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MA 20.06 Discerning Lung Cancer Cell Patterns with Confocal Endomicroscopy
S1888
Journal of Thoracic Oncology
MA 20.04 Intelligent Biopsy Device for SPN Diagnosis T. Bruha,1 J. Votruba,2 P. Michálek3 1Pulmonary, Charles University Hospital, Praha/CZ, 2Pulmonology, Charles University Hospital, Praha/CZ, 3Antrim Area Hospital, Antrim/GB Background: Solitary pulmonary nodules are increasingly encountered in current medicine. There are interesting new technologies available for this difficult diagnostics category of pulmonary pathologies like endobronchial navigation techniques and transparietal CT guided biopsy. In order to increase diagnostic yield of those techniques precise biopsy instruments are needed. Method: We utilize new instrument based on near infrared diagnostics. This simple needle sheath can be used during routine bronchoscopy examination and enables simultaneous spectral measurement and obtaining of histology tissue samples in situ at the same time. This intelligent sheath with standard needle can be used both during fluoroscopy navigation and EBUS guided navigation to confirm correct biopsy instrument position during the sampling itself. According to our results diagnostic yield of navigation method is significantly increased using such device. Instrument itself consists of elastic tubing while along the length of tube on opposite sides of cross section perimeter there are two segments fixed with 6 optic microfibers covered with insulation as NIR spectroscopic probe. Core consists of the channel for of standard biopsy needle introduction. Instrument itself is introduced to the area of interest through the working channel of the bronchoscope. Result: We performed 40 consecutive examinations of SPN (diameter 1-3cm) using intelligent needle during navigational bronchoscopic procedure executing fluoroscopy and radial EBUS. Correct placement of biopsy instrument confirmed by NIR spectroscopy was possible in 32 cases. In all of these cases positive cytology specimen containing diagnostic material was obtained. Conclusion: Intelligent NIR based biopsy needle appears to be good adjunct in the diagnosis of SPNs. More extensive studies are needed to prove diagnostic potency of this device. Keywords: NIR spectroscopy, standard needle, solitary pulmonary nodule
Vol. 12 No. 11S2
available. The objective was to discriminate pCLE patterns of lung cancer in vivo. Method: Fluorescence properties of methylene blue (MB) were examined ex vivo in confocal microscope. Next, 15 regions of the central airways were studied in vivo with pCLE and a representative image chosen for analysis with ImageJ software. Biopsy was performed for final diagnosis. Result: Ex vivo study showed no differences between 1% and 2% MB concentrations and rapid extinction of fluorescence after 10 minutes of MB application (figure). In vivo study included samples of bronchial mucosa (n ¼ 6), inflammation (n ¼ 3) and tumor (n ¼ 6). pCLE image evaluation (table) showed inflammation and tumor nuclei were bigger (except SCLC) and occupied a greater area. Fluorescence of tumor nuclei was more intense. Non fluorescent area was inferior for both inflammation and tumor samples. Number of nuclei could not discriminate between normal and tumor. Conclusion: 1. MB fluorescence is unaffected by stain concentration 2. There is exponential extinction of MB over time 3. Lung cancer cell pattern distinction in vivo is feasible Funded by Fundació MaratóTV3, SEPAR and FUCAP. Keywords: in vivo diagnosis, bronchoscopy, lung cancer
MA 20.07 Endobronchial Ultrasound Elastography: Mediastinal Staging in Non-Small Cell Lung Cancer and Technical Factors L. Yagnik, A. Mcwilliams, M. Salamonsen Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA/AU
MA 20.06 Discerning Lung Cancer Cell Patterns with Confocal Endomicroscopy M. Diez-Ferrer,1 B. Torrejon,2 N. Baixeras,3 E. Minchole,1 R.M. Ortiz,1 N. Cubero,1 R. Lopez-Lisbona,1 J. Dorca,1 A. Rosell1 1 Respiratory Medicine, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat/ES, 2Unit of Advanced Optical Microscopy, Ccitub - University of Barcelona, L’Hospitalet de Llobregat/ES, 3Pathology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat/ES Background: Probe-based confocal endomicroscopy (pCLE) allows confocal microscopy of lung tissue in vivo but limited evidence is
Background: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is the standard of care for diagnosis and mediastinal staging of non-small cell lung cancer (NSCLC). Studies suggest that elastography, an ultrasonic measure of tissue elasticity, may identify malignant lymph nodes (LNs) with sufficient accuracy to guide which LNs need sampling at EBUS and reduce the time and complexity of staging procedures. This study aims to confirm these findings while also describing technical factors that affect elastographic measurements. Method: All patients undergoing EBUS TBNA to investigate possible NSCLC were prospectively recruited. Elastographic analysis was performed prior to TBNA of LNs and later correlated with pathology from EBUS TBNA and/or surgical specimens. All LNs were
Table. Imaging features evaluated in pCLE frames
Bronchial epithelium (mean(SD)) Inflammation (mean(SD)) B cell lymphoma Adenocarcinoma Squamous cell carcinoma Small cell lung cancer Non-small cell lung cancer Hamartoma
Area occupied by nuclei (mm2)
Intensity of nuclei (UA)
Mean size of nuclei (mm2)
Non-fluorescent area (mm2)
Number of nuclei (mm2)
97,769(9,451)
126(9)
107(10)
67,100(12,567)
937(84)
117,381(22,166) 138,354 155,033 102,805 107,201 113,173 120,188
122(27) 145 198 145 157 187 145
127(15) 185 177 155 63 122 114
