Bawaadam, Hasnain

Abstract RATIONALE: As technology for biopsy of peripheral pulmonary nodules advances, the size of suspicious nodules referred for biopsy has decreased. This can be partly attributed to tools such as shape-sensing robotic-assisted bronchoscopy (ssRAB), which can increase the likelihood of a diagnostic result. Literature describing the biopsy of sub-centimeter nodules is primarily single center with a reported diagnostic yield for robotic bronchoscopy of 67%1, and 71%2 for CT-guided percutaneous biopsy; robust prospective multi-center data is needed to further understand the feasibility and clinical value of <1cm nodule biopsies. Herein, we report data from the prospective Ion Registry describing outcomes for patients with sub-centimeter nodules biopsied using ssRAB. METHODS: Patients with at least one (1) nodule <1cm that underwent ssRAB biopsy were identified from those enrolled in the Ion Registry. Subjects with multiple lesions were included if all nodules were <1cm in largest diameter. Nodule and procedure characteristics are reported with descriptive statistics; diagnostic yield was assessed using the ATS/ACCP recommended guidelines of index biopsy results only. Safety was assessed as the rate of pneumothorax requiring intervention and Nashville Grade ≥3 bleeding. RESULTS: Fifty-four (54) subjects and 57 sub-centimeter nodules were identified across 9 centers and 15 investigators; procedures were completed October 2023 through September 2024. The majority of nodules (47.4%) were incidental findings. Median nodule diameter was 8 mm (IQR: 7,9; range: 4.0-9.7 mm) with 66.7% of nodules located in the outer-third of the lung, and predominantly (57.9%) in the upper lobes. CT bronchus sign was present in 24.6% of nodules, and most (89.5%) nodule were solid. Median procedure time was 34.5 mins (IQR: 26,47; range: 9-89 mins); fixed or mobile CBCT was utilized for 80.7% (46/57) of nodules. The flexision biopsy needle and cryoprobe were used in 91% and 49% of biopsies, respectively. Diagnostic yield was 83% (45/54) using index biopsy results, 59% of which were malignant. No (0%) pneumothorax requiring intervention, Nashville Grade ≥3 bleeding events. CONCLUSION: Preliminary results from this prospective, multi-center registry cohort demonstrate peripheral nodules <1cm can be safely and effectively diagnosed through ssRAB biopsy and highlight the impact of ssRAB in enhancing lung nodule diagnosis, particularly when combined with CBCT. These findings suggest ssRAB may be considered a viable option for the biopsy of suspicious sub-centimeter nodules, further optimizing the management of patients with suspected lung cancer. REFERENCES:1. 10.1016/j.chest.2021.07.2169 2. https://doi.org/10.1016/j.clinimag.2020.04.040

Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare case of acute coronary artery dissection brought on by EGPA, which generally has a poor prognosis. A 41-year-old male with history of bronchial asthma presented to the emergency room with a 2-week history of dyspnea, cough with clear phlegm, and fever. For the past eight months he had experienced episodes with similar symptoms relieved by steroids. CT chest showed bilateral upper lobe patchy opacities with extensive workup for infectious etiology being negative. He had peripheral eosinophilia with sinusitis. He had acute coronary syndrome and Coronary angiogram showed Right coronary artery dissection. After making a diagnosis of EGPA based on American college of Rheumatology criteria, he was successfully treated with high dose immunosuppression. Coronary artery dissection is a fatal and uncommon complication of EGPA which is usually diagnosed postmortem. Early recognition of this condition ante mortem and aggressive treatment can be lifesaving as demonstrated in our case.

Obstructive sleep apnea (OSA) is a common disease with a high degree of association with and possible etiological factor for several cardiovascular diseases. Patients who are admitted to the Intensive Care Unit (ICU) are incredibly sick, have multiple co-morbidities, and are at substantial risk for mortality. A study of cardiovascular manifestations and disease processes in patients with OSA admitted to the ICU is very intriguing, and its impact is likely significant. Although much is known about these cardiovascular complications associated with OSA, there is still a paucity of high-quality evidence trying to establish causality between the two. Studies exploring the potential impact of therapeutic interventions, such as positive airway pressure therapy (PAP), on cardiovascular complications in ICU patients are also needed and should be encouraged. This study reviewed the literature currently available on this topic and potential future research directions of this clinically significant relationship between OSA and cardiovascular disease processes in the ICU and beyond.