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Transplantation |

Usefulness of Advanced Diagnostic Bronchoscopic Techniques Among Lung Transplant Recipients With Pulmonary Nodules

Gustavo Cumbo-Nacheli*, MD; Marie Budev, MD; Michael Machuzak, MD; Thomas Gildea, MD
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Cleveland Clinic, Cleveland, OH


Chest. 2012;142(4_MeetingAbstracts):1092A. doi:10.1378/chest.1390124
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Abstract

SESSION TYPE: Lung Transplantation

PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM

PURPOSE: To assess usefulness of Endobronchial Ultrasound (EBUS) and Electromagnetic Navigation (EMN) among lung transplant patients with pulmonary nodules.

METHODS: We identified patients that underwent lung transplantation at our institution, and presented with a new lung nodule from January 2009 to January 2012. We included patients in which EMN and/or EBUS was used in order to establish the etiology of each lung nodule. We describe the diagnostic yield of these advanced diagnostic modalities, pathology reports, and compared results with autopsy information, when available.

RESULTS: Twelve patients (age: 58 (± 10) years, females: 7) presented with lung nodules after pulmonary transplantation. These nodules were evident after a mean (±SD) of 17 (± 7) months. Eight lung transplants were bilateral. Twelve nodules were visualized on chest tomogram; six of these were identified in transplanted lungs, whereas six nodules were identified in native lungs. Five patients had mediastinal lymphadenopathy at the time of diagnosis. Bronchoscopy with linear EBUS was used in five patients, radial EBUS was used in eight patients. In six patients with peripheral lesions, EMN was used to localize and perform biopsies. Combined, these diagnostic modalities accurately detected etiologies in 9/12 (75%) of these nodules (6 focal pneumonias, and 3 neoplasms). These advanced bronchoscopic techniques were not able to define an etiology for nodules due to post-transplant lymphoproliferative disorder (PTLD) on 3 patients. These nodules were diagnosed at the time of autopsy.

CONCLUSIONS: Advanced bronchoscopic techniques appear to aid in the diagnosis of lung nodules, although the true value of such approach remains uncertain. Patients with PTLD were not able to be diagnosed with the use of advanced bronchoscopic techniques. Further work in this patient population is encouraged in order to elucidate improved diagnostic approaches.

CLINICAL IMPLICATIONS: The use of advanced bronchoscopic techniques in the diagnosis of lung nodules among lung transplant patients may be most useful when an infectious or a neoplastic etiology is suspected. The acquisition of a representative sample for the diagnosis of PTLD continues to pose a challenge for the bronchoscopist.

DISCLOSURE: The following authors have nothing to disclose: Gustavo Cumbo-Nacheli, Marie Budev, Michael Machuzak, Thomas Gildea

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Cleveland Clinic, Cleveland, OH

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