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S.K. Chan
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P2.12 - Pulmonology/Endoscopy (ID 713)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Pulmonology/Endoscopy
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.12-001 - Early Experience with Radial Endobronchial Ultrasound with Guide Sheath For Diagnosis of Peripheral Pulmonary Lesion (ID 8172)
09:30 - 09:30 | Author(s): S.K. Chan
- Abstract
Background:
Diagnostic yield for routine unguided bronchoscopy for peripheral pulmonary lesion (PPL) is less than 20%. Hence, CT guided transthoracic needle aspiration (TTNA) is currently the preferred method with a high diagnostic yield of 90%, however running risk of pneumothorax of around 25%. Radial endobronchial ultrasound with guide sheath (R-EBUS-GS) for diagnosis of PPL is a novel technique with diagnostic yield of 70.6% with good safety profile. However, this advanced technique is not readily available in developing nations and were further limited by the availability of other supporting modalities such as thin section computed tomography (CT) scan, fluoroscopy, thin bronchoscope, availability of rapid onsite evaluation (ROSE) and a established cytology services. To the best of our knowledge, this is the first series of R-EBUS from Malaysia.
Method:
Retrospective review of our early experience with R-EBUS-GS in diagnosing PPL at Respiratory Medicine Unit, Sarawak General Hospital over six months duration from October 2016 to May 2017.
Result:
65 patients with 68 targets were enrolled. 48 (71%) male and 20 (29%) female patients with mean age of 60.5±13.2 years old. Up to 54 (79%) cases will undergone CT guided TTNA if without R-EBUS-GS. All procedures were performed as day case under conscious sedation with mean procedure time of 37 minutes. Mean PPL size was 3.87±1.2 cm and 53.1% located in the upper lobes. We were able to localize the lesion in 58 (85.3%) cases, failed to identify in 4 (5.8%) and 3 (4.4%) had endobronchial lesion. Overall diagnostic yield for PPL that could be localized was 63.8%. Diagnostic yield for patient who suspected malignancy was 57.5%. Higher diagnostic yield is associated if lesion was orientated within the radial probe rather than adjacent to it (85.2% vs. 20%, p<0.005). Fluoroscopic guidance, CT bronchus sign and lesion size did not contribute significantly to diagnostic yield. Overall complication rate was 3% with only 1 (1.5%) patient developed pneumothorax, which was self-limiting.
Conclusion:
Radial EBUS-GS is an effective tool to guide biopsy during peripheral bronchoscopy with low complication rate. Despite various resource constraints and challenges, our early experience with R-EBUS-GS shown promising result and our center anticipates further experiences with this technique in the future.
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P2.12-002 - Radial Probe Endobronchial Ultrasound (R-EBUS) Guided Transbronchial Cryobiopsy In The Diagnosis of Peripheral Lung Mass (ID 8196)
09:30 - 09:30 | Author(s): S.K. Chan
- Abstract
Background:
Radial probe endobronchial ultrasound (R-EBUS) is a novel technique in localizing peripheral lung mass with overall diagnostic yield of 70%. Conventional biopsy techniques using forcep or fine needle aspirates guided by R-EBUS occasionally resulted in small sample which may not be suitable for immunohistochemical or molecular studies. R-EBUS guided transbronchial cryobiopsies in peripheral lung mass is a feasible technique to obtain larger tissue samples without affecting safety. We described our initial experience with three consecutive patients who underwent R-EBUS guided transbronchial cryobiopsy in our unit in May 2017.
Method:
Therapeutic flexible bronchoscope with a 2.8mm working channel, 2.0mm 20 Hz ultrasound probe (UM-S20-20R, Olympus Medical) within a 2.2mm flexible guide sheath and 1.9mm flexible cryoprobe (1150mm ERBE, Medizintechnik, Germany) was used in all cases.
Result:
The mean age was 60±11.6 years (range 47-68 years). Two cases were performed under conscious sedation and one under total intravenous anaesthesia. Mean procedural time was 48.3±15.9 minutes. All lesions were located in right upper lobe. Two patients had non-diagnostic computed tomography (CT) guided biopsy prior. Mean lesion size was 2.6±0.4cm with mean distance to the pleural of 1.2cm. All lesions were able to be identified via R-EBUS with two lesions orientated within the radial probe while one adjacent to it. Cryobiopsy was obtained by freezing the tip of cryoprobe for 5 seconds. Three attempts were performed in Case 1 and 3, two in Case 2. First two cases were guided with fluoroscopy. All patients had minimal intra-procedure post biopsy bleeding which was easily managed. Mean specimen size was 10.6mm. All biopsies yielded adenocarcinoma of lung with immunohistochemistry positive for CK7 and TTF-1.
Conclusion:
Our initial experience shows that R-EBUS guided transbronchial cryobiopsy is safe and can potentially increase the diagnostic yield of peripheral lung mass. Our center anticipate further experience with this technique in the future.
