Bronchial Research Articles

A phase II randomized trial evaluating consolidative nivolumab in locally advanced non-small cell lung cancer post neoadjuvant chemotherapy plus nivolumab and concurrent chemoradiotherapy (GASTO-1091).

8008 Background: Enhancing clinical outcomes in resectable non-small cell lung cancer (NSCLC) has been associated with neoadjuvant or perioperative administration of nivolumab. However, the efficacy and safety of consolidation nivolumab versus observation following neoadjuvant chemotherapy plus nivolumab, hypofractionated radiotherapy and concurrent chemotherapy (hypo-CCRT) in patients with unresectable stage III NSCLC remain underexplored. Methods: Conducted as a randomized, multi-center, phase 2 trial in patients with unresectable stage IIIA-C NSCLC, this study enrolled individuals aged 18 to 75 with an ECOG performance status of 0 or 1. Neoadjuvant therapy consisted of docetaxel, cisplatin, and nivolumab (360mg every 3 weeks for 2 cycles), followed by hypo-CCRT. Patients without disease progression or G2+ pneumonitis after hypo-CCRT were randomly assigned to receive nivolumab (360 mg every 3 weeks for up to 12 months) or undergo observation. Randomization factors included age, sex, smoking history, and EGFR mutation status. The primary endpoint was progression-free survival (PFS) from randomization, with preplanned analysis results reported herein. The trial is registered with ClinicalTrials.gov, NCT04085250. Results: Between Dec 3rd, 2019, and Aug 18th, 2023, 264 patients underwent neoadjuvant therapy, 242 received hypo-CCRT, and 172 were randomly assigned to nivolumab consolidation (n = 86) or observation (n = 86) post hypo-CCRT. At the January 31, 2024, data cutoff, the median follow-up for all randomized patients was 22.8 months. Nivolumab consolidation exhibited significantly longer PFS compared to observation (median not reached vs. 12.2 months [95% CI 6.2-18.1]; hazard ratio 0.49 [95% CI 0.31-0.79], p = 0.002). The 12-month and 18-month PFS rates were 72.6% and 64.8% in the consolidation group, contrasting with 52.5% and 42.3% in the observation group. Grade 3-4 nonhematological adverse events occurred in 14.0% (37/264) during neoadjuvant therapy and hypo-CCRT. Following randomization, grade 3-5 adverse events occurred in 7.0% (6/86) with consolidation (G3 pneumonitis, 2.3%; G5 pneumonitis, 1.2%; G3 proximal bronchial tree toxicity, 3.5%) and 4.6% (4/86) with observation (G3 pneumonitis, 2.3%; G3 proximal bronchial tree toxicity, 2.3%). Conclusions: Consolidation with nivolumab after neoadjuvant chemotherapy plus nivolumab and hypo-CCRT demonstrates effectiveness and tolerability for patients with unresectable stage III NSCLC. Extended follow-up is essential for confirming these findings. Clinical trial information: NCT04085250 .

Intraoperative view of the operating field showing the visualization of the luminescence with near-infrared fluorescence of the left bronchial tree during a video thoracoscopic left upper lobectomy.

Intraoperative view of the operating field showing the visualization of the luminescence with near-infrared fluorescence of the left bronchial tree during a video thoracoscopic left upper lobectomy.

Nurses' Knowledge on Management of Bronchial Asthma Disease at Rajshahi Medical College Hospital

Nurses' Knowledge on Management of Bronchial Asthma Disease at Rajshahi Medical College Hospital

Structure-specific rigid dose accumulation dosimetric analysis of ablative stereotactic MRI-guided adaptive radiation therapy in ultracentral lung lesions.

