King’s College Hospital, London, UK VIDEO-ASSISTED THORACOSCOPIC (VATS) BIOPSY IS FEASIBLE AND SAFE IN ADULT HAEMATO-ONCOLOGY PATIENTS UNDERGOING STEM CELL TRANSPLANTATION OR HIGH DOSE CHEMOTHERAPY M M Ceesay1, L Berry1, S D Desai2, M Marrinan3, R Deshpande3, D Whitaker3, S Pomplun4, A G Nicholdson7, H Sikondari1, J Wade5, M Smith6, G J Mufti1, A Pagliuca1 1Department of Haematological Medicine, 2Radiology, 3Cardio-thoracic surgery, 4Histopathology, 5Microbiology, 6Virology King’s College Hospital, London, UK Background Adverse events Pneumothorax: 37 (100%) Pneumothorax requiring treatment: none Pleural effusion- mild/moderate: 6 (16%) Haemorrhage requiring treatment: none Pain -moderately severe: 5 (14%) Long term complications: none Mortality: None Chest tube was inserted in theatre in all patients and removed within 48 h in 90%. The primary haematological diagnosis and treatments are shown in Figure 2 and 3 below: Invasive Fungal Disease (IFD), in particular invasive Aspergillosis (IA) is an important cause of morbidity and mortality in haemato-oncology patients undergoing haematopoietic stem cell transplantation (HSCT) or chemotherapy. However, the diagnosis is quite challenging and empiric therapy is common. The revised EORTC/MSG criteria is used as a diagnostic tool in clinical trials but there is little data about its usefulness in real clinical practice. We set up a prospective cohort study to improve the diagnosis and management of IFI including tissue diagnosis. Biopsy study aim Assess the feasibility and safety of tissue diagnosis, especially video-assisted thoracoscopic biopsy (VATS) in the study population Figure 2: Primary diagnosis Conclusion Results Study population Figure 1 shows the study schema. Of the 203 patients enrolled onto the Aspergillosis study there were 65 potential biopsies. Thirty eight biopsies (58%) were performed. One biopsy was excluded due to loss of biopsy material. For this study 37 biopsies were analysed on 31 patients [17 male, 14 female; median age 43y (range 21-730). The patients were followed up for a median 205 days (range 115-476). Surgical biopsy especially using the VATS procedure in immunocompromised patients is feasible and safe. Pre-operative optimization of haematological indices especially haemoglobin, platelets and clotting is crucial It is a powerful tool in clinical decision-making both for confirmation and exclusion CT scanning remains a useful clinical tool but it is non-specific Figure 3: Primary treatment Pre-operative haematological indices Hb 9.5 (6.9-13.1) g/dl Neutrophils 1.5 (0.02-7.35) x109/L Platelets 119 (41-399) x109/L INR <1.5 The vast majority (86%) of biopsies were done using the VATS procedure. The 2 extrapulmonary biopsies were of the hard palate. The histology was reviewed by 2 experienced histopathologists and the results are shown below. Methods References Neutropenic sepsis unresponsive to second-line antibiotics triggered a diagnostic work-up including a continuous volume acquisition CT. Patients with suspected lesions were referred for biopsy between March 2009 and November 2010. To increase the pre-operative localization of small indeterminate lesions 0.3-0.5 ml methylene blue was injected under CT guidance into the area forming a tract for the surgeon. De Pauw B, et al. Revised definitions of invasive fungal disease from the EORTC/MSG Consensus Group. Clin Infect Dis 2008;46:1813-21. This study is supported by an educational grant from Pfizer and Gilead Sciences Figure 1: Study population