Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases — a multicenter prospective study

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A general anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use.Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a guide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a chest tube drainage and a minor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

Transbronchial lung cryobiopsy guided by radial "mini-probe" endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

Przydatność określania obecności mutacji BRAF V600E w biopsji aspiracyjnej celowanej cienkoigłowej w zmianach niezdeterminowanych

  Introduction: Fine-needle aspiration biopsy (FNAB) is regarded as the gold standard method for the diagnosis of thyroid nodules, but it has its limitations. Additional methods that would improve sensitivity and specificity in the diagnosis of thyroid cancer (TC), especially in indeterminate lesions. Molecular tests seem to be such a tool. BRAF V600E mutation (the most common in TC) can be detected in FNAB and can be potentially a very useful ancillary marker for FNAB practice. The aim of our study was to evaluate the usefulness of the detection of the BRAF V600E mutation in FNAC in the early diagnosis of TC in patients with indeterminate cytology. Material and method: 2290 FNAB were performed and 147 indeterminate results (group 3, 4, and 5 of the Bethesda system) were obtained. Material from these groups was submitted for molecular tests for the occurrence of BRAF V600E mutation. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the tests were calculated. Results: Determining the presence of BRAF V600E mutation in FNAC material in groups 3 and 4 together and in group 5 is associated with sensitivity of TC diagnosis of 37.5% and 81.8%, respectively. In all cases the detection of BRAF V600E mutation was associated with histopathologically proving the presence of TC (specificity of the test — 100%). Conclusions: The presence of BRAF V600E mutation in FNAC material is always associated with the presence of TC. The usefulness of determining the presence of BRAF V600E in FNAC in cytological groups 3 and 4 is associated with low sensitivity in the diagnosis of thyroid cancer. Due to its high specificity BRAF V600E study may be useful in determining the scope of surgery in patients in cytological group 5. (Endokrynol Pol 2016; 67 (1): 41–47)    Wstęp: Biopsja aspiracyjna celowana cienkoigłowa (BACC) jest uznawana za złoty standard w diagnostyce guzków tarczycy. Ma ona jednak swoje ograniczenia. Poszukiwane są więc dodatkowe metody, które poprawiłyby czułość i specyficzność diagnozowania raka tarczycy, zwłaszcza w przypadku zmian niezdeterminowanych w BACC. Badania molekularne wydają się być takim narzędziem. Mutacja BRAF V600E (najczęstsza w raku tarczycy) może być wykrywana w materiale z biopsji i może wspomagać BACC w rozpoznawaniu raka tarczycy. Celem pracy była ocena przydatności wykrywania mutacji BRAF V600E w BACC w zmianach niezdeterminowanych we wczesnej diagnostyce pacjentów ze zmianami ogniskowymi w tarczycy. Materiał i metody: Przeprowadzono 2290 BACC, uzyskując w 147 próbkach wyniki niezdeterminowane (grupy 3, 4 i 5 wg klasyfikacji Bethesda). W grupie tej przeprowadzono badania molekularne w kierunku występowania mutacji BRAF V600E. Obliczono czułość, swoistość, wartość predykcyjną dodatnią, wartość predykcyjną ujemną i dokładność testu. Wyniki: Obecność mutacji BRAF V600E w grupach cytologicznych 3 i 4 łącznie oraz w grupie 5 wiązała się z czułością w rozpoznawaniu raka tarczycy odpowiednio 37,5% i 81,8%. W każdym przypadku wykrycia mutacji BRAF V600E w badaniu pooperacyjnym rozpoznano raka tarczycy (specyficzność testu —100%). Wnioski: Obecność mutacji BRAF V600E w materiale BACC jest zawsze związana z obecnością RT. Przydatność określenia obecności BRAF V600E w BACC w grupach cytologicznych 3 i 4 jest związana z niską czułością rozpoznania RT. Ze względu na wysoką specyficzność BRAF V600E badania mogą być przydatne w określaniu zakresu operacji u pacjentów z grupy cytologicznej 5. (Endokrynol Pol 2016; 67 (1): 41–47)

The Delayed Risk Stratification System in the Risk of Differentiated Thyroid Cancer Recurrence.

CONTEXT:There has been a marked increase in the detection of differentiated thyroid carcinoma (DTC) over the past few years, which has improved the prognosis. However, it is necessary to adjust treatment and monitoring strategies relative to the risk of an unfavourable disease course. MATERIALS AND METHODS:This retrospective study examined data from 916 patients with DTC who received treatment at a single centre between 2000 and 2013. The utility of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) recommended systems for early assessment of the risk of recurrent/persistent disease was compared with that of the recently recommended delayed risk stratification (DRS) system. RESULTS:The PPV and NPV for the ATA (24.59% and 95.42%, respectively) and ETA (24.28% and 95.68%, respectively) were significantly lower than those for the DRS (56.76% and 98.5%, respectively) (p<0.0001). The proportion of variance for predicting the final outcome was 15.8% for ATA, 16.1% for ETA and 56.7% for the DRS. Recurrent disease was rare (1% of patients), and was nearly always identified in patients at intermediate/high risk according to the initial stratification (9/10 cases). CONCLUSIONS:The DRS showed a better correlation with the risk of persistent disease than the early stratification systems and allows personalisation of follow-up. If clinicians plan to alter the intensity of surveillance, patients at intermediate/high risk according to the early stratification systems should remain within the specialized centers; however, low risk patients can be referred to endocrinologists or other appropriate practitioners for long-term follow-up, as these patients remained at low risk after risk re-stratification

Clinical characteristics of ten patients with recurrent disease after successful initial therapy.

<p>Clinical characteristics of ten patients with recurrent disease after successful initial therapy.</p

PPV, NPV and PVE according to the different risk stratification systems.

<p>PPV, NPV and PVE according to the different risk stratification systems.</p

Clinical outcome at the end of follow-up according to the ATA, ETA and DRS systems.

<p>Clinical outcome at the end of follow-up according to the ATA, ETA and DRS systems.</p