Definitive local therapy with stereotactic ablative radiation therapy (SABR) for ultracentral lung lesions is associated with a high risk of toxicity, including treatment related death. Stereotactic MR-guided adaptive radiation therapy (SMART) can overcome many of the challenges associated with SABR treatment of ultracentral lesions. We retrospectively identified 14 consecutive patients who received SMART to ultracentral lung lesions from 10/2019 to 01/2021. Patients had a median distance from the proximal bronchial tree (PBT) of 0.38 cm. Tumors were most often lung primary (64.3%) and HILUS group A (85.7%). A structure-specific rigid registration approach was used for cumulative dose analysis. Kaplan-Meier log-rank analysis was used for clinical outcome data and the Wilcoxon Signed Rank test was used for dosimetric data. Here we show that SMART dosimetric improvements in favor of delivered plans over predicted non-adapted plans for PBT, with improvements in proximal bronchial tree DMax of 5.7 Gy (p = 0.002) and gross tumor 100% prescription coverage of 7.3% (p = 0.002). The mean estimated follow-up is 17.2 months and 2-year local control and local failure free survival rates are 92.9% and 85.7%, respectively. There are no grade ≥ 3 toxicities. SMART has dosimetric advantages and excellent clinical outcomes for ultracentral lung tumors. Daily plan adaptation reliably improves target coverage while simultaneously reducing doses to the proximal airways. These results further characterize the therapeutic window improvements for SMART. Structure-specific rigid dose accumulation dosimetric analysis provides insights that elucidate the dosimetric advantages of SMART more so than per fractional analysis alone.

Lobar Lung Transplantation: A Single-Center 10-Year Experience

IntroductionThe shortage of donors for lung transplant is the main limitation to the preceding. Lobar transplantation is an alternative especially useful in patients with short statute and small thoracic cavities. The aim of this study was to perform a descriptive analysis of Portuguese patients who underwent lobar lung transplantation. MethodsA retrospective study was conducted, and patients submitted to lobar lung transplantation from January 2012 to December 2023 were evaluated. A descriptive analysis was made, including demographic data, lung diseases, waiting list dynamics, pre-transplant evaluations and post-transplant outcomes. ResultsSixteen lobar transplants were performed with a predominance of female patients and median age of 47 years. Most patients had interstitial lung disease or bronchiectasis either due to cystic fibrosis or non-cystic fibrosis. Median pTLC ratio was 0.73. Median waiting list time was 6 months with 9 urgent transplants and 1 emergent lobar retransplant. ECMO was used in pre, intra and postoperative periods. Most transplanted lobes were ML + RUL and LUL. The median length of stay was 58 days with complications such as PDG grade 3, bronchial tree ischemia and concentrical stenosis of bronchial anastomosis. Six patients died in this period, one in the immediate postoperative period and five during the post-transplant hospitalization, with a median survival of 20.7 months and 1-year and 5-year survival rate of 60%. Conclusionour results show a population with increased waiting list converging in many urgent cases, with an early mortality and high PGD rate. Nevertheless, mid-, and long-term survival is promising.

Generation of a healthy heavy smoker patient-derived induced pluripotent stem cell line UHOMi007-A from peripheral blood mononuclear cells

Human pluripotent stem cells (hiPSC) represent a unique opportunity to model lung development and chronic bronchial diseases. We generated a hiPSC line from a highly characterized healthy heavy smoker male donor free from emphysema or tobacco related disease. Peripheral blood mononuclear cells (PBMCs) were reprogrammed using integration-free Sendai virus. The cell line had normal karyotype, expressed pluripotency hallmarks, and differentiated into the three primary germ layers.The reported UHOMi007-A iPSC line may be used as a control to model lung development, study human chronic bronchial diseases and drug testing.

947: Evaluation of methods for automatic segmentation of the proximal bronchial tree

947: Evaluation of methods for automatic segmentation of the proximal bronchial tree

Role of Reactive Oxygen Species in the Pathogenesis of Bronchial Asthma and Obstructive Pulmonary Diseases: Systematic Review

The article discusses the role of reactive oxygen species (ROS) in the pathogenesis of bronchial asthma and obstructive pulmonary diseases. The review follows a structured approach beginning with a comprehensive search of electronic databases, then findings from the included studies were summarized and used to draw comprehensive conclusions. The authors state that increased activity of oxidative processes and insufficient activity of the antioxidant system lead to the accumulation of ROS in the respiratory tract. This leads to direct damage to epithelial cells, activation of inflammatory cells, and stimulation of inflammatory mediators. ROS also activate transcription factors that increase inflammation and airway obstruction. Thus, maintaining the balance of the oxidant-antioxidant system is an important strategy for the treatment of these diseases.Keywords: Reactive oxygen species; Bronchial asthma; Chronic obstructive pulmonary disease; Oxidative stress; Antioxidant system

