Inge Muylle

Endobronchial ultrasound in the management of nonsmall cell lung cancer

Flexible bronchoscopy plays a major role in the diagnosis and staging of lung cancer. One of the most important advances in this field is the development of endobronchial ultrasound (EBUS), which has extended the view of the bronchoscopist. These techniques are safe and allow assessment of the depth of tumour invasion in the central airways, detection of peripheral tumours before sampling, localisation of the central tumour in the lung parenchyma close to the central airways for real-time guided sampling, and staging of lymph nodes within the mediastinum. Progress in handling and analyses of the small samples obtained during EBUS procedures also allow modern pathological and molecular studies to be performed. This article reviews the data currently available in the field of convex and radial probe EBUS for the diagnosis and staging of nonsmall cell lung cancer and highlights the strengths but also the weaknesses of these new techniques.

Driver oncogenes in sub-Saharan African patients with non-small cell lung cancer

Non-small cell lung cancer can exhibit driver oncogenes, including epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), that are possible targets for therapy. The prevalence of these rearranged driver oncogenes is influenced by race, smoking habits, and gender. Most data come from Caucasian and Asian populations. To our knowledge, there is no literature available about the prevalence of driver oncogenes in Sub-Saharan Africa, where the tobacco epidemic is still in the early stage. In this small case series, 6 patients of Sub-Saharan African ethnicity with stage IV lung adenocarcinoma are described. EGFR mutation was present in 3/6 patients and ALK rearrangement in 1/6 patients. This incidence seems high but interestingly, all patients were non-smokers or light smokers. In this series, the high prevalence of driver oncogene was probably related to low smoking habits and these initial data in Sub-Saharan Africans suggest high prevalence of driver mutations for this reason.

The Feasibility of Tracheal Oxygen Supplementation during Flexible Bronchoscopy

Background: Hypoxemia is a frequent adverse event occurring during flexible bronchoscopy and is usually prevented by close monitoring and, if needed, oxygen supplementation by nasal cannula. Objective: We aim to demonstrate that tracheal oxygen supplementation during flexible bronchoscopy is a feasible, safe and effective method to restore oxygen saturation levels after oxygen desaturation. Methods: In a first phase, we compare oxygen supplementation by the tracheal or nasal route in a single blinded cross-over design in healthy volunteers. In a second phase, we study patients referred for diagnostic flexible bronchoscopy, who desaturate despite oxygen supplementation by nasal cannula, in order to assess the ability to correct hypoxemia through tracheal oxygen supplementation. Results: In the first phase, the mean capillary partial pressure of oxygen was 181 mm Hg when oxygen at a flow rate of 4 liters/min was administered by the tracheal route, compared to 125 mm Hg by the nasal route (p < 0.001). The capillary partial pressure of carbon dioxide was not significantly different. During 950 bronchoscopic procedures in the second phase of the trial, 30 patients desaturated below 90% despite oxygen supplementation by nasal cannula. In 22 out of these 30 patients, switching to the tracheal route resulted in a correction of the saturation within 120 s. In the remaining 8 patients, saturation levels were corrected after increasing the oxygen flow rate to 4 liters/min. After restoring saturation levels, the bronchoscopy could be completed in 25 of 30 patients. Conclusions: Tracheal oxygen supplementation is safe, feasible and an effective way to restore oxygen saturation levels during flexible bronchoscopy.

Le long fleuve tranquille de l'écho-endoscopie bronchique

Après l’introduction du bronchoscope flexible dans les années soixante, la technologie des ultrasons en endoscopie bronchique (EndoBronchial UltraSound, EBUS) est probablement le progrès le plus significatif, et son développement est rapide. Cela est notamment illustré par le fait que la Douadi et al. [1] nous rappellent l’absence d’évidence permettant de recommander une sédation plus ou moins profonde. Les avantages pratiques de la sédation légère sont le caractère réellement ambulatoire de la procédure et, élément souvent négligé, le fait que le patient puisse tousser à v l L t c d n d d l p c E l m u p c l

La stadification (« staging ») endoscopique

Resume La determination precise de l’atteinte mediastinale dans le cancer broncho-pulmonaire non a petites cellules a des implications therapeutiques et pronostiques majeures. Si la chirurgie demeure la technique invasive de reference, deux nouvelles techniques endoscopiques ont ete developpees et ont bouleverse la pratique actuelle. L’echographie œsophagienne (EUS) ou bronchique (EBUS) sont des techniques peu invasives, realisables sous anesthesie locale en ambulatoire, sans complications significatives. Elles permettent de guider la ponction en temps reel des ganglions mediastinaux (hilaires) avec des performances excellentes qui les positionnent comme des alternatives a la chirurgie. Les explorations mediastinales chirurgicales demeurent indiquees lorsque la prevalence de l’atteinte ganglionnaire mediastinale est faible ou lorsque l’EBUS et/ou l’EUS sont non contributifs.