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M. Vasakova



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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-032 - Bronchoscopy in the Czech Republic, 2012 (ID 2338)

      09:30 - 09:30  |  Author(s): M. Vasakova

      • 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)".

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-006 - The contribution of histopathological evaluation of small samples obtained by EBUS puncture for diagnosis of pathological masses in mediastinum (ID 263)

      09:30 - 09:30  |  Author(s): M. Vasakova

      • Abstract

      Background
      Endobronchial ultrasonography (EBUS) have reached an important position in diagnosis of tumors and enlarged lymph nodes involving mostly mediastinum. The puncture of pathological mediastinal masses under EBUS control is perfomed with thin needle and the obtained samples are mainly evaluated by means of cytology, which in case of malignant tumors does not give definite diagnosis including subtyping of tumor. Thus we aimed to evaluate the EBUS puncture samples also by means of histopathology including immunohistochemistry.

      Methods
      During one year we investigated 94 patients (53 males, 41 females, mean age 52 years) with enalrged lymph nodes or tumor spread involving mediastinum by EBUS puncture with sampling for cytology, histopathology and immunohistochemistry. 42 patients had suspicion of sarcoidosis, 32 lung cancer with diastinal involvement, 7 metastates of extrapulmonary tumor to mediastinal lymph nodes, 3 lymphoma and 10 pulmonary infiltrates with mediastinal lymphadenopathy probably of inflammatory origin. The investigation was performed under general anesthesy and the other samples from the invoved sites of lungs (aspirates, brushes, excisions, transbronchial biopsies (TBB), bronchoalveolar lavage (BAL)) were taken ad the same time.

      Results
      In the sarcoidosis group we obtained histopathologically evaluable samples from EBUS puncture of lymph nodes in 19 patients (45%) and in 8 of them (19%) the sarcoid granulomas were described. In lung cancer group we had valid samples in 23 patients (72%) and in 17 of them (53%) we diagnosed the carcinoma histopathologically including immunohistochemical analysis, and in 6 patients (19%) we confirmed normal lymph nodes. In the group of patients with extrapulmonary malignancy we defined histopathologically the metastases in mediastinal lymph nodes in 2 of 7 patients and in 1 sarcoidosis. In the patients with suspect lymhopma histopathological evaluation of lymph nodes did not support the diagnosis. In the group of pulmonary infiltrates with mediastinal lymhadenopathy we proved by histopathology normal or inflammatory lymph nodes in 5 of 10 patients.

      Conclusion
      Histopathological evaluation including immunohistochemical analysis of samples from EBUS puncture of tumors involving mediastinum and mediastinal lymh nodes is of important value mainly in lung cancer and metastatic cancer involvement. This approach enables the patients to avoid surgical bioptic procedures in non-resectable cases and thus helps to start the targetted tratment of lung cancer as early as possible. In case of sarcoidosis the histopathological evaluation of lymph node puncture samples rises the propability of stating definite diagnosis in combination with other prcedures (BAL, TBB).Figure 1 Fig.1 Small cell cancer, sample from EBUS puncture, EMA staining