Video assisted thoracoscopy surgery a viable alternative for duplication cyst excision: a case report on foregut duplication cyst

Alimentary tract duplication is a relatively uncommon congenital abnormality. It can be found anywhere from the mouth to the anus and can be symptomatic or undetectable. Although congenital duplication can happen anywhere in the gastrointestinal tract, the ileum, oesophagus, and colon are the most common locations. The foregut, which includes the stomach, and first and second segments of the duodenum, is the source of one-third of all duplications. When foregut duplication involves the bronchial tree, respiratory symptoms are often present. Furthermore, excision through surgery is required for pathological examination of the resected specimen for definitive diagnosis. The most promising surgical approach for cyst excision has been thought to be open surgical resection through a posterolateral thoracotomy incision. However, video assisted thoracoscopy surgery has recently emerged as a viable surgical option for duplication cyst removal In paediatric surgery, video assisted thoracoscopy surgery has been established to facilitate the removal of mediastinal masses. However there is a limitation of research in the literature regarding the best surgical technique for oesophageal duplication cyst excision. In girls, foregut duplication is more common, especially in cases when bronchopulmonary involvement is present. While many duplications result in issues in early development, some are discovered by accident. When foregut duplication involves the bronchial tree, respiratory symptoms are often present. Haemoptysis and respiratory distress may be present in specific cases of the patient. Here, we described a 5-year-old male infant's case of foregut duplication with bronchial involvement and its management.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Case Report: Giant bronchogenic cyst compressing the pericardium and the lung hilum

Introduction: The bronchogenic cyst is a congenital anomaly of the trachea and the bronchi resulting in a malformation that develop in the bronchial tree, most often in the middle mediastinum. It is a benign pathology, often asymptomatic, however in the case of a large bronchogenic cyst, signs of compression of the intra-thoracic organs appear and early surgery is necessary to avoid complications. Case presentation: A 49-year-old patient was referred to our department with dry cough, dyspnea and chest tightness progressing for six months. Radiological exploration concluded that a giant bronchogenic cyst, 90 mm in diameter, was very probable. Surgery was performed via a right posterolateral thoracotomy. Intraoperatively, there was a large cystic formation 100mm*80 mm of the middle mediastinum in intimate contact with the origin of the right pulmonary artery, the lower right pulmonary vein as well as the right atrium exerting a compressive effect on the bronchi. The lesion was firmly adhered to the pericardium. The cystic was ‘en bloc’ resected in totality. The postoperative course was uncomplicated. Histological examination confirmed diagnosis of a bronchogenic cyst. The patient was asymptomatic throughout the follow-up period. Clinical discussion: Apart from the possibility of malignant degeneration, a bronchogenic cyst can increase in size and become huge causing serious complications. Despite the predictive diagnostic value of imaging, definitive diagnosis of a bronchogenic cyst is confirmed by surgical excision and pathological examination. Conclusions: Surgery is almost obligatory especially if the cyst is above a certain size (about 60 mm) and in the case of giant bronchogenic cysts.

Safety and Efficacy of Stereotactic Body Radiation Therapy for Ultra-central Thoracic Tumors: A Single Center Retrospective Review

