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The eXcelon Transbronchial Aspiration Needle: Assessing Safety and Diagnostic Yield for Use with Radial Ultrasound-Guided Peripheral Lung Lesion Sampling
Description
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A7311 - The eXcelon Transbronchial Aspiration Needle: Assessing Safety and Diagnostic Yield for Use with Radial Ultrasound-Guided Peripheral Lung Lesion Sampling
Author Block: P. H. Hanneman, K. J. Diab; Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
Background
The eXcelon Transbronchial Aspiration Needle (Boston Scientific, Boston, MA, USA) is commercialized for use in the sampling of carinal, paratracheal, and hilar lesions not amenable to forceps biopsy. Its prospective validity and reliability in mediastinal-hilar diagnosis and staging has been studied previously. However, its safety and diagnostic yield when used in conjunction with radial ultrasound-guided lung lesion sampling is unknown.
Methods
We performed a chart review of seven patients with a known lung mass who underwent radial ultrasound-guided fine needle aspiration (FNA) using either a 19-gauge (1) or 21-gauge (6) eXcelon needle passed through an ultrasound sheath between April 2017 and September 2017. This was complemented by transbronchial forceps sampling through the radial ultrasound sheath during the same procedure. The procedure was performed by the same pulmonologist at a single institution with the availability of rapid on-site cytologic evaluation. Five of the seven patients were former or active smokers. The laterality of the masses was right-sided in 4/7 cases and left-sided in 3/7 cases. The smallest mass sampled was 2.8 cm x 3.6 cm, and the largest mass sampled was 9.7 cm x 8.7 cm. Outcomes assessed were diagnostic yield of FNA and post-procedure complications to the patient and/or equipment.
Results
Pathologic diagnosis of malignancy was confirmed in 3/7 cases via eXcelon FNA sampling alone. Hypocellular samples were obtained in 3/7 of cases but, utilizing transbronchial forceps sampling through the radial ultrasound sheath, organizing pneumonia was diagnosed in two cases and radiation fibrosis was diagnosed in another case. This resulted in a positive diagnostic yield in 6 of 7 cases. There were no cases of post-procedural pneumothorax as verified by plain radiography. None of the patients developed clinically significant hemoptysis requiring inpatient observation. Lastly, there was no identified damage to either the ultrasound sheath or the bronchoscope using these methods.
Conclusions
The results from our center indicate that introducing the eXcelon needle through a radial ultrasound sheath for FNA may achieve a high diagnostic yield, particularly when used in combination with transbronchial biopsies, and with an acceptably low risk of complications to both the patient and the bronchoscope. Further randomized studies comparing the eXcelon needle to conventional methods of transbronchial biopsy are indicated.
Author Block: P. H. Hanneman, K. J. Diab; Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
Background
The eXcelon Transbronchial Aspiration Needle (Boston Scientific, Boston, MA, USA) is commercialized for use in the sampling of carinal, paratracheal, and hilar lesions not amenable to forceps biopsy. Its prospective validity and reliability in mediastinal-hilar diagnosis and staging has been studied previously. However, its safety and diagnostic yield when used in conjunction with radial ultrasound-guided lung lesion sampling is unknown.
Methods
We performed a chart review of seven patients with a known lung mass who underwent radial ultrasound-guided fine needle aspiration (FNA) using either a 19-gauge (1) or 21-gauge (6) eXcelon needle passed through an ultrasound sheath between April 2017 and September 2017. This was complemented by transbronchial forceps sampling through the radial ultrasound sheath during the same procedure. The procedure was performed by the same pulmonologist at a single institution with the availability of rapid on-site cytologic evaluation. Five of the seven patients were former or active smokers. The laterality of the masses was right-sided in 4/7 cases and left-sided in 3/7 cases. The smallest mass sampled was 2.8 cm x 3.6 cm, and the largest mass sampled was 9.7 cm x 8.7 cm. Outcomes assessed were diagnostic yield of FNA and post-procedure complications to the patient and/or equipment.
Results
Pathologic diagnosis of malignancy was confirmed in 3/7 cases via eXcelon FNA sampling alone. Hypocellular samples were obtained in 3/7 of cases but, utilizing transbronchial forceps sampling through the radial ultrasound sheath, organizing pneumonia was diagnosed in two cases and radiation fibrosis was diagnosed in another case. This resulted in a positive diagnostic yield in 6 of 7 cases. There were no cases of post-procedural pneumothorax as verified by plain radiography. None of the patients developed clinically significant hemoptysis requiring inpatient observation. Lastly, there was no identified damage to either the ultrasound sheath or the bronchoscope using these methods.
Conclusions
The results from our center indicate that introducing the eXcelon needle through a radial ultrasound sheath for FNA may achieve a high diagnostic yield, particularly when used in combination with transbronchial biopsies, and with an acceptably low risk of complications to both the patient and the bronchoscope. Further randomized studies comparing the eXcelon needle to conventional methods of transbronchial biopsy are indicated.
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