Site Evaluation during Bronchoscopic Biopsy: A 2-Year Respiratory Endoscopy Central Experience. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5049248. [PMID: 31886221 PMCID: PMC6925907 DOI: 10.1155/2019/5049248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/10/2019] [Accepted: 08/08/2019] [Indexed: 01/01/2023]
Abstract
Background Rapid on-site evaluation (ROSE) is commonly used to evaluate the adequacy of biopsy materials in fine-needle aspiration; however, the diagnostic performance of ROSE during fiber optic bronchoscopy (FOB) biopsy under direct vision is rarely reported. Here, we evaluated the role of ROSE during FOB biopsy of visible lesion in trachea or bronchi. Methods The role of ROSE was prospectively evaluated in consecutive bronchoscopy specimens obtained between January 2016 and January 2018. The agreement and accuracy between ROSE and final histopathological interpretation were assessed. The frequency and possible reasons for discrepancy between ROSE and definitive histopathology results were identified. Histological and cytological classification was performed according to the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS) criteria of lung ADCs classification. Results The study enrolled 651 patients, of which 33 were excluded because of insufficient cells. Final diagnosis of malignancy was achieved in 462 cases (74.8%), whereas 156 cases (25.2%) were nonmalignant. ROSE and pathology were well correlated for the diagnosis of squamous cell carcinoma (SCC) (Kappa = 0.718, p < 0.05), adenocarcinoma (AdC) (Kappa = 0.662; p < 0.05) and small cell lung cancer (SCLC) (Kappa = 0.955; p < 0.05). In 24 cases diagnosed as malignant by ROSE and nonmalignant by pathology, the lesion tissues were surgically excised and re-analyzed, and the 24 cases were finally confirmed as malignant by pathology. Conclusions ROSE technique allows bronchoscopists to obtain viable and adequate material for the diagnosis of histopathology, and provides them with an onsite preliminary diagnosis especially in cases with inconclusive macroscopic appearance. ROSE and pathology should be used in combination to increase the accuracy of diagnosis.
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29
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Umeda Y, Otsuka M, Nishikiori H, Ikeda K, Mori Y, Kobayashi T, Asai Y, Takahashi Y, Sudo Y, Kodama K, Yamada G, Chiba H, Takahashi H. Feasibility of rapid on‐site cytological evaluation of lung cancer by a trained pulmonologist during bronchoscopy examination. Cytopathology 2019; 30:628-633. [DOI: 10.1111/cyt.12771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Yasuaki Umeda
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Mitsuo Otsuka
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Hirotaka Nishikiori
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Kimiyuki Ikeda
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yuki Mori
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Tomofumi Kobayashi
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yuichiro Asai
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yohei Takahashi
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yuta Sudo
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Kentaro Kodama
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Gen Yamada
- Department of Respiratory MedicineTeine Keijinkai Hospital Sapporo Hokkaido Japan
| | - Hirofumi Chiba
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Hiroki Takahashi
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
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30
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Shanthikumar S, Massie J, Ranganathan S, Schuhmann M, Eberhardt R, Irving LB, Herth FJF, Steinfort DP. Utility of Endobronchial Ultrasound in Assessment of Intrathoracic Lesions in Paediatric Patients. Respiration 2019; 98:340-346. [PMID: 31412340 DOI: 10.1159/000501466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In adults, linear endobronchial ultrasound (EBUS) is the preferred modality to sample intrathoracic adenopathy and radial EBUS is a useful tool to biopsy peripheral pulmonary nodules. Utility in children is less well known. OBJECTIVES The objective of this study was to review the EBUS experience of two specialist centres to better define the current role of EBUS in paediatric practice. METHODS A retrospective record review of EBUS procedures undertaken in patients aged 0-17 years at the Royal Children's Hospital (Melbourne, Australia) and Thoraxklinik (Heidelberg, Germany) was performed. Data extracted included patient demographics, clinical presentation, bronchoscope (size and model), EBUS technique used, pathologic results, need for further invasive investigation, and complications. RESULTS Between 2008 and 2017, ten EBUS procedures were performed (6 linear EBUS and 4 radial EBUS). No complications were reported. Linear EBUS was performed on subjects who were between 4 and 15 years old, with a 100% diagnostic yield. Radial EBUS was non-diagnostic in three cases of non-malignant disease. In one case, it was used successfully for imaging alone. CONCLUSION Both linear and radial EBUS are safe and feasible in children. Diagnostic yield of linear EBUS was 100%. Radial EBUS did not demonstrate utility, likely reflecting the pathologies of underlying parenchymal masses in paediatric populations.