Purpose/Objective(s)We sought to evaluate the toxicity and efficacy of stereotactic body radiotherapy (SBRT) for ultra-central thoracic tumours at our institution. Materials/MethodsPatients with ultra-central lung tumours or nodes, defined as having the planning target volume (PTV) overlapping or abutting the central bronchial tree and/or esophagus, treated at our institution with SBRT between 2009 and 2019 were retrospectively reviewed. All SBRT plans were generated with the goal of creating homogenous dose distributions. The primary endpoint was incidence of SBRT-related grade ≥3 toxicity, defined using the Common Terminology Criteria for Adverse Events (V5.0). Secondary endpoints included local failure (LF), progression-free survival (PFS) and overall survival (OS). Competing risk analysis was used to estimate incidence and identify predictors of severe toxicity and LF, while the Kaplan-Meier method was used to estimate PFS and OS. Results154 patients receiving 162 ultra-central courses of SBRT were included. The most common prescription was 50Gy in 5 fractions (42%), with doses ranging from 30-55Gy in 5 fractions (BED10 range 48-115Gy). The incidence of severe toxicity was 9.4% at 3 years. The most common severe toxicity was pneumonitis (n=4). There was 1 possible treatment related death from pneumonitis/pneumonia. Predictors of severe toxicity included increased PTV size, decreased PTV V95%, lung V5Gy, and lung V20Gy. The incidence of LF was 14% at 3 years. Predictors of LF included younger age, and greater volume of overlap between the PTV and esophagus. Median PFS was 8.8 months, while median OS was 44.0 months. ConclusionIn the largest case series of ultra-central thoracic SBRT to date, homogenously prescribed SBRT was associated with relatively low rates of severe toxicity and LF. Predictors of toxicity should be interpreted in the context of the heterogeneity in toxicities observed.

Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET)

The use of stereotactic body radiotherapy (SBRT) for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (BLINDED FOR REVIEW) aimed to determine the maximally tolerated dose (MTD) of SBRT for ultra-central (UC) non-small cell lung carcinoma (NSCLC), using a time-to-event continual reassessment methodology (TITE-CRM). Patients with T1-3N0M0 (≤ 6 cm) NSCLC were eligible. The MTD was defined as the dose of radiotherapy associated with a ≤ 30% rate of grade (G) 3-5 pre-specified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume (PTV); tumors with endobronchial invasion were excluded. This primary analysis occurred two years after completion of accrual. Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range: 65-87) and 17 (57%) were female. PTV was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%) and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range: 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia; the latter had CT findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% confidence interval [CI]: 52.3-85.3%), progression-free survival 66.1% (95% CI: 46.1-80.2%), local control 89.6% (95% CI: 71.2-96.5%), regional control 96.4% (95% CI: 77.2-99.5%) and distant control 85.9% (95% CI: 66.7-94.5%). Quality of life scores declined numerically over time, but the decreases were not clinically or statistically significant. 60 Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the pre-specified acceptability criteria, and results in excellent control for UC tumors.

Surgical Approach to Pulmonary Cystic Adenomatoid Malformations: About an Observation

Congenital cystic adenomatoid malformation (MAKC) is a congenital anomaly of lung development, and is defined as an adenomatoid proliferation of terminal respiratory structures, bronchial and distal pulmonary cystic dilatation, communicating with the bronchial tree and lacking cartilaginous rings, representing approximately 25% of congenital lung lesions, and in 80 to 85% of cases, the diagnosis is made before the age of 2 and is rarely discovered in adulthood. We report 01 case of MAKC diagnosed at the age of 06 months. The diagnosis was based on clinical elements (episode of bronchiolitis with serious signs at the age of 5 months) and radiological (TLT and CT). The lesion was located in the lower lobe of the right lung. The patient underwent a surgical resection such as a lower right lobectomy removing the lesion in one piece. The discovery of a MAKC must be recognized by clinicians. The clinical diagnosis, strongly oriented by the radiological approach, is confirmed by the anatomical pathology, the therapeutic sanction is surgical in the majority of cases. Most authors indicate surgery, especially in early childhood in order to avoid complications, mainly recurrent infections and pneumothorax, and to take advantage of the potential for lung growth.

Broncho biliary fistula following interventional radiology for hepatic metastases.

Bronchobiliary fistulas are defined as an abnormal communication between the biliary system and the bronchial tree. They are extremely rare complications of radiofrequency or microwave ablation. A 39-year-old woman with a history of neuroendocrine pancreatic carcinoma suffering from liver metastasis was treated with microwave ablation (MWA). In this case report, we present a case of intractable biliptysis from a bronchobiliary fistula secondary to an MWA. The patient was diagnosed by endoscopic retrograde cholangiopancreatograph and hepatobiliary scintigraphy. Treatment involved a right hemihepatectomy, a redo-hepaticojejunostomy, and the surgical placement of a transhepatic drain. After 6 weeks of drain placement, this could be removed. The fistula was thus successfully treated.

