Video-assisted thoracoscopic biopsy is feasible and safe in adult haemato-oncology patients undergoing stem cell transplantation or high-dose chemotherapy

Ref ID: 18616

Author:

M.M. Ceesay (1), L. Berry (1), S. Desai (1), M. Marrinan (1),
R. Deshpande (1), D. Whitaker (1), S. Pomplun (1), A. Nicholson (2),
H. Sikondari (1), J. Wade (1), M. Smith (1), G. Mufti (1),
A. Pagliuca (1)

Author address:

(1)King’s College Hospital (London, UK); (2)Royal Brompton
Hospital (London, UK)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Objectives: Invasive Aspergillosis (IA) is a serious but diffi cult
diagnosis in patients undergoing high dose chemotherapy or
haematopoietic stem cell transplantation (HSCT). For clinical
trials the European Organization for Research and Treatment
(EORTC) revised criteria is a useful diagnostic tool but there
is little data on its usefulness in clinical practice. We set up
an observational prospective cohort study in order improve our
diagnostic and management strategies using the EORTC/MSG
criteria as a diagnostic tool. Here we looked at the feasibility
and safety of tissue diagnosis using video-assisted thoracoscopic (VATS) biopsy in patients with suspected IA.
Methods: All study patients were prospectively recruited and
followed up for149;4 months after chemotherapy or HSCT. During
inpatient admission twice weekly serodiagnostic surveillance
was performed and neutropenic sepsis unresponsive to secondline antimicrobials triggered diagnostic work up for IA including
computerised tomography (CT). Patients with suspected lesions
on CT were referred for VATS biopsy. Thirty one patients underwent biopsy between 26/3/2009 and 26/11/2010.
Results: A total of 38 biopsies was performed on 31 patients.
One was excluded due to lack of histology. The median age
was 34 years (range 21-73y) with equal male/female ratio and
the median (range) follow-up was 205 (115-476) days. Fifteen patients (49%) had myeloid malignancies, 10 (32%) had
lymphoid malignancies and 6 (19%) had aplastic anaemia. At
the time of biopsy the treatment received was none in 1 (3%),
immunosuppressive therapy in 4 (11%), chemotherapy in 9
(24%), autologous HSCT in 5 (13%), and allogeneic HSCT in
18 (49%). The median (range) pre-biopsy parameters were:
platelets 120 (45-399), haemoglobin 9.5 (6.9-13.1) and neutrophils 1.4 (0.02-7.35). The biopsy was a VATS procedure in
32 (86%) cases and 4 of these involved pre-surgical CT-guided
methylene blue targeting. The results of the biopsy was helpful
in 14 (38%) where IA was proven in 4 cases while in 12 others
an alternative diagnosis was made. In the remaining 23 cases
non-specifi c infl ammatory features were present in 20 and technical diffi culties in 3 resulted in failed biopsies. The procedure
was well tolerated in all patients with no mortality and limited
morbidity (pain and minor pneumothorax) and no bleeding.
Conclusion: VATS biopsy is a safe and useful diagnostic tool
which could help guide clinical decision making and reduce
unnecessary treatment.

Abstract Number: P775

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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