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Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia, .,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia, .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia,
| | - John Massie
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarath Ranganathan
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maren Schuhmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg, Germany.,Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg, Germany.,Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg, Germany.,Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Daniel P Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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31
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Wang J, Zhao Y, Chen Q, Zhang P, Xie W, Feng J, Cao J. Diagnostic value of rapid on-site evaluation during transbronchial biopsy for peripheral lung cancer. Jpn J Clin Oncol 2019; 49:501-505. [PMID: 30855687 DOI: 10.1093/jjco/hyz025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/12/2019] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An increasing number of pulmonary lesions-particularly, peripheral lung lesions-are identified with current technological advancements. Notably, the yield of traditional bronchoscopy for the diagnosis of peripheral lung lesions is low. This study evaluated the diagnostic value of rapid on-site evaluation (ROSE) during transbronchial biopsy for peripheral lung cancer. METHODS This study included 641 patients who underwent transbronchial biopsy for suspected lung cancer at the Respiratory Department of Tianjin Medical University General Hospital between January 2012 and December 2016. Based on whether ROSE was used, patients were assigned to the ROSE group (353 patients) or non-ROSE group (288 patients). In the ROSE group, several air-dried smears were processed with Diff-Quik staining; the remaining samples were placed in 10% formalin. Diagnostic yields for central and peripheral lung cancer were compared between the two groups. In addition, ROSE results were compared with final diagnoses. RESULTS Diagnostic yield for peripheral lung cancer, stratified by pathology, was significantly higher in the ROSE group than in the non-ROSE group (42.9% vs. 30.7%, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ROSE for peripheral pulmonary lesions were 90.0%, 89.5%, 94.0%, 82.8% and 89.8%, respectively. Conformance was high between ROSE and final pathologic evaluations during transbronchial biopsy (Kappa = 0.780, P = 0.035). There were no procedure-related deaths. CONCLUSIONS ROSE during conventional transbronchial biopsy improves diagnostic yield, stratified by pathology, for patients with peripheral lung cancer via live feedback. Moreover, ROSE diagnosis correlates with final cytopathological diagnosis.
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Affiliation(s)
- Juan Wang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Yaping Zhao
- Respiratory Department of Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Qianqian Chen
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Zhang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Xie
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Feng
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Cao
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
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32
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Steinfort DP. ACCESS ALL AREAS: Electromagnetic navigation and the pulmonologist. Respirology 2019; 24:406-407. [PMID: 30803118 DOI: 10.1111/resp.13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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A Novel Approach to Detect Programed Death Ligand 1 (PD-L1) Status and Multiple Tumor Mutations Using a Single Non-Small-Cell Lung Cancer (NSCLC) Bronchoscopy Specimen. J Mol Diagn 2019; 21:186-197. [PMID: 30772141 DOI: 10.1016/j.jmoldx.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/24/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022] Open
Abstract
Multiple biomarkers are under evaluation to guide the use of immune checkpoint inhibitors in non-small-cell lung cancer (NSCLC), including programed death ligand 1 (PD-L1) tumor cell staining. We have developed a new approach that accurately quantifies PD-L1 status and identifies multiple mutations by using a single bronchoscopy specimen. A novel molecular marker was identified to detect the presence of malignant cells in radial endobronchial ultrasound bronchial brushings from NSCLC (n = 15) and benign (n = 13) nodules by quantitative real-time RT-PCR (RT-qPCR). The MMP9:TIMP3 transcript ratio was significantly increased in NSCLC and using receiver operating characteristic curve analysis accurately discriminated malignant and benign bronchoscopy specimens (area under the curve = 0.98; 95% CI, 0.93-1; P < 0.0001). Utilizing the same specimens, PD-L1 expression and multiple oncogenic mutations were detected by RT-qPCR and next-generation sequencing. A second archive of snap-frozen squamous cell carcinoma (n = 40) and control (n = 20) biopsies with matching formalin-fixed, paraffin-embedded slides were used to compare PD-L1 status by immunohistochemistry and RT-qPCR. The biopsy cohort confirmed that the MMP-9:TIMP3 ratio was predictive of malignancy and demonstrated that PD-L1 transcript expression was concordant with PD-L1 tumor cell membrane staining in NSCLC (Spearman r = 0.636, P < 0.0001). This rapid molecular approach can detect malignant cells and using the same single bronchoscopy specimen can generate high-quality unfixed nucleic acid that accurately quantify PD-L1 status and identify multiple oncogenic mutations.
