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A7306 - First In-Patient Use of a New Flexible Trans-Bronchial Needle Device for Sampling of Peripheral Lung Lesions
Author Block: R. L. Myers1, C. A. Hergott2, P. R. MacEachern2, B. Shieh2, M. Fortin3, A. Delage3, T. Shaipanich1, E. Beaudoin1, S. Lam1, M. Bonifazi4, S. Gasparini5, A. Tremblay2; 1Integrative Oncology, BC Cancer Agency, Vancouver, BC, Canada, 2University of Calgary, Calgary, AB, Canada, 3Institut Universitaire de Cardiliogie et Pneumologie, Quebec, QC, Canada, 4Universita Politecnica delle Marche, Ancona, Italy, 5Ospedale Regional Torrette, 60020 Ancona, Italy.
RATIONALE: Trans-bronchial needle aspiration (pTBNA) sampling of peripheral lung (PL) lesions can increase the diagnostic yield of bronchoscopy. Current needle devices have limitations when used with guide-sheaths(GS)/small bronchoscopes and flexibility when acute angulation is required. We report the first clinical use of a specifically designed pTBNA needle (PeriFLEX, Olympus Respiratory America [ORA], Redmond, USA) for sampling of PL. METHODS: Ten devices were supplied by ORA to each of 4 centers. Case were selected by each bronchoscopist at the time of sampling of a PL beyond the field of view of the bronchoscope. A retrospective chart review was then performed. RESULTS: Mean patient age was 66.5 years (+/- 11.3, range 32-87) and 60% were female. All cases were performed under moderate sedation. Radial pEBUS with GS was used for 30 (75%) of procedures (SG-200C, n=17, SG-201C, n=13) while fluoroscopy was used in 13 cases (32.5%). Average PL size was 35.1mm (+/- 18.0, range 9-80). Distance of PL from the costal pleura was mean of 18.8mm (+/- 18.8, range 0-66) and 20 (50%) of lesions were in the upper lobes and 5 (12.5%) were subsolid. Probe position was within the PL in 83.3% of pEBUS cases and adjacent in 16.7%. Other sampling devices used included forceps (75%), cytology brush (70%), lavage/washings (67.5%) and linear EBUS (40%). One case of mild bleeding (3.3%) after pTBNA sampling was noted. No pneumothorax was noted post-procedure. A specific diagnosis was obtained in 34 (85%) of cases, 22 (55%) of which were malignant, with lavage/washing positive in 7 (23.3%), brush 10 (33.3%), forceps 13 (43.3%), linear EBUS 5 (16.7%) and pTBNA 22 (55%). pTBNA was exclusively diagnostic in 9 (22.5%) cases (5 lung cancers) with regards to the PL while in 1 of these cases linear EBUS of a mediastinal node was also diagnostic. CONCLUSIONS: In this case series of pTBNA sampling of PL with a new flexible device, pTBNA demonstrated the highest diagnostic yield over other sampling modalities, as well as providing the sole diagnostic sample in 22.5% of cases, although this was facilitated by on-site evaluation of specimens in many cases. No significant complications were noted. pTBNA should be considered as a primary sampling tool for PL. A novel needle device with the ability to pass through a small guide sheath or working channel (≥1.7mm) and with enough flexibility to access all pulmonary segments was effective and safe in this study.