MONDAY, SEPTEMBER 9TH 2013

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1 Poster Discussion Room 3.3-4:45-6:45 MONDAY, SEPTEMBER 9TH Clinical problems in mediastinal and pleural malignancies P3069 Clinical, immunohistochemical and genetic analysis of 50 thymic epithelial tumours managed in Rennes University Hospital between 000 and 0 Mallorie Kerjouan, Stéphane Jouneau, Nisrine Choukeir, Dan Christian Chiforeanu, Alexandra Lespagnol 3, Marc-Antoine Belaud-Rotureau 4, Hervé Léna, Romain Corre, Benoit Desrues. Respiratory Department, Pontchaillou Rennes University Hospital, Rennes, France; Anatomy and Pathologic Cytology Department, Pontchaillou Rennes University Hospital, Rennes, France; 3 Molecular Genetic and Genomic Department, Pontchaillou Rennes University Hospital, Rennes, France; 4 Molecular Biology and Cytogenetic Department, Pontchaillou Rennes University Hospital, Rennes, France Background. Thymic epithelial tumours (TET) are rare and characterized by different evolution depending on histology and invasion stage. The therapeutic management is a subject of increasing interest. Aims. To analyse the clinical features of patients with TET and assess their management. To identify tumours biomarkers with a prognostic or a predictive interest. Methods. Adults with TET managed in Rennes University Hospital between 000 and 0 were selected. Their clinical and pathological features were retrospectively analysed. The expression of ERCC, VEGF, VEGFR, VEGFR and HER proteins was assessed by immunohistochemistry (IHC). Oncogenic mutations in PIK3CA, BRAF, NRAS, HER genes were analysed by pyrosequencing. EGFR and ALK amplification, and ALK gene rearrangement were evaluated by fluorescence in situ hybridization (FISH). Results. 50 TET were included, 46 thymomas and 4 thymic carcinomas. Their clinical, histological features, and their invasion stages were concordant with published studies. Therapeutic management was in accordance with current guidelines. 46 tumours were analysed by IHC. The expression of VEGF and VEGFR was significantly higher in thymic carcinomas compared to thymomas, and in invasive tumours for VEGF. For the first time, a NRAS mutation was described in a patient with B thymoma. The analysis of ALK gene, performed for the first time in TET, was negative, without amplification or rearrangement. Conclusion. Management of TET in our Centre was in accordance with guidelines. The analysis of angiogenesis may be interesting for the prognosis of these tumours. ALK gene might not be involved in TET biology. P3070 Thymoma: A retrospective analysis of 0 years in a cardiothoracic surgery department Claudia Lares dos Santos, Marta Sousa, Filipe Leite 3, João Bernardo 3, Lina Carvalho 4, Manuel Antunes 3. Pulmonology Department, Centro Hospitalar e Universitário De Coimbra - Hospital Geral, Coimbra, Portugal; Resident of Common Year, Centro Hospitalar e Universitário De Coimbra, Coimbra, Portugal; 3 Cardiothoracic Surgery Department, Centro Hospitalar e Universitário De Coimbra, Coimbra, Portugal; 4 Pathology Department, Centro Hospitalar e Universitário De Coimbra - Hospitais Da Universidade De Coimbra, Coimbra, Portugal Introduction: Thymoma is a rare tumor but is the most common neoplasm of anterior mediastinum. Not infrequently it is an incidental finding on routine imaging studies. Aims and Objectives: Characterize demographics, clinical presentation, radiology, histological and surgical classification and performed therapy in a population with thymoma. Evaluate survival at 5 and 0 years. Methods: This study was conducted in a cardiothoracic surgery department which covers an area of about one million and a half inhabitants. Medical records of patients diagnosed with thymoma between 993 and 0 were reviewed. Statistical analysis was performed with SPSS vs 7.0 for Windows. Results: We identified 07 patients, mean age years (min: ; max: 86), 53.3% males. Previous malignancy was reported in 4%. Good Syndrome, pure red cell aplasia or autoimmune thyroiditis were reported in 3,7%. About 7% had previously diagnosed myasthenia gravis. In 3.7% thymoma was an incidental finding. Most common symptoms were dyspnea (7.