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H. Lee
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-023 - A Complete Thoracic Navigation System to Allow for Nodal and Parenchymal Molecular Assessment in NSCLC: A Prospective Human Study (ID 1174)
09:30 - 09:30 | Author(s): H. Lee
- Abstract
Background:
Peripheral pulmonary nodules (PPN) remain a diagnostic challenge for physicians. Minimally invasive biopsy methods for molecular analysis include endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), navigational bronchoscopy (NB) and transthoracic needle aspiration under computer tomography (CT) guidance. Recently, a combined thoracic navigation system (TNS) allowing for NB and electromagnetic navigational trans-thoracic needle aspiration (N-TTNA) has become available allowing for all necessary procedures to obtain diagnostic and molecular analysis for NSCLC to be performed during a single procedural session.
Methods:
This study was a prospective single arm study examining the success in obtaining molecular tissue in NSCLC cases from the lymph nodes and/or PPN using a novel combined diagnostic approach with TNS (EBUS, NB and N-TTNA) in a single procedural setting. Consecutive patients who consented with a PPN undergoing bronchoscopy were enrolled. All patients underwent convex EBUS for full lymph node staging followed by NB and N-TTNA. All non-diagnostic biopsies were followed with radiographic interval imaging revealing a decrease in size or resolution or a surgical biopsy was performed. The primary outcome was successful acquisition and testing of tissue for molecular analysis.
Results:
Twenty-four subjects with PPN were enrolled in this study (9 male and 15 female) with a median age of 70 years (range 52-85). An EBUS with NB and/or N-TTNA was completed in 24/24 (100%) of the patients. In this cohort, there were seven cases of Adenocarcinoma in which adequate tissue for molecular analysis was obtained in all (100%) of the cases. PPN diagnostic tissue that was adequate for molecular testing was achieved in six out of seven patients (85%). Four patients had evidence of nodal disease on EBUS and all four (100%) nodal samples were adequate for molecular analysis. When a complete TNS is performed combining convex EBUS with the combined TNS procedure for complete staging, the overall diagnostic yield was 92%. No bleeding or hemoptysis events were encountered during the study. There were two (8%) subjects required small bore pigtail catheter placement secondary to pneumothorax.
Conclusion:
This is the first human study demonstrating the sampling adequacy for both nodal and parenchymal tissue sampling for NSCLC molecular analysis in a single procedural setting. Multicentered prospective studies are needed to confirm the utility of these findings in an era of expanding need for tissue acquisition in a minimally invasive setting.