Research on Anatomical Types and Variations of Lung Segment Bronchi Based on Artificial Intelligence 3D Reconstruction Technology

Aims: To investigate the anatomic type and variation of segmental bronchus based on artificial intelligence 3D reconstruction technology. Methods: The image data of 200 patients who underwent thin-layer enhanced chest CT examination in the Department of Thoracic Surgery of Shandong Public Health Clinical Center from December 2021 to December 2022 were selected. The bronchi and blood vessels of the affected side of the lung were reconstructed according to the CT scanning data of the patients, and the anatomic types and anatomic variations of the bronchi of each lung segment on the affected side were observed and statistically analyzed. Results: There were basically four anatomical types of the right superior lobar bronchus, of which the three branching subtypes B1, B2 and B3 are the most common anatomical types. There are two types of right middle lobe bronchus, of which the B4 and B5 subtypes are the most common anatomic types. For the left lung, 4 types of segmental bronchus were found and (B1+2a+b, B1+2c), (B3a, B3b+c) was the most common anatomical type. Two types of bronchus were found in the left superior lobe of the lung. Type B4 and type B5 were the most common anatomical types. In addition, there were 3 types of bronchi in the dorsal segment of the left inferior lobe, and 3 types in the anterior, external and posterior basal segment bronchi of the left inferior lobe, among which B8, B9+B10 (57.6%) were the most common. Conclusion: The anatomical types of segmental and subsegmental bronchus are complex and varied, and there may be rare anatomical variations. Therefore, before performing relevant operations, it is necessary to be familiar with the relevant operations and the branch types of corresponding bronchus in advance to ensure the smooth operation.

Improved Bronchial Tree Image Reconstruction from the Lateral Decubitus Position of Computed Tomography Images for Virtual Navigation: A Case Report

Improved Bronchial Tree Image Reconstruction from the Lateral Decubitus Position of Computed Tomography Images for Virtual Navigation: A Case Report

Transport and deposition of microplastics and nanoplastics in the human respiratory tract

Recent studies have unveiled the presence of nano- and microplastics (NMPs) within both human and avian respiratory systems, prompting an exploration into the interactions between these particles and the human respiratory system. Experimental evidence has strongly suggested that these plastic particles amplify human susceptibility to a spectrum of lung disorders, including chronic obstructive pulmonary disease, fibrosis, dyspnea, asthma, and the formation of frosted glass nodules. To advance the understanding, this study employs computational fluid-particle dynamics (CFPD) to study the transfer and deposition of poly-dispersed 1-100 nm nanoplastics and 1-100 μm microplastics under three breathing conditions. Notably, this investigation utilized a computerized tomography-based full respiratory tract model, comprehensively spanning regions from the nasal cavity to the 13th generation of the bronchial tree, providing a highly detailed representation of the anatomical complexities of the human respiratory system. The outcomes reveal distinctive deposition patterns of spherical, cylindrical, and tetrahedral NMPs in the human respiratory tract, elucidating the significant impact of breathing rate, pinpointing specific deposition hotspots, and highlighting the critical role of particle size in governing transport and deposition behavior. This study establishes a link between the behavior of nanoplastics within the respiratory tract and its consequential impact, providing insights that extend across three critical domains. Firstly, in environmental health, the research contributes to understanding NMP-related air pollution. Secondly, within respiratory medicine, the findings shed light on NMPs' role in respiratory disorders. Finally, this study guides the formulation of regulations addressing permissible NMP levels and mitigating associated health and environmental risks.

Safety and Efficacy of Moderate-Intensity Stereotactic Body Radiation Therapy for Ultra-Central Lung Tumor.

