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Outcomes of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy using guide sheath and the target fixing technique

Tue, 31 Dec 2024 15:00:00 GMT

Title: Outcomes of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy using guide sheath and the target fixing technique Author(s): Taehun Kim; Seong Hwan Youn; Mi-Ae Kim; Hyun Jung Kim; Yongshik Kwon; Jae Seok Park; Sun Hyo Park Abstract: Background: The need to obtain high-quality samples from lung nodule suspected malignancy is continuing to rise. This study aimed to evaluate the diagnostic yield of radial probe endobronchial ultrasound-guided transbronchial lung cryobiopsy (RP-EBUS-TBLC) using guide sheath (GS) for lung lesions suspected of malignancy on computed tomography (CT). Methods: This retrospective observational study included patients who underwent RP-EBUS-TBLC using GS between January 2023 and April 2025 in South Korea. We introduced Dohyun’s method (a target-fixing technique) used to overcome the respiratory gating of the target during semi-real-time biopsy. After identifying the target lesion, the bronchoscope was inserted and fixed within the segment; the position was maintained while RP-EBUS was withdrawn, and the lesion stability during respiration was confirmed. Results: The final inclusion of 120 patients was analyzed. After the exclusion of patients with an indeterminate diagnosis, the final diagnostic yield was 94.8% (90.8% to 95.0% considering indeterminate diagnosis). The sensitivity and specificity were 93.7% and 100.0%, respectively. Pneumothorax occurred in 5.0% (6/120) of patients. Grade 3 or higher bleeding was observed in two patients, and a Fogarty balloon catheter was preemptively used in five patients at the operator’s discretion. In the multivariate logistic regression, the CT-bronchus sign emerged as the only significant factor associated with pathological confirmation. However, lesion size, eccentricity, and lower lung distribution were not significantly associated. Conclusions: RP-EBUS-TBLC using GS demonstrated high diagnostic yield and acceptable safety for the diagnosis of lung lesions. Dohyun’s method may facilitate continuous targeting of lesions during semi-real-time biopsy, particularly in cases where respiratory motion and non-within-RP-EBUS target lesions present challenges.

Adjuvant chemotherapy before osimertinib in EGFR-mutated stage IB lung adenocarcinoma: a clinical dilemma

Tue, 31 Dec 2024 15:00:00 GMT

Title: Adjuvant chemotherapy before osimertinib in EGFR-mutated stage IB lung adenocarcinoma: a clinical dilemma Author(s): Sun Hyo Park; Jin Han Park; Tae Hun Kim; Sun Ha Choi; Ji Eun Park; Insu Kim; Ji Yeon Kim; Tae Hoon Kim; Taehoon Lee; Hyun Kyu Cho; Jong Hwan Jeong; Jung Wook Yang; Hyun-Kyung Lee; Ho Young Lee; Ho Jin Jung; Jung Seop Eom; June Hong Ahn Abstract: Background: The ADAURA trial demonstrated the efficacy of adjuvant osimertinib in patients with resected, early-stage, epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). However, the role of adjuvant chemotherapy followed by osimertinib for patients with high-risk, EGFR-mutant stage IB (<4 cm) adenocarcinoma remains unclear. The aim of this study is to evaluate the efficacy of adjuvant chemotherapy in these patients. Methods: This retrospective study analyzed the medical records of patients with pathologic stage IB (T2aN0M0, <4 cm) EGFR-mutant adenocarcinoma of the lung who had high-risk factors and underwent surgical resection between January 2010 and January 2017. We evaluated the clinical impact of adjuvant chemotherapy and analyzed risk factors associated with recurrence-free survival (RFS) and overall survival (OS). Results: Of the 178 patients, 42 (23.6%) and 136 (76.4%) were in the adjuvant chemotherapy and non-adjuvant chemotherapy groups, respectively. Median RFS was 55 and 97 months in the adjuvant chemotherapy and non-adjuvant chemotherapy groups, respectively (P=0.22). Notably, 2-, 5-, and 10-year RFS rates were 71.4%, 49.9%, and 35.7% for the adjuvant chemotherapy group and 78.9%, 57.3%, and 49.9% for the non-adjuvant chemotherapy group, respectively. Multivariate analysis identified age ≥60 years, lymphovascular invasion, and micropapillary/solid predominant patterns as independent predictors of recurrence. Conversely, overweight patients (body mass index ≥25 kg/m2) had a lower risk of recurrence. Median OS was 134 and 145 months in the adjuvant chemotherapy and non-adjuvant chemotherapy groups, respectively (P=0.84). Multivariate analysis identified age ≥60 years and micropapillary/solid predominant patterns as independent predictors of OS. Conclusions: The efficacy of adjuvant chemotherapy in patients with stage IB (<4 cm) EGFR-mutant adenocarcinoma and high-risk features remains uncertain.

Response to the letter to the editor regarding "role of bariatric surgery in patients with advanced heart failure"

Tue, 31 Dec 2024 15:00:00 GMT

Title: Response to the letter to the editor regarding "role of bariatric surgery in patients with advanced heart failure" Author(s): Darae Kim; In-Cheol Kim; Jong-Chan Youn; Jon A Kobashigawa

Plaque vulnerability and thrombus formation according to area stenosis in chronic stable angina

Tue, 31 Dec 2024 15:00:00 GMT

Title: Plaque vulnerability and thrombus formation according to area stenosis in chronic stable angina Author(s): Eun-Seok Shin; Jun-Hyok Oh; Chang-Wook Nam; Bon-Kwon Koo Abstract: The relationship between luminal stenosis severity and plaque vulnerability in chronic stable angina (CSA) is not well studied. This study aimed to investigate the link between stenosis severity, plaque characteristics, and thrombus prevalence in CSA patients using optical coherence tomography. The 174 lesions (146 patients) with CSA divided into three groups according to the percentage of area stenosis (AS); group A (AS < 50%), group B (50% ≤ AS < 70%), and group C (AS ≥ 70%). Twenty-four lesions of group A, 51 lesions of group B, and 99 lesions from group C were studied. The prevalence of thrombus was 19.0% and it was significantly different among the three groups (none in group A vs. 17.6% in group B vs. 24.2% in group C; P = 0.024). The more severe the luminal narrowing, the more thrombus occurred, with a higher prevalence at the minimal lumen area site. Additionally greater the area stenosis, the higher the prevalence of lipid-rich plaque, thin cap plaque, macrophage infiltration, and ruptured plaque. In the multivariate analysis, thrombus was independently associated with ruptured plaque (OR = 20.96, CI 8.40–57.69, P < 0.001), macrophage infiltration (OR = 3.77, CI 1.53–10.72, P = 0.007), lipid angle (OR = 1.01, CI 1.00–1.01, P = 0.004), and area stenosis (OR = 1.05, CI 1.02–1.10, P = 0.002). In patients with CSA, the prevalence of thrombus, as assessed by OCT, is not uncommon. Plaque vulnerability, including thrombus occurrence, increased with the severity of area stenosis and was more prevalent at the minimal lumen site exposed to high shear stress.