Zivka Eri

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.

Autofluorescence videobronchoscopy (AFI) for the assessment of tumor extension in lung cancer.

The major objective of our study was to determine the specificity and sensitivity of AFI videobronchoscopy vs. white light videobronchoscopy, in the assessment of lung cancer extent. Secondary objective was to investigate whether or not AFI can reveal greater extension of the tumor, and can it influence therapy making decision. Autofluorescence videobronchoscopy systems are new technology for visualization of bronchial mucosa, and the proper indications for such systems will be determined in the near future. In this prospective trial we have enrolled 27 patients with suspected lung cancer in whom we performed 108 diagnostic biopsies and 54 control biopsies. All patients underwent WL videobronchoscopy followed by Auto Fluorescence Imaging (AFI) examination of tracheobronchial tree. We were using videobronchoscope BF-F260 and EVIS LUCERA SPECTRUM processor unit. Overall specificity for AFI in the diagnostics of lung cancer was found to be 85%, sensitivity was 90%, positive predictive value (PPV) 78%, and negative predictive value (NPV) 94%. Specificity, sensitivity, PPV, and NPV for WL videobronchoscopy in lung cancer diagnostics were 54%, 64%, 51%, and 69%, respectively. Relative sensitivity ratio of AFI over WL videobronchoscopy, which is calculated to be 1.41, confirmed superiority of AFI in lung cancer diagnostics. We confirmed significant correlation between the greater extension of the tumor (assessed with AFI) and the therapeutical decision in lung cancer treatment (p = 0.01). Influence of AFI on therapeutical decision was significant (p = 0.034). AFI videobronchoscopy system yields significantly higher sensitivity and specificity for the assessment of lung cancer extent than WLB videobronchoscopy alone. It had shown to be able to influence therapeutic option for lung cancer treatment. Further studies are needed to evaluate and validate these results.

Detection of premalignant bronchial lesions can be significantly improved by combination of advanced bronchoscopic imaging techniques

BACKGROUND: The search for the most efficient bronchoscopic imaging tool in detection of early lung cancer is still active. The major aim of this study was to determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each bronchoscopic technique and their combination in detection of premalignant bronchial lesions. METHODS: This was a prospective trial that enrolled 96 patients with indication for bronchoscopy. Lesions were classified as visually positive if pathological fluorescence was observed under autofluorescence imaging (AFI) videobronchoscopy or dotted, tortuous, and abrupt-ending blood vessels were identified under narrow band imaging (NBI) videobronchoscopy. Squamous metaplasia, mild, moderate, or severe dysplasia, and carcinoma in situ (CIS) were regarded as histologically positive lesions. RESULTS: Sensitivity, specificity, PPV, and NPV of white light videobronchoscopy (WLB) in detection of premalignant lesions were 26.5%, 63.9%, 34.4%, and 54.9%, respectively; the corresponding values for AFI were 52%, 79.6%, 64.6%, and 69.9% respectively, for NBI were 66%, 84.6%, 75.4%, 77.7%, respectively, while the values for combination of NBI and AFI were 86.1%, 86.6%, 84.6%, and 88%, respectively. Combination of NBI and AFI significantly improves sensitivity when compared to each individual technique (P < 0.001). When specificity is of concern, combination of techniques improves specificity of WLB (P < 0.001) and specificity of AFI (P = 0.03), but it does not have significant influence on specificity of NBI (P = 0.53). CONCLUSION: Combination of NBI and AFI in detection of premalignant bronchial lesions increases both sensitivity and specificity of each technique. However, it seems that NBI is most sufficient and effective in detection of these lesions.

Chronic necrotizing pulmonary aspergillosis

INTRODUCTION Chronic necrotizing pulmonary aspergillosis (CNPA) is a cavitary, infectious process of lung parenchyma with slow progressive course. Vascular invasion and dissemination to other organs are unusual. CASE REPORT We presented a 25-year old man with bilineal acute leukaemia who developed pulmonary and systemic symptoms. Chest CT showed nodular consolidations and cavitary lesions in both lungs. Bronchial biopsy revealed necrotic hyphae but it was negative for Aspergillus by culture. Serum was positive for antibodies to Aspergillus, but it was negative for antigens. A thoracoscopic lung biopsy of the upper left lobe revealed necrosis of lung tissue, with acute and chronic inflammation of the cavity wall and the presence of hyphae consistent with Aspergillus species. CONCLUSION Although confirmation of the diagnosis is difficult, a combination of characteristic clinical, radiological and histological findings and either serological results positive for Aspergillus or the isolation of Aspergillus from respiratory samples are highly indicative of CNPA.

Analysis of discrepancies of core needle biopsy and surgical specimens for accurate evaluation of hormonal receptors and epidermal growth factor receptor 2 status of invasive breast cancer patients

Breast cancer is a serious health problem. It is the most common cancer in women. The aim of this study was to estimate the concordance between ER, PR receptor and HER-2 immunohistochemistry assessment scores in pared CNB (core needle biopsy) and surgical specimens. Histological grade, oestrogen receptor (ER) status, progesterone receptor (PR) status, and human epidermal growth factor receptor-2 (HER2) status were evaluated in a blinded fashion in CNB and in surgical excision specimens. Absolute concordance rate between core needle biopsies and surgical specimens for histological grade was 50% with κ value (0,15) for ER 92% with κ value (0,79), PR 88% with κ value (0,73) and for HER2 96% with κ value (0,91). CNB can provide reliable information in evaluation of ER, PR and HER2 status in an invasive breast carcinoma. Ključne reči: breast cancer, core needle biopsy, oestrogen receptors, progesterone receptors, HER-2. Analiza odstupanja statusa hormonskih receptora i receptora za epidermalni faktor rasta 2 u uzorcima dobijenim iglenom biopsijom i hirurškim uzorkom kod obolelih od invazivnog karcinoma dojke Ljiljana Tadic Latinovic1, Zivka Eri2, Darko Jovic3, Aleksandra Salapura1, Jovan Culum3, Branislava Jakovljevic3, Ilija Baros1, Slavica Maric4 1 Department of Pathology, University Clinical Center of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina 2 Canter for Molecular Genetics, Institute for Pulmonary Diseases, Sremska Kamenica, Republic of Serbia 3 Surgical Clinic “S-Tetik”, Banja Luka, Republic of Srpska, Bosnia and Herzegovina 4 International Medical CantersCentar za Radioterapiju Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

AB 10. Relation between histological types of lung cancer and vascular patterns visualized by narrow band imaging (NBI) videobronchoscopy

Background Narrow Band Imaging (NBI) videobronchoscopy is a new technique for visualization of microvascular changes in bronchial mucosa. The primary aim of this study was to evaluate relation between vascular patterns visualized by NBI and histology of lung cancer.

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.