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• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11978

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    P2.24-032 - Bronchoscopy in the Czech Republic, 2012 (ID 2338)

    09:30 - 09:30  |  Author(s): M. Marel
    • Abstract

    Background
    The incidence of lung cancer in the Czech Republic has been unacceptably high for decades. It has reached 91/100 000 in men and 31/100 000 in women. Bronchoscopy plays an important role in the diagnostic process. To assess the quality and density of the bronchological net and to determine the current situation in the implementation of bronchoscopy in the Czech Republic we decided to carry out a national survey.

    Methods
    A bronchological questionnaire was sent by e-mail to every pneumologist performing bronchoscopy. With the help of repeated e–mails and additional telephone interviews we achieved a response rate of more than 95%.

    Results
    In 2012 there were 56 centers performing bronchoscopy in adults and 9 in children in the Czech Republic. The bronchological units of adult clinics employed 169 bronchologists using 231 fiberscopes, out of which 88 were video bronchoscopes and 79 rigid bronchoscopes. Altogether 30 354 bronchoscopies were performed in adults. General anesthesia was used in 2 146 cases, the rest was carried out under local anesthesia. The total number also includes 1767 bronchoscopies performed using rigid instrumentation. Cytological examination of the material obtained during bronchoscopy was carried out by a pathologist (Department of Clinical Pathology) at 34 centers, by a pneumologist trained in cytology at 13 centers and by both the pathologist and the pneumologist at 9 centers. Interventional bronchoscopic procedures (laser, electrocautery, stenting, brachytherapy, cryocautery and the introduction of endobronchial valves) were used in 17 departments. Altogether the above mentioned procedures were performed 654 times during one year. All 9 children's bronchological departments employed 12 bronchoscopists, using a total number of 29 fiberscopes, out of which 17 were video bronchoscopes. Seven pediatric bronchoscopy centers also used rigid instrumentation. The total number of pediatric bronchoscopies performed in 2012 was 682, the majority of them (621) under general anesthesia. Out of all bronchoscopies, the rigid bronchoscopy was performed in 32 cases. At five centers cytology examination was performed by a pathologist, at 3 centers by a pneumologist trained in cytology and at one center by both specialists together. Further analysis of the specialized bronchological procedures (endobronchial ultrasound, autofluorescence), including a comparison with previous surveys will be given in the lecture or on the poster.

    Conclusion
    The level of bronchological service offered in the Czech Republic is comparable with the most developed countries and serves a prompt and exact diagnostics of patients with respiratory disorders including lung cancer. "Supported by Projects (Ministry of Health) of conceptual development of research organization 00064203 (FN Motol, Prague, Czech Republic)".

• 12837

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  P3.22 - Poster Session 3 - Epidemiology, Etiology (ID 168)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12838

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    P3.22-001 - Incidence of lung cancer and pulmonary emphysema, a study of 708 autopsy cases from University Hospital Motol, Prague (ID 957)

    09:30 - 09:30  |  Author(s): M. Marel
    • Abstract

    Background
    The incidence of lung cancer in the Czech Republic is high. It has reached 91/100 000 in men and 31/100 000 in women. The TNM stages I and II are diagnosed in less than 20% of all patients. Patients with COPD are at higher risk of lung cancer. How exactly emphysema affects the development of malignancy and how many patients with/without emphysema will suffer from lung cancer is unknown. Likewise, we do not know how many patients with existing lung cancer are diagnosed post-mortem and we have been interested in whether this group of patients shares any common features. Therefore, we decided to carry out an autopsy study which would provide answers to our questions.

    Methods
    We compared clinical data with autopsy findings in patients, both adults and children, from the largest hospital in the Czech Republic. During two studied years (2011-2013) we obtained complete sets of data on 708 patients.

    Results
    The studied group included 398 men and 310 women, with a median age of 71 years. Autopsies found a total of 55 lung cancer cases (7.8% of the set). Out of these, 24 (44%) tumours were diagnosed only by autopsy. In 40% of autopsy cases emphysema was proved along with a pulmonary malignancy. In the group of 24 patients with newly diagnosed lung cancer, emphysema was more common than in patients with a previously known tumour (50% vs. 32%).Patients with lung cancer discovered during autopsy died due to CHF in 8 cases, pneumonia in 6 cases, exacerbation of COPD in 2 cases, stroke in 2 cases, other tumours in 3 cases, and abdominal conditions in 3 cases. Emphysema during lifetime has been described less often than post-mortem (84 vs. 197 patients). The prevalence of autopsy proven emphysema was therefore 27.8%, the prevalence determined by clinical data was 11.8%. Lung cancer was diagnosed in one of every 10 patients with emphysema (20/197) and one in every 15 patients without emphysema (35/511).

    Conclusion
    The number of patients undiagnosed with lung cancer during their lifetime (44%) was higher than both literature data and our expectations. Studies carried out in the past accounted for 1 newly diagnosed lung cancer case per 80 autopsies, whereas in our group the ratio was 1:30 (Ošťádal, Studia pneumologica, 1994). On the other hand 27.8% cases with emphysema confirmed by autopsy corresponded with data in literature (15-65%; Thurlbeck, W. et Wright, J. L.: Chronic Airflow Obstruction) and results of similar previous studies which proved emphysema in 53% of autopsies on cases around the age of 70 years (Dalquen, P.: Incidence of Pulmonary Emphysema, and Study of 467 randomised autopsy cases 1, Beiträge zur Pathologie, 153, 4, 330-381). Our further results confirmed our clinical experience about the more frequent occurrence of lung cancer in patients with emphysema (1 in 10) compared with those without emphysema (1 in 15). "Supported by Projects (Ministry of Health) of conceptual development of research organization 00064203 (FN Motol, Prague, Czech Republic)."