Endobronchial Ultrasound Guided Transbronchial Needle Aspiration Of Mediastinal And Hilar Lymph Nodes- Five Years Of Experience At A Cancer Setting Hospital In Pakistan.

BACKGROUND: Endobronchial Ultrasound (EBUS) guided Transbronchial needle aspiration (TBNA) offers a minimally invasive diagnostic tool for mediastinal lymphadenopathy (ML). This study is done with the objective to determine the diagnostic utility of EBUS TBNA for ML in cancer and non-cancer patients. METHODS: This cross-sectional study, in which data was collected retrospectively included TBNA cytopathology and microbiology results of all patients who underwent EBUS at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore between July 2013 until July 2018. They were analysed to determine sensitivity and specificity of EBUS. RESULTS: Total 609 patients, comprising 362 (59%) male and 470 (77%) cancer patients were included. Mean age was 52±18 years. TBNA cytology was malignant in 118 (25%) cancer and 20 (14%) non-cancer patients. Percentage malignant ML was highest in small cell lung cancer (93%) among thoracic and renal cell carcinoma (35%) among extra thoracic cancers. Only 27% cancer patients with flourodeoxyglucose-18 avid ML had malignant cytology. Sarcoidosis was diagnosed in 115 (19%) patients (sensitivity 91%, specificity 97%) while tuberculosis in 76 (12%) (Sensitivity 87% and specificity 98%). Endobronchial Ultrasound changed management in 76% cancer patients via multidisciplinary meetings with no reported complications and estimated sensitivity and specificity of 98% and 100% respectively. CONCLUSIONS: Endobronchial Ultrasound is an accurate diagnostic tool for ML and can facilitate multidisciplinary cancer care.

Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases.

BACKGROUND: Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome. OBJECTIVE: To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD. METHODS: A cross-sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t-test was used to compare mean difference of clinical characteristics between pre- and post-airway stenting. Kaplan-Meier curves were used to assess overall survival. RESULTS: A total of 51 patients had stent insertion with mean age 46.63±17.10years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients, respectively. There was statistically significant mean difference in pre- and post-procedure oxygen saturation (mean (M)=89.8, standard deviation (SD)=6.70 vs M =95.5,SD=2.54.p =0.001) and performance status (M =3.65,SD =0.6 vs M =2.59, SD=0.83.p =0.001). Overall median survival was 16±3.44 weeks, highest amongst patients with intrinsic obstruction (27±6.51 weeks). CONCLUSION: Airway stenting is an effective endoscopic procedure to re-establish airway patency in MAD with minimal complications..