Diagnosis Of Thoracic Malignancy Research Articles

Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review.

Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.

Value of peripheral blood circulating tumor cell detection in the diagnosis of thoracic diseases and the prediction of severity.

Circulating tumor cell (CTC) detection, as a noninvasive liquid biopsy method, has been used in the diagnosis, prognostic indication, and monitoring of a variety of cancers. In this study, we aimed to investigate whether CTC detection could be used in the early diagnosis and prediction of severity of thoracic diseases. We enrolled 168 thoracic disease patients, all of whom underwent pathological biopsy. Carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) measurement was also performed in 146 patients. There were 131 cases of malignant thoracic diseases and 37 cases of benign lesions. We detected CTCs in a 5ml peripheral blood sample with the CTCBiopsy® system and analyzed the value of CTC count for predicting disease severity. Of 131 patients with a diagnosis of thoracic malignancy, CTCs were found in blood samples from 122 patients. However, only 2 out of 37 patients with benign thoracic disease had no detectable CTCs. There was no significant correlation between CTC count and benign and malignant lesions (P = 0.986). However, among 131 patients who had been diagnosed with malignant lesions, 33 had lymph node metastasis or distant metastasis. The presence of CTCs was significantly correlated with metastasis (P = 0.016 OR = 1.14). The area under the receiver operating characteristic (ROC) curve was 0.625 (95% confidence interval (CI), 0.519 to 0.730 P = 0.032). In addition, with stage IA1 as the cutoff, all patients were further divided into an early-stage group and a late-stage group. CTC count was significantly correlated with disease progression (P = 0.031 OR = 1.11), with an area under the curve (AUC) of 0.599 (95% CI, 0.506-0.692 P = 0.47). The sensitivity and specificity of CTC detection for the diagnosis of disease stage were 72.3% and 45.5%, respectively. In addition, the cutoff of 2.5 CTCs was the same when predicting disease metastasis and staging. Furthermore, the combination of CTC count, demographic characteristics and tumor markers had better predictive significance for disease staging. CTC count can effectively indicate the stages and metastasis of thoracic diseases, but it cannot differentiate benign and malignant diseases.

Endoscopic nodal staging in oligometastatic non-small cell lung cancer (NSCLC) being treated with stereotactic ablative radiotherapy (ENDO-SABR)

BackgroundResearch in treatment of non-small cell lung cancer (NSCLC) has shown promising results with stereotactic ablative radiotherapy (SABR) of oligometastatic disease, wherein distant disease may be limited to one or a few distant organs by host factors. Traditionally, PET/CT has been used in detecting metastatic disease and avoiding futile surgical intervention, however, sensitivity and specificity is limited to only 81 and 79%, respectively. Mediastinal staging still identifies occult nodal disease in up to 20% of NSCLC patients initially thought to be operative candidates. Endobronchial ultrasound and transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive tool for the staging and diagnosis of thoracic malignancy. When EBUS is combined with endoscopic ultrasound using the same bronchoscope (EUS-B), the diagnostic sensitivity and negative predictive value increase to 84 and 97%, respectively. Endoscopic staging in patients with advanced disease has never been studied, but may inform treatment if a curative SABR approach is being taken.MethodsThis is a multi-centre, prospective, cohort study with two-stage design. In the first stage, 10 patients with oligometastatic NSCLC (lung tumour ± hilar/mediastinal lymphadenopathy) with up to 5 synchronous metastases will be enrolled An additional 19 patients will be enrolled in the second stage if rate of treatment change is greater than 10% in the first stage. Patients will be subject to EBUS or combined modality EBUS/EUS-B to assess bilateral lymph node stations using a N3 to N2 to N1 progression. Primary endpoint is defined as the rate of change to treatment plan including change from SABR to conventional dose radiation, change in mediastinal radiation field, and change from curative to palliative intent treatment.DiscussionIf a curative approach with SABR for oligometastatic disease is being explored, invasive mediastinal staging may guide treatment and prognosis. This study will provide insight into the use of endoscopic mediastinal staging in determining changes in treatment plan of NSCLC. Results will inform the design of future phase II trials.Trial registrationClinicaltrials.gov identifier NCT04852588. Date of registration: April 19, 2021. Protocol version: 1.1 on December 9, 2021.

