SESSION TITLE: EBUS and Advanced Bronchoscopy Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is currently the diagnostic modality of choice for mediastinal adenopathy and lung cancer staging. Melanoma primary or metastatic to lungs is rare and presents diagnostic and therapeutic challenges. The clinical utility of EBUS-TBNA for evaluation of metastatic melanoma to lungs is not well defined. The aim of our study is to assess if EBUS-TBNA sampling is adequate for morphological diagnosis and molecular DNA analysis of melanoma at our institution.
METHODS: A retrospective review of all patients who underwent EBUS-TBNA in the last five years and suspicious of recurrence of melanoma to the lung was performed. EBUS-TBNA procedure was performed as OPD under conscious sedation. The followings were collected: Age & gender, clinical history and presentation, primary site of origin, total no. of lymph nodes/mass biopsied, presence or absence of ROSE, final diagnosis and molecular analysis (including BRAF), clinical follow up.
RESULTS: Of the 1358 consecutive patients reviewed, we identified 7 patients who had EBUS-TBNA and had a diagnosis of melanoma; all were enrolled in this study. There were 5 men and 2 women with an average age of 60.3 years (± SD 11.4). 4/7 had metastatic melanoma, 1/7 had NSCLC and 2/7 had sarcoidosis. The primary site of origin of 4 metastatic melanoma lesions were foot, shoulder, back & scalp. One patient recurred after 18.5 years of the initial diagnosis and the average primary diagnosis time in the remaining 3 lesion was 9 years. Average biopsied lymph nodes station were two. ROSE was present in 2/4 cases; in all 4 patients IHC analysis performed was positive for S100, HMB45 & Melan A. One patient had BRAF mutation at time of his primary diagnosis, in the remaining 3 patients all had sufficient sample for BRAF gene mutations analysis (2/3 +ive). No serious post-procedural complications with EBUS were recorded. 4/4 patients are alive to date (mean follow-up 1 year).
CONCLUSIONS: We conclude that EBUS-TBNA can be performed satisfactorily for morphologic and immunohistochemical verification of the diagnosis as well as sufficient DNA analysis for BRAF testing.
CLINICAL IMPLICATIONS: Ebus can adequately sample for morphologic and immunohistochemical verification of the diagnosis as well as DNA testing in metatstatic melanoma.
DISCLOSURE: The following authors have nothing to disclose: Amir Khan, Carolina Carillo, William Geddie, Kazuhiro Yasufuku
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