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THE FEASIBILITY OF TRANSVASCULAR ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION: A SINGLE TERTIARY-CARE CENTER EXPERIENCE WITH 35 PATIENTS

2020; Elsevier BV; Volume: 158; Issue: 4 Linguagem: Inglês

10.1016/j.chest.2020.08.1690

1931-3543

Rami Naaman, Adil A. Sheikh, Khalil Diab,

Lung Cancer Diagnosis and Treatment

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Thoracic vascular structures often preclude transbronchial access to central lung parenchymal lesions and lymph nodes, thereby necessitating either a surgical or trans-vascular needle aspiration (TVNA) approach for diagnostic sampling. There is a dearth of data on the safety of EBUS-TVNA with reports citing concerns of bleeding, iatrogenic injury or infection. We reviewed EBUS-TVNA cases done at our tertiary care center to assess the safety and efficacy of this technique in obtaining diagnostic samples. METHODS: We performed a retrospective analysis of 35 cases of endobronchial ultrasound-guided transbronchial aspirations with a transvascular approach. Cases reviewed in the Cerner electronic medical records (EMR) ranged between March 2013 and October 2018. EMR was reviewed for patient comorbidities and smoking status, anticoagulation intake, procedural details, sample results and post-procedural course, including the need for additional procedure to establish the diagnosis. Post-procedure complications of interest included bleeding, pneumothorax or respiratory failure. We also presented individual cases where malignancies were better characterized, leading to more appropriate treatments. RESULTS: Thirty-five (35) EBUS-TVNA procedures were reviewed. Twenty-nine (29) of them were performed by traversing the main pulmonary artery or its branches. Three (3) involved trans-vascular access through the azygous vein, two via the brachiocephalic artery and one through the superior vena cava. The most common chronic medical problem in our population was hypertension (20 patients, 57%). Only four patients (11.4%) suffered post-procedural complications: one patient had minimal hemoptysis while another suffered moderate bleeding that was controlled with intra-procedural Epinephrine and saline infusion. The third patient needed to be admitted with acute hypoxic respiratory failure due to an exacerbation of their COPD while the fourth developed a rapid ventricular rate on top of their pre-existing atrial fibrillation. None of our patient suffered complications at a later time, up to 3 months after the procedure. Rapid On-Site Evaluation (ROSE) yielded hypocellular samples in 7 patients only (20%). Malignancy was diagnosed on final pathology in 23 patients (65.7%), including 4 extra-thoracic metastatic malignancies. Our aspirations failed to identify malignancy in only 4 patients (11.4%). Those required a secondary intervention to establish the diagnosis. CONCLUSIONS: In our single-center experience, the EBUS-TVNA procedure had high success rate in sampling and leading to definitive diagnoses of malignant lesions. It was also associated with low rates of post-procedural complications. CLINICAL IMPLICATIONS: Further trials are needed to assess its efficacy compared to more invasive procedures. DISCLOSURES: No relevant relationships by Khalil Diab, source=Web Response No relevant relationships by Rami Naaman, source=Web Response No relevant relationships by Adil Sheikh, source=Web Response