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Douglas N, Ng I, Nazeem F, Lee K, Mezzavia P, Krieser R, Steinfort D, Irving L, Segal R. A randomised controlled trial comparing high-flow nasal oxygen with standard management for conscious sedation during bronchoscopy. Anaesthesia 2017; 73:169-176. [DOI: 10.1111/anae.14156] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Affiliation(s)
- N. Douglas
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - I. Ng
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - F. Nazeem
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - K. Lee
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - P. Mezzavia
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - R. Krieser
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - D. Steinfort
- Department of Respiratory Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - L. Irving
- Department of Respiratory Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - R. Segal
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
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Wimaleswaran H, Farmer MW, Irving LB, Jennings BR, Steinfort DP. Pulmonologist-performed transoesophageal sampling for lung cancer staging using an endobronchial ultrasound video-bronchoscope: an Australian experience. Intern Med J 2017; 47:205-210. [PMID: 27860078 DOI: 10.1111/imj.13330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/16/2016] [Accepted: 11/03/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transoesophageal endobronchial ultrasound (EBUS) video-bronchoscope insertion provides pulmonologists access to conduct endoscopic fine-needle aspiration (EUS-B-FNA) of mediastinal lymph node (LN) lesions and also assist in lung cancer staging by sampling left adrenal gland (LAG) lesions. Limited literature has described additional diagnostic value whilst maintaining patient safety. To elicit whether combining endoscopic transoesophageal fine-needle aspiration using convex probe bronchoscope (EUS-B-FNA) and EBUS bronchoscopy enhances the diagnostic yield of mediastinal nodal staging in lung cancer, whilst maintaining safety. METHODS All eligible patients with paraoesophageal lesions on thoracic computed tomography (CT) underwent pulmonologist-performed EUS-B-FNA at two tertiary centres and were included in this prospective observational cohort study. RESULTS EUS-B-FNA sampling was performed at 69 mediastinal LN lesion sites, including 17 sites inaccessible to bronchoscopic sampling. Four LAG lesions were sampled via EUS-B-FNA. There were no complications. EBUS-TBNA was augmented by EUS-B-FNA because of accessibility of sampling lesions otherwise unamenable bronchoscopically, thereby increasing diagnostic utility. Diagnostic sensitivity of EUS-B-FNA for malignancy in mediastinal LN lesions was 88% (51 of 58). For mediastinal LN lesions not amenable to EBUS-TBNA, the sensitivity for diagnosis of malignancy via EUS-B-FNA was 88% (15 of 17). Diagnostic sensitivity of EUS-B-FNA for malignancy in LAG lesions was 50% (2 of 4). CONCLUSION EUS-B-FNA is a precise and safe approach in the evaluation and staging of lung cancer when performed by a pulmonologist. It complements and increases the diagnostic utility of EBUS-TBNA by further coverage of mediastinal LN stations and access to LAG lesions.