A Review of Exhaled Volatile Organic Compounds as Biomarkers for Thoracic Malignancies

Lung cancer, malignant pleural mesothelioma, and esophageal cancer are the most common thoracic malignancies and are responsible for substantial cancer-related morbidity and mortality worldwide. Early cancer identification prompts earlier intervention and can therefore improve patient survival. Traditional diagnostics are costly and invasive, however, creating an urgent need for alternative methods. Over the past 30 years, breath analysis has emerged as a rapid, minimally invasive, and cost-effective approach. Metabolites in exhaled breath, known as volatile organic compounds (VOCs), reflect internal biomolecular processes and their composition has been shown to vary in association with numerous pathological states. This review provides an overview on the use of VOCs in exhaled breath for the early screening and diagnosis of thoracic malignancies. Study design, methodology, and significant results from over sixty studies published since 1990 are specified and summarized. A total of 439 significant VOCs are reported in the literature, mainly consisting of aromatic compounds, aldehydes, alkanes, lipids, ketones, and sulfur-containing compounds. Diagnostic sensitivities and specificities range from 51-100% and 68.8 – 100%, respectively. Cancer-specific VOC profiles and associations of clinical interest (e.g., comorbidities, histology, and staging) are emphasized and discussed. While there is considerable evidence to support the diagnostic utility of VOCs, the lack of standardization and external validation in large independent cohorts remain key barriers to clinical translation. However, efforts to address these limitations are currently underway.

OUTCOMES OF PATIENTS WITH A NON-DIAGNOSTIC INITIAL BRONCHOSCOPY FOR SUSPECTED THORACIC MALIGNANCY

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Flexible fiberoptic bronchoscopy plays an important role in the diagnosis of thoracic malignancies. The rate of lung cancer detection on bronchoscopy ranges between 30-75%. There is sparse data regarding the outcome of patients suspected of thoracic malignancies and an initial negative bronchoscopy. The goal of this study was to evaluate the outcomes of patients with an initial non-diagnostic bronchoscopy. In addition, we compared them with the diagnostic group to identify variables predictive of a diagnostic bronchoscopy. METHODS: This was a retrospective review of medical records of patients who underwent bronchoscopy with biopsy and/or needle aspiration for suspected thoracic malignancy. The study period was from January 2012 to December 2017. The study was approved by the institutional review board. RESULTS: 225 patients were included in the study. There were 116 (51.56%) males and the mean age of the cohort was 62 years. 115 (51.11%) bronchoscopies were non-diagnostic. Of the 115 patients with a non-diagnostic bronchoscopy, 57 (49.57%) were lost to follow-up. Of the remaining 58 patients, 41 (70.69%) had resolution or stabilization of radiological abnormalities. Additional tissue biopsy revealed 15 (25.86%) patients with thoracic malignancies of which 11 were primary lung cancers. 4 other malignancies included lymphoma, metastatic squamous cell carcinoma, pharyngeal small cell carcinoma, and thymoma. 2 were identified to be granulomas. In univariate analysis, HIV infection was the only comorbidity found more frequently in the non-diagnostic group and weight loss was the only symptom associated with a diagnostic bronchoscopy. Presence of lung mass and mediastinal adenopathy was predictive of a diagnostic procedure, while solitary nodule predicted a non-diagnostic bronchoscopy. Performance of endobronchial biopsy and transbronchial needle aspiration was predictive of a diagnostic bronchoscopy while transbronchial biopsy was predictive of a non-diagnostic bronchoscopy. CONCLUSIONS: Our diagnostic bronchoscopic yield of 48.89% in suspected thoracic malignancy was similar to other studies. Close follow up of patients with non-diagnostic procedures identified malignancies in about 26% of them. CLINICAL IMPLICATIONS: Follow up of patients with initial non-diagnostic bronchoscopies is of paramount importance, as up to 26% of those patients have been found to have malignancy upon further investigation. In our inner-city community, post-procedure follow up is a challenge due to various factors and physicians need to consider them in patients with initial non-diagnostic procedures. DISCLOSURES: No relevant relationships by Gilda Diaz-Fuentes, source=Web Response No relevant relationships by Maneesh Gaddam, source=Web Response No relevant relationships by Sindhaghatta Venkatram, source=Web Response

COMMUNICATION WITH PRIMARY CARE REGARDING END OF LIFE CARE (EOLC) IN RESPIRATORY MEDICINE

BackgroundLeeds Teaching Hospitals is a flagship trust for the EoLC strategy. We aim to improve the identification of these patients, and critically the communication with the patient, family and primary...

P232 Communication and End of Life Care (EoLC) in People with Respiratory Disease

BackgroundLeeds Teaching Hospitals Trust (LTHT) is a flagship trust for the National End of Life Care (EoLC) strategy. Key areas of improvement in EoLC have been identified, including identification of...