Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION FIVE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
Session 5: Smoking / Lung Cancer
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
5
SESSION
SESSION FIVE ONE
5.1
A study to compare the efficiency of sterile talc, tetracycline
and bleomycin as sclerosing agents for medical pluerodesis
in the treatment of malignant pleural effusions
Background
Malignant pleural effusion is a common
complication of metastatic disease.Particularly
lung cancer, that is often managed by drainage
and medical pleurodesis. Sterile talc, tetracycline,
and bleomycin have all been shown to be effective
sclerosants. No randomized clinical trial has
directly compared all three agents in the medical
management of malignant pleural effusion.
Methods
A prospective, randomised trial was carried out across
multiple sites between September 2001 and August
2005. After complete drainage with symptom relief,
patients with confirmed malignant pleural effusions,
were allocated to receive intrapleural sterile talc (5g),
tetracycline (1500mg) or bleomycin (60mg). Exclusion
criteria included WHO performance status >2, small
cell cancers and leukaemias. Primary outcome was
response rate evaluated by radiographic improvement
at one month after pleurodesis.
Results
Seventy patients were enrolled in the study; six
patients were withdrawn before pleurodesis.
Demographics and pleural fluid characteristics were
comparable across all three groups. One patient
randomised to talc experienced adult respiratory
distress syndrome (ARDS).
There was no significant difference in response rates
between sclerosants. While there was a significantly
higher CRP response to pleurodesis in the talc group,
this was not associated with an improved response
rate at one month.
Conclusion
There was no difference in the efficacy of sterile talc,
tetracycline and bleomycin as sclerosant agents
in the medical management of malignant pleural
effusions.
TALC TETRACYCLINE BLEOMYCIN P-VALUES
N 23 19 22
CXR response at one month 79% 77% 88% ns
Mean ΔCRP mg/L
(Pre to Day 3 post pleurodesis)
+156 +63 +43
Talc:Tet, 0.023,
Talc:Bleo, 0.004
Tet: Bleo, 0.455
MT Henry, 1 B Ladd, 1
J Tuggey, 1 C Bowker, 1
AG Arnold, 2
1. Dept of Respiratory
Medicine, Leeds
General Infirmary,
Leeds, UK
2. Castle Hill Hospital,
East Yorkshire, UK
5.3
material in 58.1% of all patients (68.8% of Group
A and 46.3% of Group B). It was the only positive
procedure in 11.6% (11.1% of Group A and 12.2%
of Group B). A cytopathologist attended 51.2% of
procedures, resulting in a diagnostic TBNA in 63.6%.
In comparison, TBNA was diagnostic in 42.8% when
ROSE was not performed (p=0.053).
Conclusions
The results suggest that central TBNA compliments
other diagnostic techniques in evaluation of the
visualized portion of the endobronchial tree, and may
improve diagnostic yield. This appears to be further
enhanced by ROSE.
Diagnostic yield of fluoroscopic-guided transbronchial
needle aspiration of peripheral pulmonary lesions
Introduction
Peripheral pulmonary lesions which are not visible
within the endobronchial tree usually require
radiological or surgical techniques to provide tissue
diagnosis. The role of transbronchial needle aspirate
(TBNA) in central lesions is well documented.
However it is not routinely utilized as part of the
evaluation of peripheral lesions.
Method
We carried out a retrospective analysis of all
patients over a two-year period in whom TBNA
was performed as part of the diagnostic work-up
of peripheral pulmonary lesions. We compared the
overall yield of TBNA when rapid on-site cytologic
evaluation (ROSE) was available with that when a
cytopathologist was not available. We also compared
the diagnostic yield of TBNA with that of BAL and
transbronchial biopsy (TBBx) in those patients who
had all 3 tests performed and had a final diagnosis of
malignancy.
Results
Of 146 patients in whom TBNA was perfomed, 143
were available for analysis. Mean age was 66 years.
A cytopathologist attended for 60% of all procedures
resulting in a diagnositic TBNA in 50.4%. In
comparison, only 25.9% of TBNAs yielded a diagnosis
when ROSE was not performed (p=0.003).
Malignancy was confirmed in 56 patients by a
combination of TBNA, TBBx and BAL. TBNA was
positive for malignancy in 43 (76.8%) of cases, and
was the only positive diagnostic procedure in 12
(21.4%). TBBx was positive in 36 (64.3%) and was the
only positive procedure in 10 (17.9%). BAL was positive
in 19 (33.9%) but was the only positive procedure in
only 2 cases (3.6%).
Conclusions
The addition of fluoroscopic-guided TBNA to BAL and
TBBx enhances the diagnostic yield of bronchoscopy
in peripheral lung cancer. This appears to be further
enhanced by ROSE.
D Breen, D O’Callaghan,
B Kent, S Nicholson,
J Keane, F O’Connell
Dept of Respiratory
Medicine and
Histopathology,
St James’s Hospital,
Dublin
5.2
Med. Survival (days) 96 102 201 ns
Diagnostic usefulness of central transbronchial needle
aspirate
Introduction
Central transbronchial needle aspiration (TBNA) is an
established tool for sampling the visualized portion
of the endobronchial tree. This may compliment
other conventional diagnostic techniques routinely
used at bronchoscopy, including airway lavage,
brushings and biopsy.
Method
We carried out a review of all patients over a twoyear
period in whom central TBNA was performed as
part of their diagnostic work-up. We also compared
the overall yield of TBNA when rapid on-site cytologic
evaluation (ROSE) was available with that when a
cytopathologist was not available.
Results
Central TBNA was carried out in 86 patients. Average
age was 64.1 years. An endobronchial abnormality
[Group A] was noted in 45 (52.3%) and the airways
were entirely normal [Group B] in 41 (47.7%).
Specimens obtained by TBNA contained diagnostic
D O’Callaghan, D Breen,
B Kent, S Nicholson,
J Keane, F O’Connell
Dept of Respiratory
Medicine, CResT
Directorate, St James’s
Hospital, Dublin
5.4
The Irish workplace smoking ban; an analysis of the
exposure levels in Dublin bars
Introduction
On the 29 th March 2004, the Irish Government
introduced legislation prohibiting the consumption
of tobacco products in most workplaces.
Controversially, the ban applied to the hospitality
industry, including licensed premises. The time
prior and subsequent to the introduction of the ban
provided an opportunity to assess the exposure
levels of particulates and benzene in Dublin pubs,
and the effectiveness of the new legislation at
protecting workers and patrons from unnecessary
exposure to Environmental Tobacco Smoke
Method
Particulate levels (PM2.5 and PM10) were measured
in 43 pubs, prior and subsequent to the introduction
of the smoking ban, using a light scattering optical
based instrument (Aerocet 531). For consistency
purposes, repeat measurements were conducted
on the same day of the week, and the same month,
one year later from the original measurements.
Simultaneously, benzene levels were monitored
using passive benzene badges incorporating an
activated carbon absorption element. In each public
house, the benzene sampler was co-located with
the AEROCET monitor, as near as possible to the
breathing zone.
M McCaffrey, 1
PG Goodman, 2
L Clancy 3
1. Dublin City Council
2. Dublin Institute of
Technology,
3. Research Institute
for a Tobacco Free
Society
50 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3
IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 51