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Affiliation(s)
- Hari Wimaleswaran
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael W Farmer
- Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louis B Irving
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Barton R Jennings
- Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Daniel P Steinfort
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Pulmonologist-Performed Per-Esophageal Needle Aspiration of Parenchymal Lung Lesions Using an EBUS Bronchoscope: Diagnostic Utility and Safety. J Bronchology Interv Pulmonol 2017; 24:117-124. [PMID: 28005836 DOI: 10.1097/lbr.0000000000000350] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transesophageal introduction of the endobronchial ultrasound (EBUS) videobronchoscope allows pulmonologists to perform endoscopic ultrasound fine-needle aspiration (EUS-B-FNA) of mediastinal lesions. Safety, diagnostic accuracy, and feasibility of EUS-B-FNA in evaluation of pulmonary parenchymal lesions are not established. METHODS All patients undergoing pulmonologist-performed EUS-B-FNA of parenchymal lung lesions at 2 tertiary centers were included in this prospective observational cohort study. RESULTS EUS-B-FNA sampling of parenchymal lesions was performed in 27 patients. Mean (±SD) lesion size was 36±16 mm. Seven lesions were ≤18 mm. Pneumothorax occurred in 1 patient (3.7%, 95% confidence interval, 0.001%-19%). Ten target lesions (36%) were in locations inaccessible to bronchoscopic sampling via the airways, and 9 lesions were inaccessible to EBUS-guided transbronchial needle aspiration and in locations associated with low diagnostic yield from radial EBUS. EUS-B-FNA was diagnostic in 26 patients (96%), and sensitivity of EUS-B-FNA was 100% (95% confidence interval, 87%-100%) for both lung cancer (n=21) and for pulmonary metastatic lesions (n=5). CONCLUSIONS Pulmonologist-performed EUS-B-FNA is safe and accurate in the evaluation parenchymal lung lesions. Diagnostic accuracy is high. EUS-B-FNA may achieve access to sites not amenable to other forms of bronchoscopic sampling, or increase diagnostic accuracy in patients where anatomic position predicts a low diagnostic yield.
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Leong TL, Christie M, Kranz S, Pham K, Hsu A, Irving LB, Asselin-Labat ML, Steinfort DP. Evaluating the Genomic Yield of a Single Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Lung Cancer: Meeting the Challenge of Doing More With Less. Clin Lung Cancer 2017; 18:e467-e472. [PMID: 28576592 DOI: 10.1016/j.cllc.2017.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Minimally invasive techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), yield small specimens that are adequate for cytologic diagnosis of lung cancer, but also need to provide material for molecular analysis to guide treatment. The number of EBUS-TBNA passes needed for mutation testing remains unclear. We sought to assess the adequacy of a single pass for genomic profiling of actionable mutations. METHODS In a prospective observational study, paired samples from the same lesion were obtained from patients undergoing EBUS-TBNA for lung cancer diagnosis/staging. Following tumor cell confirmation by rapid on-site evaluation, a "reference" sample comprising ≥ 3 passes was obtained and formalin-fixed paraffin-embedded. A "study" sample comprising a single pass was taken and snap-frozen. The primary outcome was DNA yield and quality from a single pass. The secondary outcome was diagnostic accuracy of a single pass for detecting actionable mutations. RESULTS In 40 patients, single-pass specimens yielded a mean 3.98 μg of highly intact DNA, well above the minimum threshold for targeted sequencing, which was performed in adenocarcinoma cases (n = 24). In 23 cases, there was 100% agreement in mutation status between reference and study samples. In 1 case, the reference sample failed to generate a molecular diagnosis owing to insufficient tumor cells; however, the study specimen identified a KRAS mutation. Tumor cell percentage in mutation-positive specimens was 1% to 70%, suggesting that single-pass samples detect mutations even when tumor cell content is low. CONCLUSION Single EBUS-TBNA passes yield DNA of high quantity and quality with high accuracy for molecular profiling, irrespective of tumor cell content.