35,124(32,630) 49,269 5,225 54,301 11,257 32,359 25,438
933(225) 746 875 663 1,687 926 1,058
Journal of Thoracic Oncology
MA 20.04 Intelligent Biopsy Device for SPN Diagnosis T. Bruha,1 J. Votruba,2 P. Michálek3 1Pulmonary, Charles University Hospital, Praha/CZ, 2Pulmonology, Charles University Hospital, Praha/CZ, 3Antrim Area Hospital, Antrim/GB Background: Solitary pulmonary nodules are increasingly encountered in current medicine. There are interesting new technologies available for this difficult diagnostics category of pulmonary pathologies like endobronchial navigation techniques and transparietal CT guided biopsy. In order to increase diagnostic yield of those techniques precise biopsy instruments are needed. Method: We utilize new instrument based on near infrared diagnostics. This simple needle sheath can be used during routine bronchoscopy examination and enables simultaneous spectral measurement and obtaining of histology tissue samples in situ at the same time. This intelligent sheath with standard needle can be used both during fluoroscopy navigation and EBUS guided navigation to confirm correct biopsy instrument position during the sampling itself. According to our results diagnostic yield of navigation method is significantly increased using such device. Instrument itself consists of elastic tubing while along the length of tube on opposite sides of cross section perimeter there are two segments fixed with 6 optic microfibers covered with insulation as NIR spectroscopic probe. Core consists of the channel for of standard biopsy needle introduction. Instrument itself is introduced to the area of interest through the working channel of the bronchoscope. Result: We performed 40 consecutive examinations of SPN (diameter 1-3cm) using intelligent needle during navigational bronchoscopic procedure executing fluoroscopy and radial EBUS. Correct placement of biopsy instrument confirmed by NIR spectroscopy was possible in 32 cases. In all of these cases positive cytology specimen containing diagnostic material was obtained. Conclusion: Intelligent NIR based biopsy needle appears to be good adjunct in the diagnosis of SPNs. More extensive studies are needed to prove diagnostic potency of this device. Keywords: NIR spectroscopy, standard needle, solitary pulmonary nodule
Vol. 12 No. 11S2
available. The objective was to discriminate pCLE patterns of lung cancer in vivo. Method: Fluorescence properties of methylene blue (MB) were examined ex vivo in confocal microscope. Next, 15 regions of the central airways were studied in vivo with pCLE and a representative image chosen for analysis with ImageJ software. Biopsy was performed for final diagnosis. Result: Ex vivo study showed no differences between 1% and 2% MB concentrations and rapid extinction of fluorescence after 10 minutes of MB application (figure). In vivo study included samples of bronchial mucosa (n ¼ 6), inflammation (n ¼ 3) and tumor (n ¼ 6). pCLE image evaluation (table) showed inflammation and tumor nuclei were bigger (except SCLC) and occupied a greater area. Fluorescence of tumor nuclei was more intense. Non fluorescent area was inferior for both inflammation and tumor samples. Number of nuclei could not discriminate between normal and tumor. Conclusion: 1. MB fluorescence is unaffected by stain concentration 2. There is exponential extinction of MB over time 3. Lung cancer cell pattern distinction in vivo is feasible Funded by Fundació MaratóTV3, SEPAR and FUCAP. Keywords: in vivo diagnosis, bronchoscopy, lung cancer
MA 20.07 Endobronchial Ultrasound Elastography: Mediastinal Staging in Non-Small Cell Lung Cancer and Technical Factors L. Yagnik, A. Mcwilliams, M. Salamonsen Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA/AU
MA 20.06 Discerning Lung Cancer Cell Patterns with Confocal Endomicroscopy M. Diez-Ferrer,1 B. Torrejon,2 N. Baixeras,3 E. Minchole,1 R.M. Ortiz,1 N. Cubero,1 R. Lopez-Lisbona,1 J. Dorca,1 A. Rosell1 1 Respiratory Medicine, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat/ES, 2Unit of Advanced Optical Microscopy, Ccitub - University of Barcelona, L’Hospitalet de Llobregat/ES, 3Pathology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat/ES Background: Probe-based confocal endomicroscopy (pCLE) allows confocal microscopy of lung tissue in vivo but limited evidence is
Background: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is the standard of care for diagnosis and mediastinal staging of non-small cell lung cancer (NSCLC). Studies suggest that elastography, an ultrasonic measure of tissue elasticity, may identify malignant lymph nodes (LNs) with sufficient accuracy to guide which LNs need sampling at EBUS and reduce the time and complexity of staging procedures. This study aims to confirm these findings while also describing technical factors that affect elastographic measurements. Method: All patients undergoing EBUS TBNA to investigate possible NSCLC were prospectively recruited. Elastographic analysis was performed prior to TBNA of LNs and later correlated with pathology from EBUS TBNA and/or surgical specimens. All LNs were
Table. Imaging features evaluated in pCLE frames
Bronchial epithelium (mean(SD)) Inflammation (mean(SD)) B cell lymphoma Adenocarcinoma Squamous cell carcinoma Small cell lung cancer Non-small cell lung cancer Hamartoma
Area occupied by nuclei (mm2)
Intensity of nuclei (UA)
Mean size of nuclei (mm2)
Non-fluorescent area (mm2)
Number of nuclei (mm2)
97,769(9,451)
126(9)
107(10)
67,100(12,567)
937(84)
117,381(22,166) 138,354 155,033 102,805 107,201 113,173 120,188
122(27) 145 198 145 157 187 145
127(15) 185 177 155 63 122 114
35,124(32,630) 49,269 5,225 54,301 11,257 32,359 25,438
933(225) 746 875 663 1,687 926 1,058