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A. Rosell
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MA05 - Innovative Techniques in Pulmonology and the Impact on Lung Cancer (ID 378)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Pulmonology
- Presentations: 1
- Moderators:J. Eckmayr, P.R. Mohapatra
- Coordinates: 12/05/2016, 16:00 - 17:30, Strauss 1
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MA05.01 - Virtual Bronchoscopic Navigation-Guided Ultrathin Bronchoscopy for Diagnosing Peripheral Pulmonary Lesions (ID 4875)
16:00 - 16:06 | Author(s): A. Rosell
- Abstract
- Presentation
Background:
Diagnosis of peripheral pulmonary lesions with ultrathin bronchoscopy (UTH) has fewer complications than transthoracic needle aspiration (TTNA). However, diagnostic yield with UTH is lower. Virtual bronchoscopic navigation (VBN) might increase diagnostic performance of UTH. The main objective was to compare diagnostic yield of UTH with and without VBN.
Methods:
Prospective case-control study paired 1:2 for lesion size and localization, bronchus sign, sex and final diagnosis. LungPoint (Broncus, USA) was used to plan and navigate based upon online image analysis, putting endoscopic and virtual images in correspondence. Fluoroscopy was used in all. Sampling included bronchial washing and brushing (if no direct vision) or biopsy (if lesion directly visualized). Statistical analyses R-3.2.3.
Results:
Total of 63 patients (VBN and non-VBN, 21:42). Clinical characteristics in table 1. Diagnostic yield was 75% vs 43.9% (p=0.029). Factors associated to positive diagnosis in table 2. Further diagnostic techniques were needed in 14% vs 52% (p=0.001). No differences seen in procedure duration or complications. Figure 1 Figure 2
Conclusion:
VBN significantly improves the diagnostic yield of ultrathin bronchoscopy for diagnosing peripheral pulmonary lesions, especially those located in the utmost periphery and fluoroscopically not visible. Therefore, use of VBN reduces the need for further diagnostic procedures. Funded by La MaratóTV3-20133510, FIS-ETES PI09/90917, FUCAP and SEPAR.
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P1.04 - Poster Session with Presenters Present (ID 456)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Pulmonology
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.04-002 - Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation (ID 4869)
14:30 - 14:30 | Author(s): A. Rosell
- Abstract
Background:
A main weakness of virtual bronchoscopic navigation (VBN) is unsuccessful segmentation of distal branches approaching peripheral pulmonary nodules (PPN). CT scan acquisition protocol is pivotal for segmentation covering the utmost periphery. We hypothesize that application of continuous positive airway pressure (CPAP) during CT acquisition could improve visualization and segmentation of peripheral bronchi. The purpose of the present pilot study is to compare quality of segmentations under 4 CT acquisition modes: inspiration (INSP), expiration (EXP) and both with CPAP (INSP-CPAP and EXP-CPAP).
Methods:
In 10 patients 320-detector row CT scans with slice thickness of 0.5 mm were performed in the 4 modes. In first 5 patients a pressure ranging 6-10 cmH~2~O was applied for 3 min immediately before CT acquisition (CPAP6-10). In following 5 a pressure of 10 cmH~2~O was applied, followed by 3 min of expiratory maneuvers and non-CPAP acquisitions (CPAP10). Segmentations were obtained and measurements manually calculated with a VBN system (LungPoint, Broncus Technologies, Inc., Mountain View, CA, USA). Comparisons for the inspiratory and expiratory models were made upon main airways area (proximal trachea, distal trachea and main bronchi) and distance of the path to the nodule (DIST-PN). Also, 2 random bronchi per lobe were selected and the number of bifurcations (BIF) and distance (DIST) from carina to the very end of the selected bronchi were manually counted and median calculated. Statistical analyses with R-3.2.3.
Results:
See table 1.Figure 1
Conclusion:
A tendency towards enlargement and improved segmentation of airways is seen with the use of CPAP in both levels of pressure. However, the power of this pilot study is limited and larger studies might be encouraged. Funded by La MaratóTV3-20133510, FIS PI09/90917, DPI2015-65286-R, 2014-SGR-1470, PROD-2014-00065, FUCAP and SEPAR.
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P1.04-009 - Bacterial Population Dynamics in Colonization of Airway Stents in Patients with Cancer (ID 4906)
14:30 - 14:30 | Author(s): A. Rosell
- Abstract
Background:
Stent placement is an increasingly used treatment for malignant tracheobronchial stenosis. The main complication related to airway stents is bacterial colonization causing chronic cough and sputum, halitosis, recurrent bronchial infections, pneumonia and even sepsis. The main objectives were to describe potentially pathogenic bacteria (PPM) involved in stent colonization and to analyze PPM dynamics during follow-up.
Methods:
Prospective study in patients with malignant stenosis treated with stent placement. Bronchial washings (BW) were performed before and at least 1 month after stent placement. Qualitative cultures of PPM isolated in BW were performed. Statistical analyses with R-3.2.3.
Results:
Total of 65 patients, 56 (86%) men, mean age 64 (±10) y/o, 58 (89%) current or former smokers, 2 (3%) bronchiectasis, 28 (43%) COPD. Cancers were: primary lung cancer (n=52, 80%) followed by thyroid (n=4, 6%), esophagus (n=2, 3%) and other (n=7, 11%); stenosis were located in trachea (n=14, 21%), main carina (n=16, 25%) and main bronchi (n=35, 54%); and stent types included metal (n=30, 46%) and silicone (n=35, 54%). Isolated PPM in BW (table 1). Airway colonization was absent in 14 (21.5%) and present in 79%, of which it was persistent in 33 (50.8%) and intermittent in 16 (24.6%). Only 2 (3.1%) became negative. Median time until colonization was 35 days (IQR 28-116), with no significant differences between stent types or location. Figure 1
Conclusion:
The majority of patients with malignant stenosis treated with airway stents develop early and persistent colonization by PPM, regardless of stent type.
