ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Diagnostic Yield After Clinical and Radiologic Follow-Up of Biopsy with Virtual Bronchoscopic Navigation (VBN) for Pulmonary Nodules in Patients with High Rates of Advanced Lung Disease
Session Title
TP46 - TP046 INVESTIGATIONS IN INTERVENTIONAL PULMONOLOGY AND PLEURAL DISEASE
Abstract
A2422 - Diagnostic Yield After Clinical and Radiologic Follow-Up of Biopsy with Virtual Bronchoscopic Navigation (VBN) for Pulmonary Nodules in Patients with High Rates of Advanced Lung Disease
Author Block: R. M. Marron1, S. Verga2, C. Veselis3, H. Zhao1, G. J. Criner2; 1Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, United States, 2Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States, 3Radiology, Lewis Katz School of Medicine, Philadelphia, PA, United States.
Rationale: Patients with advanced lung disease may present with pulmonary nodules that require a biopsy. Transthoracic needle biopsy (TTNB) has a higher complication rate than biopsy via virtual bronchoscopic navigation (VBN), which is an important factor in patients with advanced lung disease. The diagnostic yield of VBN in this group in whom the risks of TTNB are unacceptable is uncertain. We report the diagnostic yield of nodules biopsied with VBN in patients with high rates of advanced lung disease after clinical and radiologic follow-up.Methods: VBN was used in 96 patients to biopsy 110 pulmonary nodules. Pulmonary function testing (PFT), 6-minute walk distance, and radiographic evidence of emphysema or interstitial lung diseases (ILD) were gathered. Follow-up radiographic and clinical data was gathered on patients with benign or non-diagnostic biopsy diagnoses to determine the diagnostic yield. Statistical analysis with chi-square and t-testing was performed to determine the impact of the collected clinical factors on diagnostic yield to determine results in our cohort with high rates of advanced lung disease.Results: Ninety-six patients with 110 nodules underwent VBN. Our analysis for diagnostic yield is of 80 patients- 23 that were diagnosed with malignancy at the time of the bronchoscopy as well as 57 with initially benign/non-specific diagnoses that had clinical follow-up (16 patients were lost to follow-up). Of the 57 with initial benign/non-specific diagnoses 23 were later found to have malignancy and were therefore “false-negatives.” The overall diagnostic yield was 71.3%. For the group the mean forced expiratory volume in 1-second (FEV1) was 61% predicted (SD 25), residual volume was 129% predicted (SD 62), diffusing capacity for carbon monoxide (DLCO) was 48% predicted (SD20). Seventy-four patients (93%) had radiographic emphysema with 60% having moderate-severe emphysema. Fourteen patients (17.5%) had radiographic ILD. Twenty-five patients (31%) were on supplemental oxygen. None of these factors led to significantly different rates of diagnostic yield. There was a statistically significant difference in diagnostic yield with regards to 6-minute walk distance- with a lower walk-distance in those with false-negative diagnoses (245 meters, SD 88) than in those with correct diagnoses (296 meters, SD 76) (p=0.039).Conclusion. In a cohort with high burden of advanced lung disease the presence of hypoxemia, emphysema, ILD, and chronic hypoxemia did not affect the diagnostic yield of VBN for pulmonary nodules after clinical and radiographic follow-up. Those with false-negative biopsies did have a significantly lower 6-minute walk distance than those with accurate diagnoses.
Author Block: R. M. Marron1, S. Verga2, C. Veselis3, H. Zhao1, G. J. Criner2; 1Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, United States, 2Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States, 3Radiology, Lewis Katz School of Medicine, Philadelphia, PA, United States.
Rationale: Patients with advanced lung disease may present with pulmonary nodules that require a biopsy. Transthoracic needle biopsy (TTNB) has a higher complication rate than biopsy via virtual bronchoscopic navigation (VBN), which is an important factor in patients with advanced lung disease. The diagnostic yield of VBN in this group in whom the risks of TTNB are unacceptable is uncertain. We report the diagnostic yield of nodules biopsied with VBN in patients with high rates of advanced lung disease after clinical and radiologic follow-up.Methods: VBN was used in 96 patients to biopsy 110 pulmonary nodules. Pulmonary function testing (PFT), 6-minute walk distance, and radiographic evidence of emphysema or interstitial lung diseases (ILD) were gathered. Follow-up radiographic and clinical data was gathered on patients with benign or non-diagnostic biopsy diagnoses to determine the diagnostic yield. Statistical analysis with chi-square and t-testing was performed to determine the impact of the collected clinical factors on diagnostic yield to determine results in our cohort with high rates of advanced lung disease.Results: Ninety-six patients with 110 nodules underwent VBN. Our analysis for diagnostic yield is of 80 patients- 23 that were diagnosed with malignancy at the time of the bronchoscopy as well as 57 with initially benign/non-specific diagnoses that had clinical follow-up (16 patients were lost to follow-up). Of the 57 with initial benign/non-specific diagnoses 23 were later found to have malignancy and were therefore “false-negatives.” The overall diagnostic yield was 71.3%. For the group the mean forced expiratory volume in 1-second (FEV1) was 61% predicted (SD 25), residual volume was 129% predicted (SD 62), diffusing capacity for carbon monoxide (DLCO) was 48% predicted (SD20). Seventy-four patients (93%) had radiographic emphysema with 60% having moderate-severe emphysema. Fourteen patients (17.5%) had radiographic ILD. Twenty-five patients (31%) were on supplemental oxygen. None of these factors led to significantly different rates of diagnostic yield. There was a statistically significant difference in diagnostic yield with regards to 6-minute walk distance- with a lower walk-distance in those with false-negative diagnoses (245 meters, SD 88) than in those with correct diagnoses (296 meters, SD 76) (p=0.039).Conclusion. In a cohort with high burden of advanced lung disease the presence of hypoxemia, emphysema, ILD, and chronic hypoxemia did not affect the diagnostic yield of VBN for pulmonary nodules after clinical and radiographic follow-up. Those with false-negative biopsies did have a significantly lower 6-minute walk distance than those with accurate diagnoses.
