1. 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 ). The patients were followed up for a median 205 days (range ).
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 ( ) g/dl
Neutrophils 1.5 ( ) 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 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:
This study is supported by an educational grant from Pfizer and Gilead Sciences
Figure 1: Study population