Milan Antonic

Narrow Band Imaging Videobronchoscopy Improves Assessment of Lung Cancer Extension and Influences Therapeutic Strategy

OBJECTIVE Narrow band imaging (NBI) videobronchoscopy is a new technique aimed at lung cancer detection. This study investigated its sensitivity and specificity for evaluation of lung cancer extension and its possible influence on therapeutic decision, compared with white light videobronchoscopy. METHODS In this prospective study, we evaluated 106 patients with suspected lung cancer. All patients were examined using EVIS LUCERA videoendoscopy system. In every patient, at least three biopsies were taken from places visualized as pathologic, surrounding primary tumor, and three biopsies from places that appeared normal. The overall number of biopsies performed in 106 patients was 636. RESULTS The specificity and sensitivity of NBI in revealing greater lung cancer extension were 85.6% and 95%, respectively; positive and negative predictive values were 84% and 95.6%, respectively. Specificity and sensitivity were significantly better when compared with white light bronchoscopy alone (P < 0.01). NBI led to the change in therapeutic decision in 14 patients. There was statistically significant correlation between NBI assessment of tumor extension and change in therapeutic decision (P < 0.000). CONCLUSIONS NBI showed significantly better specificity and sensitivity in the assessment of lung cancer extension. NBI proved that it might have potential influence on therapeutic decision, making it more accurate. The procedure is safe and easily deployed in everyday practice.

Autofluorescence Imaging Videobronchoscopy Improves Assessment of Tumor Margins and Affects Therapeutic Strategy in Central Lung Cancer

OBJECTIVE Autofluorescence imaging (AFI) videobronchoscopy is a new endoscopic tool that improves visualization of neoplastic changes in the bronchial mucosa. The major aim of our study was to determine sensitivity and specificity of the technique in the assessment of tumor extent (margins). The secondary objective was to evaluate the possible effect of AFI on the change in therapeutic decisions of lung cancer treatment. METHODS In this prospective trial, we enrolled 104 patients in whom we performed 624 targeted biopsies, 3 from the pathologically altered mucosa (red-brownish or magenta colored) and 3 from randomly picked normal areas. We were using the Olympus BF-F260 videobronchoscope and EVIS LUCERA system. White light videobronchoscopy (WLB) preceded AFI examination and biopsy collection. All biopsy specimens were examined by a pathologist blinded to bronchoscopy findings, and where applicable surgically resected specimens were examined. RESULTS In 14.4% of the patients, AFI revealed a greater extent of the tumor than WLB, and in 11.5% that finding led to change in therapeutic decision (lesser or greater resection or avoidance of surgery). We found a significant correlation between tumor extent determined by AFI and changes in therapeutic decisions (P < 0.01). Sensitivity, specificity, positive predictive value and negative predictive value for AFI in the assessment of tumor extension were 93%, 92%, 92% and 93%, respectively. Corresponding results for WLB were 84%, 79%, 77% and 85%, respectively. Relative sensitivity of AFI is 1.11. CONCLUSIONS Our results confirm that AFI videobronchoscopy significantly improves the assessment of central lung cancer extension and influences the therapeutic strategy. This technique has greater sensitivity and specificity, in assessment of tumor margins, than WLB alone.

Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer.

INTRODUCTION: Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer. METHODS: In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment. RESULTS: There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001). CONCLUSION: Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.

Clinical risk factors for early complications after high-dose-rate endobronchial brachytherapy in the palliative treatment of lung cancer.

PURPOSE This study sought to identify the rate of complications and clinical risk factors for early complications of high-dose-rate endobronchial brachytherapy (HDR-EBBT). The identification of these risk factors could result in a decrease or avoidance of complications. PATIENTS AND METHODS We analyzed risk factors for complications in 761 patients with advanced-stage lung cancer who were treated with HDR-EBBT as a part of the multimodality therapy. We reviewed patient, radiology, and bronchology charts for complications of HDR-EBBT. Complications were defined as severe hypoxemia, global respiratory failure, cardiac arrhythmia requiring additional treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction > or = 6 months previously, stabilized hypertension, arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external-beam radiation therapy, chemotherapy, and interventional pulmonology treatment. Age, sex, tumor histology, and tumor localization were also subjected to multivariate analyses. RESULTS The rate of complications was 5.4%. Statistically significant (P = .001) risk factors for complications of HDR-EBBT included stabilized hypertension, controlled chronic cardiac arrhythmias, COPD, and stabilized cardiomyopathy. We found a significant correlation between age and number of risk factors, and the occurrence of complications (P = .001). CONCLUSION Our results indicate that closer monitoring of patients with identified risk factors is advisable. Such monitoring should be performed both before and after treatment, to avoid complications.

82P AUTOFLUORESCENCE VIDEOBRONCHOSCOPY (AFI) IMPROVES ASSESSMENT IN CENTRAL LUNG CANCER EXTENSION

Background: The aim of this study is to evaluate a role of some tools in the diagnosis of pleural effusion. Methods: A retrospective analysis among 1207 patients was conducted at our department between 2004 and 2006. The patients were between 4 89 years of age (mean 47.4) and comprised 785 (65%) males and 422 (35%) females. Results: Thoracocentesis (TC) with cytologic fluid examination was performed in all patients. The TC was informative in 517 (42.8%) cases. Among them tuberculosis was diagnosed in 45% cases, nonspecific pleuritis in 40.6%, and malignancy in 14.4%. Complications of TC (pneumothorax) were encountered in 19 (1.5%) cases. Ratio cost/informativeness (RC/I) was 2.8. Closed pleural Abrahams or core biopsy (CPACB) was performed in 354 patients (29.3%). The CPACB was informative in 318 (89.8%) cases. Among them 36.3% had tuberculosis, 34.8% nonspecific pleuritis and 17.9% malignancy. Complications of CPACB (hemothorax, pneumothorax, wall tumor invasion) were encountered in 15 (4.2%) cases. The RC/I was 4.7. Thoracoscopic pleural biopcy (TPB) was performed in 173 (14.6%) patients. TPB was informative in 165 (95.3%) patients. Among them 39.4% had tuberculosis, 32.3% nonspecific pleuritis and 25.3% malignancy. Complications of TPB (hemothorax, pneumothorax, wall tumor invasion, empyema) were encountered in 20 (11.6%) cases. The RC/I was 14.2. The VATS pleural biopsy was performed in 189 (15.6%) patients. It was informative in 184 (97.3%) patients. Among them 34.1% had tuberculosis, 30.4% nonspecific pleuritis and 35.5% malignancy. Complications of VATS (hemothorax, pneumothorax, wall tumor invasion) were noted in 14 (7.4%) cases. The RC/I was 22.5. Minithoracotomy for diagnosis was performed in 7 (0.5%) cases. The RC/I was 23.7. Diagnosis in 12 (0.9%) cases was obtained by autopsy. Conclusions: Our results prove CPAB, TPB and VATS to be efficient diagnostic methods, easy to perform, and with low risk. The cost and level of complications for CPAB is lower than for TPB and VATS.