Arfaras-Melainis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Tissue sampling of peripheral lung nodules is a challenge in clinical practice. CT guided biopsy has good yield but is associated with high rate of pneumothorax. Bronchoscopic biopsy is a safer method. We studied the variables that potentially affect the yield of diagnostic peripheral bronchoscopy. METHODS:In retrospective study of diagnostic bronchoscopy using radial endobronchial ultrasound (rEBUS) from 11/2015 to 8/2018 in our large academic hospital, we studied the association of different potential variables and diagnostic yield of peripheral lung lesions. The successful result was defined strictly and only if either a positive malignancy or a definite benign disease was detected. Benign disease diagnosis included sarcoidosis, infection (that clinically explained the lesion), or a follow up image for at least 18 months which showed stability of the nodule. Otherwise, the bronchoscopy was counted as unsuccessful. The studied variables include: lesion size, distance from the closest pleural surface, FDG avidity in PET/CT scan, border characteristic, solid or non-solid appearance, location in upper/middle or lower lobe and the type of captured rEBUS view. Logistic regressions were used to associate above characteristics with the yield.RESULTS: 161 peripheral lung lesions were studied. In all cases, bronchoscopy and rEBUS were performed using a thin bronchoscope (4 mm OD), and sampling was done using needle aspiration, forceps biopsy and transbronchial brushing. The overall diagnostic yield was 63%; the larger the size of lesion, the higher the yield. The yield dropped significantly to 42% in nodules with diameter #15 mm. The concentric rEBUS view was strongly associated with higher rates of success (p¼1.6e-6). In nodules #15 mm, an irregular border was more often associated with a concentric view compared to regular border (p¼0.011 by Fisher's Exact Test). CONCLUSIONS:The concentric rEBUS view which is an indication of access into the middle of lesion compared to eccentric view which represents access to its periphery, was strongly associated with higher rates of success, similar to what is known in current literature. Even though the nodules #15 mm had lower biopsy yield, our data show that if these lesions have an irregular border, they will give a concentric view, more conducive to successful biopsy. This is likely a reflection of how the small caliber tools navigate through terminal bronchiole inside the interlobular segments of lung. Concentric view is obtained when the nodule surrounded the terminal bronchiole that is probed by rEBUS tool, and this proximity was observed more in nodules with irregular border. CLINICAL IMPLICATIONS:In early stage lung cancer diagnosis, an irregular border of nodules #15 mm in size could be a predictor of successful biopsy. More studies are needed to evaluate the predictors of successful bronchoscopic biopsy.
Introducción: La Neutropenia Febril es una complicación potencialmente fatal del tratamiento del cáncer, relacionada con mayor morbilidad, mortalidad, disminución de dosis o retardo en los ciclos de quimioterapia, y resultados finales pobres. Estudios anteriores han demostrado el beneficio de Factor Estimulante de Colonias de Granulocitos en la reducción de tiempo de hospitalización, antibióticos intravenosos, fiebre y recuperación del conteo absoluto de neutrófilos. Se decide realizar el presente reporte ya que no existen datos respecto al manejo y respuesta al tratamiento en nuestro medio. Métodos: El presente estudio descriptivo, retrospectivo, fue realizado en el Instituto del Cáncer SOLCA – Cuenca. Se revisaron las historias clínicas del período 2010 – 2011. Las variables analizadas fueron: número de días de hospitalización, fiebre, uso de antibióticos intravenosos, y días de recuperación de neutropenia a >500/mm3 y >1000/mm3. Resultados: La estancia hospitalaria tuvo una mediana de 6 días, los días de terapia antibiótica intravenosa fueron iguales a los días de hospitalización. 79 eventos se recuperaron a un conteo absoluto de neutrófilos >500/mm3, en una mediana de 4 días; 72 eventos se recuperaron a >1000 /mm3 en una mediana de 4 días. La mayoría de los eventos se volvieron afebriles en una mediana de 1 día. Conclusión: Los resultados de las variables estancia hospitalaria, uso de antibióticos intravenosos y la duración de la fiebre fueron similares a los ya descritos en estudios anteriores, la recuperación del conteo absoluto de neutrófilos, fue más tardía, mostrando diferencias importantes con la bibliografía.
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