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Affiliation(s)
- Tracy L Leong
- Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - Michael Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Sevastjan Kranz
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kym Pham
- Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Arthur Hsu
- Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Louis B Irving
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Marie-Liesse Asselin-Labat
- Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Daniel P Steinfort
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Safety and Efficacy of Radial EBUS for the Investigation of Peripheral Pulmonary Lesions in Patients With Advanced COPD. J Bronchology Interv Pulmonol 2017; 23:192-8. [PMID: 27454473 DOI: 10.1097/lbr.0000000000000288] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Peripheral pulmonary lesion (PPL) is a common scenario in patients with chronic obstructive pulmonary disease (COPD) and represents a high risk of malignancy. Severe COPD is associated with higher complication rates following percutaneous biopsy, and routine bronchoscopy. Safety and diagnostic performance of radial endobronchial ultrasound bronchoscopy (R-EBUS) in patients with advanced COPD has not been previously assessed. METHODS We examined a retrospective cohort of patients with advanced COPD undergoing R-EBUS for the evaluation of PPL. RESULTS During the study period, 92 patients underwent 94 R-EBUS procedures. In 50 cases, patients had severe obstructive deficit with mean forced expiratory volume in 1 second (FEV1) of 1.01±0.28 L, and FEV1% predicted 39.7±8.2. In 44 cases, patients had mild-moderate obstruction with severe diffusion impairment, with mean diffusion capacity for carbon monoxide% predicted of 41.2±7.9. Pneumothorax requiring intercostal catheter insertion occurred in 2 patients (2.1%). In 10 cases (10.6%; 95% confidence interval, 4.4%-16.8%) patients experienced acute respiratory failure. Diagnostic yield was 63% (59/94) and overall sensitivity for primary lung malignancy was 70% (53/76). Nine patients had a diagnosis on R-EBUS obviating lung resection. CONCLUSION R-EBUS is safe and accurate for the investigation of PPL in patients with advanced COPD.
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Izumo T, Matsumoto Y, Sasada S, Chavez C, Nakai T, Tsuchida T. Utility of rapid on-site cytologic evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions. Jpn J Clin Oncol 2016; 47:221-225. [DOI: 10.1093/jjco/hyw180] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/03/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takehiro Izumo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Shinji Sasada
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Christine Chavez
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Toshiyuki Nakai
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Bonney A, Christie M, Beaty A, Lunke S, Taylor G, Irving L, Steinfort D. The feasibility of molecular testing on cell blocks created from brush tip washings in the assessment of peripheral lung lesions. J Thorac Dis 2016; 8:2551-2555. [PMID: 27747008 DOI: 10.21037/jtd.2016.08.85] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND With the rapid development of genotype-guided therapies, molecular testing is becoming important in the management of lung cancer. Bronchoscopy is one of the most common investigations performed to diagnose and investigate lung cancer. Given the limited samples often produced by bronchoscopy, this study aims to evaluate the feasibility of performing molecular testing on cell blocks created from bronchoscope cytology brush tip washings (BTW). METHODS Patients with positive brush cytology for tumour cells had cell blocks created from the BTW. Mutations were detected using amplicon-based massively parallel sequencing of targeted regions of EGFR, KRAS, and BRAF genes. RESULTS A total of 45 patients were included in this study. Of those, 91% had adequate specimens for molecular analysis and 66% of patients with adenocarcinoma had mutations detected. Bronchial brush tip wash cell blocks were the sole specimen available for molecular testing in 27 (60%) patients. CONCLUSIONS The findings of this study demonstrate that molecular testing can be performed on cell blocks created from BTW and this technique may allow for an increase in bronchoscope specimens amenable to molecular testing without further increasing morbidity and mortality.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Michael Christie
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Australia;; Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Anne Beaty
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Australia
| | - Sebastian Lunke
- Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Graham Taylor
- Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia;; Department of Medicine, University of Melbourne, Melbourne, Australia
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A Comparison of Techniques for Optimal Performance of Bronchoalveolar Lavage. J Bronchology Interv Pulmonol 2016; 22:300-5. [PMID: 26428510 DOI: 10.1097/lbr.0000000000000201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bronchoalveolar lavage (BAL) is a commonly used diagnostic and research tool. Currently, there is limited evidence regarding standardizing this technique. The type of suction method and number of aliquots used as well as the anatomic lung segment sampled are not standardized nor well studied. Our primary aim was to compare the quantity and quality of BAL specimens using 2 suction methods, hand-held syringe versus wall suction. Our secondary aim was to assess which anatomic lung segment yields the greatest BAL results and how many aliquots are required. METHODS A prospective clinical study was performed in patients undergoing bronchoscopies using hand-held syringe or wall suction. On the basis of radiologic findings, 100 mL (with 4 aliquots) of normal saline was instilled and the percentage volume return calculated. RESULTS Sixy-six patients were enrolled. Thirty-three patients received hand-held syringe and 33 using wall suction. There was no significant difference in the percentage volume returned, or the adequacy of fluid between these suction methods. When comparing volumes of return from different lobes, greater returns were demonstrated from the right middle lobe (P=0.002). In addition, with each sequential aliquot instilled, the return of fluid was increased significantly (P<0.001). CONCLUSIONS No significant difference was observed between hand-held syringe and wall suction in terms of volumes returned and microbiological or diagnostic yield. Performance of BAL in the right middle lobe is associated with increased return and should be preferentially used when performing a nontargeted BAL in patients with diffuse computed tomography chest changes.
