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J.F. Turner
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P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.04-060 - Analysis of Lung Microbiome From Patients Undergoing Bronchoscopy (ID 1072)
09:30 - 09:30 | Author(s): J.F. Turner
- Abstract
Background:
Recent studies have demonstrated diversity in the lung microbiomes of chronic obstructive pulmonary disease and healthy individuals. Lung microbial communities may not just serve as a predictor of cancer development, but also as a target of pharmacological cancer prevention strategies. We sought to characterize the lung microbiome diversity within patients with lung cancer for comparison to those without lung cancer.
Methods:
Signed informed consent was obtained from patients ages 18 years and older that underwent a bronchoscopy during the course of clinical evaluation at one of two cancer centers. A bronchial lavage was collected for research purposes after routine bronchoscopic procedures were completed. The lavage sample was collected in a sterile collection container and immediately placed on dry ice. Subsequently, samples were diluted 1:1, incubated with dithiothreitol to aid in mucus dissolution, and then mechanically homogenized. DNA was extracted and 515F/806R 16S rRNA primers used to amplify Variable Region 4. Amplicons were sequenced using the Illumina MiSeq. Sequences were clustered into operational taxonomic units (OTUs) using QIIME’s open reference OTU picking workflow, and taxonomy was assigned to OTUs by classification against the Greengenes database using the RDP Classifier. Microbial communities were compared using phylogenetic beta diversity metrics based on 16S rRNA reads. Statistical significance of diversity between samples was determined by comparing the UniFrac distances between pairs of samples using parametric and non-parametric Monte Carlo-based t-tests. Differences in alpha diversity were tested using a t-test comparing the distributions of diversity values across the sample types.
Results:
None of the patients undergoing a research-related bronchial lavage experienced a significant adverse event from the procedure. There were seven lung cancer patients with a median age of 56.0 years (range 45-75). Of these, six were current/former smokers with an average of 32.5 pack-years. All seven lung cancer patients were Caucasian with five using prescription inhalers and none on recent antibiotics. Five patients had adenocarcinoma and one each of squamous cell carcinoma and small cell lung cancer. There were six non-lung cancer patients with a median age of 57.5 years (range 39-68). Of these, three were current/former smokers with an average of 40 pack-years. All six non-lung cancer patients were Caucasian with three using prescription inhalers and one recently taking antibiotics. Analyses of the microbiota present in lung samples show the presence of multiple bacterial taxonomic groups in each sample, however, the phylogenetic diversity of the bacterial community is low compared to other body sites. Fusobacteria represented a significant portion of the bacterial community of lavage samples. Not surprisingly, the community composition of these samples is most similar to human oral communities, however, a portion of these communities is unlike communities from other characterized human body sites and we are still actively investigating these differences.
Conclusion:
Microbiota associated with lung cancer have not been well-characterized or associated with treatment and outcome. Our analyses suggest that bacterial communities may play an important role in cancer development and present an opportunity to better characterize these communities and their components. Updated results will be presented at WCLC.
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-016 - Upstaging of Lung Cancer - Use of Endobronchial Ultrasound in the Prediction of T4 Disease (ID 2462)
09:30 - 09:30 | Author(s): J.F. Turner
- Abstract
Background:
There has been an increased utilization of radial and convex probe endobronchial ultrasound with application in the nodal staging of the mediastinum for bronchogenic carcinoma. Prior work has demonstrated that vascular invasion (Vi) is associated with upstaging and a worsened prognosis in those patients with non-small cell carcinoma. Utilization of endobronchial ultrasound has been promulgated to improve the sensitivity of transbronchial needle aspiration (TBNA), but also to avoid vascular puncture. As such, imaging of the pulmonary vasculature is routinely performed and may allow insight and confirmation of CT imaging of vascular invasion.
Methods:
We present the case of a patient presenting with scant hemoptysis where the CT scan was interpreted as possible invasion of the right pulmonary artery (Fig 1). The literature was reviewed as to the effect of vascular invasion on upstaging patients with lung cancer and he underwent a diagnostic procedure.
Results:
Bronchoscopy and endobronchial ultrasound were performed to allow nodal TBNA to permit pathologic diagnosis and staging of the patient’s identified lung mass. During the procedure, ultrasound of the pulmonary vasculature revealed extensive invasion and mass effect from the central tumor mass (Fig 2). Using these synergistic techniques, the patient was upstaged to T4 and was referred for consultation with medical and radiation oncology. Fig. 1: Figure 1 Fig. 2: Figure 2
Conclusion:
Vascular invasion has previously been demonstrated to result in upstaging and a poorer prognosis. Critical to the workup, then, is not only diagnostic pathology, but also rapid and accurate staging and a decision regarding appropriateness of surgical resection. We believe our case illustrates that with the synergistic use of convex or radial endobronchial ultrasound during initial bronchoscopy, vascular invasion may be accurately confirmed resulting in improved decisions in patient care.
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P3.06-017 - The Search for Cancer: Procedures in High Risk Patients: Elevated Cardiac Risk in Patients Undergoing Bronchoscopy (ID 2376)
09:30 - 09:30 | Author(s): J.F. Turner
- Abstract
Background:
There has been an increased utilization of tomographic imaging to aid in the acute evaluation of patients with chest complaints and in high-risk patients to screen for lung cancer with the recently reported National Lung Screening Trial (NLST). In particular, utilization of CT-angiograms in the emergency room may, increasingly, identify patients presenting with concurrent cardiac injury and imaging abnormalities concerning for lung cancer.
Methods:
We present the case of a 75 year old male with chest pain and a non-resolving pulmonary infiltrate concerning for lung cancer. Although the chest pain was felt to be secondary to the pulmonary abnormality, evaluation by the bronchoscopy and anesthesia services revealed severe hypertension and an elevated troponin. The procedure was cancelled and cardiology was consulted with cardiac evaluation, control of blood pressure, and subsequent bronchoscopy.
Results:
Although review of the literature revealed extensive study of preoperative risk stratification for surgery there was a paucity of studies regarding the performance of bronchoscopy in the setting of hypertension and possible silent ischemia, particularly in patients with concurrent elevated troponin levels. We use this case to review the current literature and propose recommendations in the setting of cardiac ischemia with a rapid pathway for evaluation and treatment to allow needed bronchoscopic diagnostic procedures.
Conclusion:
Bronchoscopy in patients with hypertension or chest pain, particularly in the setting of elevated troponins, is poorly studied and may result in an increased risk of silent ischemia. Consideration for additional cardiac evaluation or peri-operative use of beta-blockers is warranted. Additionally, prospective studies to determine the incidence of silent ischemia in patients, such as presented, should be considered.
