Browsing by Author "Casal, Roberto F."
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Item Combined pleuroscopy and endobronchial ultrasound for diagnosis and staging of suspected lung cancer(2018) Rodríguez Vial, Macarena; Eapen, George A.; Casal, Roberto F.; Sarkiss, Mona G.; Ost, David E.; Vakil, Erik; Grosu, Horiana B.The standard approach to staging of lung cancer in patients with pleural effusion (clinical M1a) is thoracentesis followed by pleural biopsies if the cytologic analysis is negative. If pleural biopsy findings are negative, endobronchial ultrasound-guided transbronchial needle aspiration is used to complete the staging process and, in some cases, obtain diagnosis. In this case series we report 7 patients in which a combined procedure was performed for staging of known or suspected lung cancer. We found that the combined approach was both feasible and safe in this case series.Item Diagnostic performance of endobronchial ultrasound-guided mediastinal lymph node sampling in early stage non-small cell lung cancer: A prospective study(2018) Rodríguez Vial, Macarena; O’connell, Oisin J.; Grosu, Horiana B.; Hernández, Mike; Noor, Laila; Casal, Roberto F.; Stewart, John; Sarkiss, Mona; Jiménez, Carlos A.; Rice, David; Mehran, Reza; Ost, David E.; Eapen, George A.Background and objective: Standard nodal staging of lung cancer consists of positron emission tomography/ computed tomography (PET/CT), followed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) if PET/CT shows mediastinal lymphadenopathy. Sensitivity of EBUS-TBNA in patients with N0/N1 disease by PET/CT is unclear and largely based on retrospective studies. We assessed the sensitivity of EBUS-TBNA in this setting. Methods: We enrolled patients with proven or suspected lung cancer staged as N0/N1 by PET/CT and without metastatic disease (M0), who underwent staging EBUS-TBNA. Primary outcome was sensitivity of EBUS-TBNA compared with a composite reference standard of surgical stage or EBUS-TBNA stage if EBUS demonstrated N2/N3 disease. Results: Seventy-five patients were included in the analysis. Mean tumour size was 3.52 cm (1.63). Fifteen of 75 patients (20%) had N2 disease. EBUS-TBNA identified six while nine were only identified at surgery. Sensitivity of EBUS-TBNA for N2 disease was 40% (95% CI: 16.3–67.7%). Conclusion: A significant proportion of patients with N0/N1 disease by PET/CT had N2 disease (20%) and EBUS-TBNA identified a substantial fraction of these patients, thus improving diagnostic accuracy compared with PET/CT alone. Sensitivity of EBUS-TBNA however appears lower compared with historical data from patients with larger volume mediastinal disease. Therefore, strategies to improve EBUS-TBNA accuracy in this population should be further exploredItem Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy(2017) Grosu, Horiana B.; Vial-Rodriguez, Macarena; Vakil, Erik; Casal, Roberto F.; Eapen, George A.; Morice, Rodolfo; Stewart, John; Sarkiss, Mona G.; Ost, David E.Rationale: During diagnostic thoracoscopy, talc pleurodesis after biopsy is appropriate if the probability of malignancy is sufficiently high. Findings on direct visual assessment of the pleura during thoracoscopy, rapid onsite evaluation (ROSE) of touch preparations (touch preps) of thoracoscopic biopsy specimens, and preoperative imaging may help predict the likelihood of malignancy; however, data on the performance of these methods are limited. Objectives: To assess the performance of ROSE of touch preps, direct visual assessment of the pleura during thoracoscopy, and preoperative imaging in diagnosing malignancy. Methods: Patients who underwent ROSE of touch preps during thoracoscopy for suspected malignancy were retrospectively reviewed. Malignancy was diagnosed on the basis of final pathologic examination of pleural biopsy specimens. ROSE results were categorized as malignant, benign, or atypical cells. Visual assessment results were categorized as tumor studding present or absent. Positron emission tomography (PET) and computed tomography (CT) findings were categorized as abnormal or normal pleura. Likelihood ratios were calculated for each category of test result. Results: The study included 44 patients, 26 (59%) with a final pathologic diagnosis of malignancy. Likelihood ratios were as follows: for ROSE of touch preps: malignant, 1.97 (95% confidence interval [CI], 0.90–4.34); atypical cells, 0.69 (95% CI, 0.21–2.27); benign, 0.11 (95% CI, 0.01–0.93); for direct visual assessment: tumor studding present, 3.63 (95% CI, 1.32–9.99); tumor studding absent, 0.24 (95% CI, 0.09–0.64); for PET: abnormal pleura, 9.39 (95% CI, 1.42–62); normal pleura, 0.24 (95% CI, 0.11–0.52); and for CT: abnormal pleura, 13.15 (95% CI, 1.93–89.63); normal pleura, 0.28 (95% CI, 0.15–0.54). Conclusions: A finding of no malignant cells on ROSE of touch preps during thoracoscopy lowers the likelihood of malignancy significantly, whereas finding of tumor studding on direct visual assessment during thoracoscopy only moderately increases the likelihood of malignancy. A positive finding on PET and/or CT increases the likelihood of malignancy significantly in a moderate-risk patient group and can be used as an adjunct to predict malignancy before pleurodesis.