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• W2894821626 abstract "SESSION TITLE: Lung Cancer 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Transbronchial lung cryobiopsy (TBLC) is an increasingly popular technique used to obtain lung specimens for pathologic evaluation. While several studies have reported the superiority of TBLC in obtaining specimens for diagnosis of diffuse lung disease, the technique is less studied in neoplastic disease. Here, we present two cases of adenocarcinoma in situ (AIS) diagnosed using specimens obtained through TBLC. CASE PRESENTATION: Case 1A 55-year-old male with a family history of lung cancer and personal history of smoking with possible multi-metal occupational exposure presented with two months of productive cough. The patient was diagnosed with left lung pneumonia by his primary care physician and treated with multiple courses of antibiotics without resolution. A CT chest was obtained, revealing large irregular regions of mass-like consolidation in the left upper lobe with numerous bilateral pulmonary nodules, extensive airspace disease, and multiple enlarged mediastinal lymph nodes. Pulmonary was consulted and TBLC of the left upper and lower lobes was performed. Biopsy results showed adenocarcinoma with lepidic-predominant features.Case 2A 60-year-old female with a 20-pack year history presented in the outpatient pulmonary clinic with a chronic cough for the past four months, associated with shortness of breath on exertion. A chest x-ray showed right upper lobe, right lower lobe, and perihilar nodular infiltrates. A CT chest was then performed, showing widespread bilateral predominantly nodular lung disease characterized by groundglass and cavitary nodules with a dense consolidation in the right upper lobe. TBLC of the right upper lobe was obtained and found to be adenocarcinoma, non-mucinous lepidic pattern. DISCUSSION: The diagnostic yield of transbronchial lung biopsy with conventional forceps technique has a sensitivity of 0.34 for lesions smaller than 2 cm in diameter and 0.63 for lesions larger than 2 cm. While surgical lung biopsy increases diagnostic yield, it is associated with increased complications. TBLC has been shown to provide larger pathology specimens with decreased crush artifact, allowing for improved pathologic evaluation. This increased diagnostic yield has been confirmed by meta-analyses for the diagnosis of interstitial lung disease. However, there is less published data confirming that this increased yield also applies to patients with neoplastic disease. These two cases presented here suggest that TBLC is also safe and effective in the diagnosis of AIS, showcasing the need for further research in this area. CONCLUSIONS: TBLC was safe and effective in obtaining an appropriate pathology specimen in two patients with AIS. Further research should be performed to confirm that the increased diagnostic yield of TBLC for interstitial lung disease is also applicable to neoplastic lung disease. Reference #1: Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta-analysis. Respirology. 2016;21(5):834–41. Reference #2: Johannson KA, Marcoux VS, Ronksley PE, Ryerson CJ. Diagnostic yield and complications of transbronchial lung cryobiopsy for interstitial lung disease: A systematic review and metaanalysis. Ann Am Thorac Soc. 2016;13(10):1828–38. Reference #3: Patricia Rivera M, Mehta AC. Initial Diagnosis of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007;132:131S–148S. DISCLOSURES: No relevant relationships by Andrew Astin, source=Web Response No relevant relationships by Ezmin George, source=Web Response No relevant relationships by Jeff Hon, source=Web Response No relevant relationships by Vikas Pathak, source=Web Response No relevant relationships by Christine Zhou, source=Web Response" @default.
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• W2894821626 date "2018-10-01" @default.
• W2894821626 modified "2023-09-25" @default.
• W2894821626 title "ROLE OF TRANSBRONCHIAL LUNG CRYOBIOPSY IN THE DIAGNOSIS OF ADENOCARCINOMA IN SITU" @default.
• W2894821626 doi "https://doi.org/10.1016/j.chest.2018.08.557" @default.
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