Browsing by Author "Biswas, Abhishek"
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Item Clinical performance of endobronchial ultrasound‐guided transbronchial needle aspiration for assessing programmed death ligand‐1 expression in nonsmall cell lung cancer(Wiley Periodicals, Inc., 2018) Biswas, Abhishek; Leon, Marino; Drew, Peter; Fernández‐Bussy, Sebastián; Furtado, Larissa; Jantz, Michael; Mehta, HirenBackground: Pembrolizumab was recently approved as a first line agent for metastatic NSCLC in patients with high programmed death-ligand 1 (PD-L1) expression. Objetives: Since a significant portion of lung cancer is diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA); there is a need for PD-L1 testing in these specimens. However, to date few studies have evaluated performance of cytology specimens from EBUS TBNA for PD-L1 analysis. Methods: Patients who had a diagnosis of NSCLC and in whom ancillary testing, i.e., next generation sequencing (NGS), anaplastic lymphoma kinase (ALK), and PD-L1 expression was requested between January and May 2017 were reviewed. RESULTS: Fifty of the 112 patients reviewed had the diagnosis of NSCLC for which ancillary testing was requested. Twelve patients (24%) had squamous cell carcinoma, twenty-seven had adenocarcinoma (54%), five had NSCLC favor adenocarcinoma (10%), two had NSCLC favor squamous cell cancer (4%), and four had NSCLC not otherwise specified (NOS) (8%). Size of the lymph nodes or lesion sampled ranged from 10 to 50 mm. Four (8%) patients had insufficient number of tumor cells in the cell block for any of the ancillary molecular testing. Forty-one (82%) patients had an adequate sample for all three ancillary tests. Satisfactory results for PD-L1 expression for all cases was 86% with 14 (32%) patients having levels of PD-L1 expression >50%. CONCLUSION: EBUS TBNA is effective and has a high proportion of satisfactory results for testing PD-L1 expression on tumor cells in addition to NGS and ALK FISH.Item Photodynamic Therapy for Bronchial Microscopic Residual Disease After Resection in Lung Cancer(2019) Mehta, Hiren J.; Biswas, Abhishek; Fernández-Bussy, Sebastián; Pipkin, Mauricio; Machuca, Tiago; Jantz, Michael A.Background: The goal of lung cancer surgery is a complete tumor resection (R0 resection) with clear margins. 4% to 5% of resections have microscopic residual disease associated with worse prognosis. Definitive management is resection of residual tumor, which may not be tolerated by many patients, and definitive management is not well studied in these patients. We treated patients with stage I cancer and bronchial mucosal residual disease (MRD) with bronchoscopic photodynamic therapy (PDT). Methods: All patients who underwent definitive surgery for early-stage lung cancer were reviewed. Patients with R1 resection, stage I disease with MRD and or carcinoma in situ along the stump site were treated with bronchoscopic PDT. Patient characteristics, histology, type and site of surgery, pattern of recurrence, recurrence status, adverse events, and survival data were evaluated. Results: Eleven patients with bronchial mucosal R1 resection were treated with PDT along the stump site. The median age was 67. Three patients had carcinoma in situ and 8 had MRD. One patient (9%) had local recurrence 1 year after PDT treatment and was treated with radiation. Four patients (36%) had no evidence of recurrence to date after a median follow-up of 4 years and the other 6 patients had evidence of regional (16%) or distant (39%) recurrence. The local control rate was 91%. One patient developed pneumonia and other had photosensitivity reaction. Conclusion: Bronchoscopic PDT is safe and effective in selected group of patients with non-small cell lung cancer who have MRD along the stump site.