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Pulmonology Procedures |

Intraoperative Autofluorescence Bronchoscopy Optimizes Pulmonary Resection

Jennifer Toth*, MD; Konstantin Zubelevitskiy, MD; Jussuf Kaifi, MD; Michael Reed, MD
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Penn State Milton S. Hershey Medical Center, Hershey, PA


Chest. 2012;142(4_MeetingAbstracts):922A. doi:10.1378/chest.1384724
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Abstract

SESSION TYPE: Bronchoscopy and Interventional Procedures Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Effective pulmonary resection for malignancy requires a negative surgical margin. Direct visualization of the airway remains essential for determining bronchial involvement. Autofluorescence (AF) bronchoscopy is a technique that relies on changes in native tissue reflectance of ultraviolet light as cells progress from normal to malignant. These changes are often invisible under white light, whereas they are seen as red rather than green with AF. We hypothesized that AF bronchoscopy would permit precise airway assessment, optimizing planning of pulmonary resection.

METHODS: Patients undergoing pulmonary resection for malignancy routinely have bronchoscopy. Here we performed airway examinations with white light and AF using the Xillix Onco-LIFE bronchoscope. Areas of abnormal AF were biopsied prior to resection. At surgery, bronchial margins were assessed by frozen section. For a 6-month period we identified patients whose AF study impacted surgical planning. We reviewed demographics, staging, bronchoscopy and operative reports, pathology, and outcomes.

RESULTS: 8 of 31 patients (26%) undergoing pulmonary resection had AF bronchoscopy findings that impacted surgical planning. All predicted negative margins by AF were verified to be negative on frozen section and final pathology. All had complete (R0) resections. AF demonstrated that parenchymal-sparing operations were appropriate in 4 patients; in 2 resectability was proven; 1 with suspicious mucosa at the lobar orifice was shown resectable via VATS lobectomy; and 1 who had neoadjuvant therapy for a hilar tumor with N2 disease was deemed technically appropriate for lobectomy. Predictably, AF impacted surgical planning for central tumors: adenoid cystic carcinoma, squamous cell carcinoma, and carcinoid. There were no operative deaths.

CONCLUSIONS: AF bronchoscopy optimizes airway assessment prior to pulmonary resection. This technique may precisely determine the ideal bronchial transection site, limiting the number of airway resections and frozen sections to achieve a negative margin. It may demonstrate that patients originally deemed unresectable can indeed undergo surgery. It is effective for defining the extent of bronchial disease, allowing parenchymal-sparing procedures.

CLINICAL IMPLICATIONS: Thoracic surgical and interventional pulmonology programs that provide advanced lung cancer care might consider utilizing AF bronchoscopy when planning pulmonary resection for malignancy.

DISCLOSURE: The following authors have nothing to disclose: Jennifer Toth, Konstantin Zubelevitskiy, Jussuf Kaifi, Michael Reed

No Product/Research Disclosure Information

Penn State Milton S. Hershey Medical Center, Hershey, PA

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