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Porfyridis I, Georgiadis G, Michael M, Frangopoulos F, Vogazianos P, Papadopoulos A, Kara P, Charalampous C, Georgiou A. Rapid on-site evaluation with the Hemacolor rapid staining method of medical thoracoscopy biopsy specimens for the management of pleural disease. Respirology 2016; 21:1106-12. [PMID: 27080382 DOI: 10.1111/resp.12799] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Medical thoracoscopy (MT) is useful for the management of pleural disease. Rapid on-site evaluation (ROSE) of transbronchial needle aspirates proved to be useful during bronchoscopy. We aimed to evaluate the diagnostic performance of ROSE of MT biopsy specimens and thoracoscopists' impression of the macroscopic appearance and assess the intermodality agreement between ROSE and final histopathologic diagnosis. METHODS Sixty two patients with exudative pleural effusions further investigated with MT were enrolled. MT was performed under local anaesthesia and conscious sedation, using the rigid pleuroscope. ROSE with the Hemacolor rapid staining method of the biopsy specimens was performed. Thoracoscopists' impression of the macroscopic appearance was recorded. The final diagnosis was established following histopathological examination. RESULTS Thoracoscopic pleural biopsies were diagnosed in 61 patients (98.4%). Group A (n = 25) consisted of patients with malignancy and group B (n = 37) with benign disorders. Area under the curve of ROSE for the diagnosis of malignancy was 0.86 (95% CI: 0.76-0.96, P < 0.001), with a sensitivity of 79.17%, specificity of 94.59%, diagnostic accuracy of 88.5%, positive predictive value of 90.5% and negative predictive value of 87.5%. Intermodality agreement between ROSE and histopathology was good (κ ± SE = 0.615 ± 0.084, P < 0.001). Area under the curve of the thoracoscopists' impression of macroscopic appearance was 0.72 (95% CI: 0.58-0.85, P = 0.001), with a sensitivity of 100%, specificity of 44.7%, positive predictive value of 53.33% and negative predictive value of 100%. CONCLUSION Rapid on-site evaluation during MT was found to have high accuracy for predicting malignancy. ROSE can provide the thoracoscopist with an on-site preliminary diagnosis, especially in cases with inconclusive macroscopic appearance.
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Affiliation(s)
| | | | - Michalis Michael
- Cytopathology Department, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | | | - Panayiota Kara
- Histopathology Department, Nicosia General Hospital, Nicosia, Cyprus
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Bonney A, Beaty A, See K, Irving L, Steinfort D. Diagnostic Utility of Bronchial Brush-Tip Washings for the Immunohistochemical Assessment of Peripheral Lung Lesions. Acta Cytol 2016; 60:74-8. [PMID: 26918654 DOI: 10.1159/000444044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/08/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Immunohistochemistry (IHC) is an important component of lung cancer diagnosis and management, although performance can be limited due to tissue availability. We describe a novel technique for processing brush-tip washings (BTW) and evaluate the feasibility of IHC testing on these samples. STUDY DESIGN All patients who had cell blocks (CB) created from BTW following bronchoscopic investigation of peripheral lung lesions were included. CB were assessed for adequate material before undergoing IHC staining. RESULTS 75 patients were included in the study, with bronchoscopic diagnosis of malignancy achieved in 77%. Sixty-seven samples (89%) had sufficient cells for diagnosis on CB and 56 of these (84%) proved amenable to IHC. CB created from BTW were the sole specimens available for IHC subtyping in 7 patients (9%). CONCLUSIONS CB are easily created from BTW and are a simple method for increasing the diagnostic utility of bronchoscopic specimens without increasing the risk or duration of bronchoscopy. IHC can be easily performed in a high proportion of cases, increasing the likelihood of accurate sub-typing of tumours following diagnostic bronchoscopy.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory Medicine, The Royal Melbourne Hospital, University of Melbourne Health, Parkville, Vic., Australia
