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Y.H. Khor



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    P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pulmonology + Endoscopy/Pulmonary
    • Presentations: 1
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      P1.17-005 - Evaluation of the implementation of interventional bronchoscopy: Local data from the Austin Hospital, Melbourne (ID 2169)

      09:30 - 09:30  |  Author(s): Y.H. Khor

      • Abstract

      Background
      Newer interventional bronchoscopy techniques, including radial and linear endobronchial ultrasound (EBUS), and electromagnetic navigation bronchoscopy (ENB), have recently been established at the Austin Hospital, Melbourne. Linear EBUS has been recommended as the preferred method for preoperative invasive staging of non-small cell lung cancer with comparably high sensitivity compared to mediastinoscopy. Radial EBUS and ENB improve the sensitivity compared to conventional bronchoscopy for investigation of peripheral lung lesions. Radiologically guided transthoracic biopsy has superior diagnostic performance, radial EBUS and ENB are safer with significantly lower pneumothorax rate. We present our results of a newly established interventional bronchoscopy service in the evaluation of patients with suspected lung cancer.

      Methods
      A retrospective review was performed of all patients referred to our department for interventional bronchoscopy between April 2012 and June 2013 in whom lung cancer was suspected based on clinical presentation, radiographic imaging and/or positron emission tomography. Using physician-led conscious sedation, the procedures were performed or supervised by an experienced bronchoscopist. Procedure related complications were also recorded. Non-diagnostic procedures were classified as true negative if an alternative tissue diagnosis was found, the lesion resolved on follow up or if another diagnostic procedure confirmed the negative result. Patients with negative results with no follow up data available were included as false negative.

      Results
      Linear EBUS Of the total 92 cases, 43 (47%) were performed for investigation of suspected malignancy. TBNA was not performed in one of the cases as no abnormal lymph nodes were identified on EBUS. Sensitivity was 98%, specificity 100%, positive predictive value 100% and negative predictive value 91%.

      Malignanat Lesions Numbers (n)
      Primary Lung Cancer Small cell carcinoma Non-small cell carcinoma - unclassified Adenocarcinoma Adenosquamous carcinoma SquamousOthers Metastatic breast cancer Lymphoma 14 2 16 2 4 1 2
      Peripheral lung lesions 40 cases of radial EBUS and 16 cases of ENB were performed. For malignancy, the diagnostic yields for radial EBUS and ENB were 70% and 40%, respectively. Non-malignant diagnoses were found in 10 cases and an infective organism was identified in 8 of these. Complications There was no significant complication requiring hospital admissions, blood transfusions or surgical interventions. Minor complications include bleedings (3), tachycardia or arrhythmia (5), excessive cough (3), agitation (1), hypertension (1).

      Conclusion
      The results of the interventional bronchoscopy service at the Austin Hospital is comparable with published data on these procedures. This has improved the assessment of patients with suspected lung cancer.

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    P3.17 - Poster Session 3 - Bronchoscopy, Endoscopy (ID 185)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track:
    • Presentations: 1
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      P3.17-003 - Implementation of Rapid On-Site Evaluation for Linear EBUS: Local experience from the Austin Hospital, Melbourne (ID 2027)

      09:30 - 09:30  |  Author(s): Y.H. Khor

      • Abstract

      Background
      Linear endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is widely used for tissue sampling of mediastinal and hilar lesions. Rapid On-Site Evaluation (ROSE) is a technique where TBNA samples are rapidly processed and screened for diagnostic material intra-procedure. The use of ROSE improves diagnostic yield, cost-effectiveness, and reduces procedural time. Until recently, at Austin Health, EBUS TBNA samples were prepared in the endoscopy room and evaluated off-site. Preliminary results were conveyed to the bronchoscopist via telephone leading to significant delay. We propose that the implementation of ROSE to assist EBUS-TBNA procedures will reduce the number of lymph node aspirates performed without reducing the quality or diagnostic yield.

      Methods
      Consecutive EBUS-TBNA cases were prospectively evaluated following institution of ROSE. The number of lymph node stations sampled and the number of aspirations per lymph node station were recorded. This was compared to a retrospective dataset of 69 consecutive cases preceeding the commencement of ROSE. Specimen Preparation Material obtained from TBNA was transferred onto numbered slides with at least one air-dried smear and one 95% alcohol fixed smear prepared per puncture. Remaining material was put into a saline pot for cell block preparation. A cytologist's assessment of specimen adequacy and presence of diagnostic material was performed on-site after a rapid H&E stain. Lymph node stations sampled and number of aspirations performed was recorded.

      Results
      Preliminary results

      Pre-ROSE Post-ROSE p value
      Number of cases 69 21 -
      Median number of punctures 4 4 0.23
      Median number of punctures per lesion 2 2.5 0.46
      > 1 lesion investigated (%) 66 48
      For suspected lung cancer cases, the concordance rate between ROSE and final cytologic diagnosis was 92%. Data collection is ongoing.

      Conclusion
      Utilising ROSE during EBUS TBNA lead to a non-significant reduction in the number of lymph node stations sampled. However, it did not change the number of punctures performed.