Anshuman Chaturvedi

EBUS-TBNA in Elderly Patients with Lung Cancer: Safety and Performance Outcomes

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) enables minimally invasive lymph node sampling during bronchoscopy under conscious sedation. The primary purpose of this study was to investigate the safety profile of EBUS-TBNA in an elderly population. The secondary aim was to assess the efficacy of EBUS-TBNA for nodal staging and pathological diagnosis in elderly patients with primary lung cancer. Methods: This was a prospective cohort study of patients undergoing EBUS-TBNA, between March 2010 and August 2012, at a single U.K. hospital site. Procedure and outcome data including 6-month follow-up were collected prospectively. Patients were divided into less than 70 (<70yrs) or 70 and older (≥70yrs) age categories for analysis. Results: Four hundred and fifty-one patients underwent EBUS-TBNA during the study period. Mean age of the patients was 66.9 ± 11.9 years, 43.9% (n=198) of them were aged ≥70yrs. Older patients (≥70yrs) had a worse performance status (p=0.0001) and required significantly lower levels of sedation (p<0.000001) but had similar overall complication rates (<70yrs 8.7% versus ≥70yrs 5.1%; p=0.13) and tolerated the procedure better than younger patients (p=0.036). Sensitivity (92.9% versus 86.4%; p=0.12) was equivalent, but negative predictive value (91.8% versus 73.9%; p=0.001) and diagnostic accuracy (96.0% versus 90.2%; p=0.02) of nodal sampling in patients with confirmed or suspected lung cancer (n=273) was higher in the ≥70yrs cohort (n=131, 48.0%). However, the prevalence of nodal malignancy was significantly different between the two groups as was the proportion of patients subject to surgical lymph node sampling after negative EBUS-TBNA. EBUS-TBNA samples produced low non–small-cell lung cancer–not otherwise specified rates (6.9%) and high levels of successful epidermal growth factor receptor mutation analysis (97.5%) irrespective of age category. Conclusion: EBUS is a safe and well-tolerated procedure in elderly patients, which facilitates accurate pathological diagnosis and minimally invasive staging in patients with lung cancer.

Pulmonary artery sarcoma: a rare thoracic tumor frequently misdiagnosed at presentation

This case illustrates a rare but important differential diagnosis of pulmonary emboli in the field of thoracic oncology, that of pulmonary artery sarcoma. It describes particular clinical features that may raise suspicion of this tumor in cases of suspected pulmonary emboli, and highlights novel radiological modalities and tissue sampling techniques in such cases. Surgical resection, as part of multi‐modality therapy, is the cornerstone of treatment that has seen survival dramatically improve in recent years for patients with this rare cancer.

Rheumatoid nodule on the anterior mitral valve leaflet

Symptomatic cardiac rheumatoid nodules are a rare but recognized manifestation of rheumatoid arthritis. We describe the surgical management of a rheumatic nodule involving the anterior leaflet of the mitral valve.

89P: Investigating the potential utility of the alternative IASLC nodal staging classification in NSCLC

Age (years) 69 (48–84) Sex Female 19/32 (59%) Male 13/32 (41%) Smoking Status Current 7/32 (22%) Previous 21/32 (66%) Never smokers 4/32 (12%) Pack-years 54 (5–120) Family History of Lung Cancer 3/32 (9%) Race Caucasian 32/32 (100%) Lesions at diagnosis per patient 2.4 (1–6) 1 lesion at diagnosis 2/32 (6%) 2 lesions at diagnosis 19/32 (59%) 3 lesions at diagnosis 9/32 (28%) 4 lesions at diagnosis 1/32 (3%) 6 lesions at diagnosis 1/32 (3%) Lobes involved in diagnosis 1 lobe involved 7/32 (22%) 2 lobes involved 15/32 (78%) Unilateral disease 7/32 (22%) Right lung: 4 cases; Left lung: 3 cases Bilateral disease 25/32 (78%) Size of lesions (cm; n = 90) 2.7 (0.7–8.6) Size of the largest lesion Less than 3 cm 15/32 (47%) 3–7 cm 14/32 (44%) Larger than 7 cm 3/32 (9%) T staging of largest lesion (AJCC,7th edition) T1 10/32 (31%) T2 7/32 (22%) T3 12/32 (38%) 10 cases with lesions in same lobe – 2 cases based on size T4 3/32 (9%) 1 case with lesion in different ipsilateral lobe; 2 cases with invasion of nearby structures Biopsy results in the same patient Adenocarcinoma only 23/32 (71%) SQCC only 2/32 (6%) Adenocarcinoma + SQCC 2/32 (6%) Adenocarcinoma + MALT 1/32 (3%) Adenocarcinoma + neuroendocrine tumor 1/32 (3%) Adenocarcinoma + sarcomatoid tumor 1/32 (3%) Adenocarcinoma + poorly differentiated carcinoma 1/32 (3%) SQCC + poorly differentiated carcinoma 1/32 (3%)

42 Endobronchial ultrasound (EBUS)-guided transbronchial biopsy/brush of peripheral pulmonary nodules: an initial cancer centre experience

42 Endobronchial ultrasound (EBUS)-guided transbronchial biopsy/brush of peripheral pulmonary nodules: an initial cancer centre experience L. Brown1, A. Chaturvedi2, H. Doran2, L. Joseph2, P. Bishop2, P.V. Barber1, R. Booton1. 1North West Lung Centre, University Hospital of South Manchester, UK, School of Translational Medicine, University of Manchester, United Kingdom, 2Department of Pathology, University Hospital of South Manchester, United Kingdom