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Steinfort DP, Siva S, Leong TL, Rose M, Herath D, Antippa P, Ball DL, Irving LB. Systematic Endobronchial Ultrasound-guided Mediastinal Staging Versus Positron Emission Tomography for Comprehensive Mediastinal Staging in NSCLC Before Radical Radiotherapy of Non-small Cell Lung Cancer: A Pilot Study. Medicine (Baltimore) 2016; 95:e2488. [PMID: 26937894 PMCID: PMC4778990 DOI: 10.1097/md.0000000000002488] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Despite known limitations of positron emission tomography (PET) for mediastinal staging of non-small cell lung cancer (NSCLC), radiation treatment fields are generally based on PET-identified disease extent. However, no studies have examined the accuracy of FDG-PET/CT on a per-node basis in patients being considered for curative-intent radiotherapy in NSCLC.In a prospective trial, patients with NSCLC being considered for definitive thoracic radiotherapy (± systemic chemotherapy) underwent minimally invasive systematic mediastinal evaluation with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following noninvasive staging with integrated PET-CT.Thirty patients underwent EBUS-TBNA, with TBNA performed from a mean 2.5 lymph node (LN) stations per patient (median 3, range 1-5). Discordant findings between PET-CT and EBUS-TBNA were observed in 10 patients (33%, 95% CI 19%-51%). PET-occult LN metastases were demonstrated by EBUS in 4 patients, whereas a lesser extent of mediastinal involvement, compared with FDG-PET, was demonstrated by EBUS in 6 patients, including 2 patients downstaged from cN3 to pN2. LNs upstaged by EBUS were significantly smaller than nodes downstaged by EBUS, 7.5 mm (range 7-9) versus 12 mm (range 6-21), P = 0.005.A significant proportion of patients considered for definitive radiotherapy (+/-chemotherapy) undergoing systematic mediastinal evaluation with EBUS-TBNA in this study have an extent of mediastinal NSCLC involvement discordant with that indicated by PET-CT. Systematic EBUS-TBNA may aid in defining the extent of mediastinal involvement in NSCLC patients undergoing radiotherapy. Systematic EBUS-TBNA has the potential to contribute significantly to radiotherapy planning and delivery, by either identifying occult nodal metastases, or demonstrating FDG-avid LNs to be disease-free.
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Affiliation(s)
- Daniel P Steinfort
- From the Department of Cancer Medicine, Peter MacCallum Cancer Institute, East Melbourne (DPS, LBI); Department of Medicine, University of Melbourne (DPS, TLL, LBI); Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville (DPS, MR, LBI); Department of Respiratory Medicine, Monash Medical Centre, Clayton (DPS); Department of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne (SS, DLB); Sir Peter MacCallum Department of Oncology, University of Melbourne (SS, DLB); Department of Nuclear Medicine (DG); Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Parkville (PA); and Department of Cancer Surgery, Peter MacCallum Cancer Institute (PA), East Melbourne, Australia
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Steinfort DP, Bonney A, See K, Irving LB. Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions. Eur Respir J 2015; 47:607-14. [PMID: 26541529 DOI: 10.1183/13993003.00786-2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022]
Abstract
Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±sd). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield.
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Affiliation(s)
- Daniel P Steinfort
- Dept of Medicine, University of Melbourne, Parkville, Australia Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Asha Bonney
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Katharine See
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Louis B Irving
- Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
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Deng C, Cao X, Lin Q, Chen L, Yang M, Ding H, Liu K, Zhang X. An irregular pulmonary nodule was confirmed diagnosis of aspiration pneumonia by finding plant cells through rapid on-site evaluation. CLINICAL RESPIRATORY JOURNAL 2015; 11:117-121. [PMID: 25831992 DOI: 10.1111/crj.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/23/2015] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Chaosheng Deng
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Xiaoming Cao
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Qichang Lin
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Lingying Chen
- Department of Pathology; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Minxia Yang
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Haibo Ding
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Kaixiong Liu
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
| | - Xin Zhang
- Respiratory Disease Institution; Department of Respiratory Disease; First Affiliated Hospital; Fujian Medical University; Fuzhou Fujian Province China
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