Background and Objectives: Ultra-central (UC) lung tumors are defined as those abutting the proximal bronchial tree. Stereotactic body radiation therapy (SBRT) for UC tumors is difficult because of concerns about severe toxicities. Therefore, we report the safety and efficacy of moderate-intensity SBRT for UC tumors at our institution. Materials and Methods: From January 2017 to May 2021, we treated 20 patients with UC tumors with SBRT at a dose of 45-60 Gy in 10 fractions. The primary endpoints were local control (LC) and overall survival (OS). Results: The median follow-up time was 15.8 months (range: 2.7-53.8 months). Ten of the 20 patients (50.0%) showed a complete response, five (25.0%) had a partial response, two (10.0%) had stable disease, and three (15.0%) showed progressive disease (PD). The response and disease control rates were 75.0% and 85.0%, respectively. Patients with PD showed local progression at median 8.3 months (range: 6.8-19.1 months) after SBRT. One-year and 2-year OS rates were 79.4% and 62.4%, respectively. One-year and 2-year LC rates are 87.1% and 76.2%, respectively. Eight patients died due to a non-radiation therapy related cause. One patient experienced grade 5 massive hemoptysis 6 months after SBRT, resulting in death. One patient experienced grade 2 esophageal pain and two experienced grade 2 radiation pneumonitis. Otherwise, no grade 3 or higher toxicities were reported. Conclusions: Moderate-intensity SBRT offers effective control of UC tumors and is a well-tolerated treatment for such tumors.

Abstract 3747: Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor

Abstract Lung cancers identified with low-dose CT are typically early stage without endobronchial lesions, and most require a pathological diagnosis using invasive procedures. We conducted a study analyzing bronchial washing (BW) fluid using targeted panel sequencing to evaluate its diagnostic performance. And we aimed to elucidate the characteristics of patients group in which this method could be effectively applied. We prospectively enrolled patients with an incidental lung lesion suspected of early-stage lung cancer on chest CT and no visible endobronchial lesion on bronchoscopy from June 2017 to March 2018 at two independent hospitals. Lung cancer was histologically diagnosed using a diagnostic work-up including surgical lung biopsy, percutaneous needle biopsy, endobronchial ultrasound, and other biopsies. BW was performed on each patient in the subsegmental bronchus where the lung lesion was suspected to be located. Among shared genes between the panels for each cohort, we selected 8 genes that are frequently mutated known oncogenes/tumor suppressor genes in lung cancer not to consider passenger mutations for diagnosis. In addition, several filtering criteria were considered to differentiate cancer. Since criterion d considered definitive somatic mutations [known hotspot mutations or loss of function mutations with variant allele fraction (VAF) ≥ 2%] with criterion c (≥ 2 COSMIC11 variants with VAF ≥ 1%), the sensitivity was increased without loss of precision and the sensitivity of sequencing was higher than BW cytology. In total, 164 subjects (114 with lung cancer and 50 with benign) were enrolled. Of lung cancer patients, necrosis was observed on chest CT in 44 (38.6%) patients and malignant cells were identified upon BW cytological examination in 33 (28.9%) patients. Of total, 33 (20.1%) patients had complications related to invasive diagnostic test. By the panel with the criterion d, 42 patients (25.6%) were classified as cancer. The panel showed 100% of specificity, 100% of positive predictive value for diagnosing cancer whereas it had relatively low sensitivity. Twenty patients who were classified as cancer by sequencing despite of negative cytology. In the group with necrosis, the proportion of patients with positive for sequencing only was significantly higher than that of patients with positive for cytology only. In addition, the sensitivity of BW sequencing reached 75% in patients with necrotic tumors. The prevalence of necrotic tumors was significantly higher in SQC than in ADC. The significant proportion (66.7%) of primary tumors with positive for sequencing only and located in outer area had necrosis. This study demonstrated that BW sequencing could be applied for diagnosis in patients with necrotic lung lesion suspected of early-stage lung cancer in chest CT. It would be possible to reduce the frequency of unnecessary invasive procedures and subsequent complications. Citation Format: Jun Hyeok Lim, Hyun-Tae Shin, Sunmin Park, Woo Kyung Ryu, Lucia Kim, Kyung-Hee Lee, Sung Min Ko, Seung Jae Lee, Jung Soo Kim, Jeong-Seon Ryu. Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3747.