%), cough (.5%) and chest pain (0.6%). Constitutional symptoms were present in 8.0%. According to WHO pathologic classification, most frequent types were: AB (38.3%) and B (9.0%). According to Masaoka-Koga staging, most frequent stages were: I (5.3%) and IIA (3.7%). Neoadjuvant treatment was performed in.9%. Adjuvant treatment was offered in 5.%. Survival at 5 and 0 years was 9.0 % and 8.5%. Conclusion: Thymoma occurred in a wide spectrum of ages, without gender preference. Myasthenia gravis was frequent. Thymoma was an occasional finding in about /3 of the cases. Most frequent type and stage were AB (WHO) and I (Masaoka-Koga). Ten year survival exceeded 80%. P307 and adrenergic receptors are significantly under-expressed in malignant pleural mesothelioma Dimitrios Magouliotis, Vasiliki Tasiopoulou, Ioannis Lempesis, Rajesh Jagirdar, Evgeniy Solenov, Chrissi Hatzoglou, Paschalis-Adam Molyvdas, Konstantinos Gourgoulianis 3, Sotirios Zarogiannis,3. Department of Physiology, University of Thessaly Medical School, Larissa, Greece; Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation; 3 Department of Respiratory Medicine, University of Thessaly Medical School, Larissa, Greece Background: Up-regulation of the gene expression of beta adrenergic receptors has been reported in several malignancies. Their role has been implicated in tumor dissemination (cell proliferation and metastasis). Pharmacological manipulation of these properties, has been proposed as a potential therapeutic approach. Nevertheless, no information exist regarding their expression in malignant pleural mesothelioma (MPM). Aims: Our aim was to investigate the gene expression levels of adrenergic receptors in MPM as compared to healthy controls. Methods: We used gene expression data from the Oncomine Cancer Microarray database comparing MPM versus healthy tissue in order to investigate the differential expression profile of beta adrenergic receptors. Gene expression data were log transformed, median centered per array, and standard deviation was normalized to one per array. Gene expression was considered to be significantly over- or under- expressed when p<0.05 comparing MPM vs. healthy controls. Results: In MPM, the gene expression of ADRB and ADRB are significantly decreased compared to healthy tissue (p=0.05 and p<0.000 respectively). On the contrary, there was no significant difference in the gene expression of ADRB3 (p=0.89). Deming regression analysis revealed a significant positive association (p=0.048) between the gene expression of ADRB and ADRB given by the following equation: ADRB = 5.65 ADRB.7. Conclusions: Our findings suggest that at the transcriptional level in MPM, and adrenergic receptors are down-regulated. Their gene expression patterns seem to be associated. The pathophysiologic basis of our findings requires further investigation. P307 Pleurodesis for malignant pleural effusions: A comparison of bleomycin or tranexamic acid alone versus a combination of both Essam Mohamed, Elsayed Ali, Hamdy Mahmoud 3. Cardiothoracic Surgery, Sohag Faculty of Medicine, Sohag, Egypt; Oncology, Sohag Faculty of Medicine, Sohag, Egypt; 3 Chest Diseases and Tuberculosis, Sohag Faculty of Medicine, Sohag, Egypt BACKGROUND and OBJECTIVE: Searching for the ideal pleurodesis agent still continues, Bleomycin is one of the most commonly used agents for pleurodesis. Tranexamic acid have been reported as a cheap pleurodesis agent by many authors. In this study, we evaluate the efficacy, safety and cost of using a combination of bleomycin and Tranexamic acid versus each agent alone. METHODS: Sixty three patients with massive malignant pleural effusions were divided in 3 equal groups in a simple randomized manner. Tranexamic acid (30 mg/kg [maximum of g] in 50 ml of normal saline) was administered through a chest tube in Group. Group received bleomycin ( U/kg [maximum of 60 U] in 70 ml of normal saline). Group 3 received the above preparations (tranexamic acid, 30 mg/kg [maximum of g] in 40 ml of normal saline and bleomycin, U/kg [maximum of 60 U] in 50 ml of normal saline) instilled one following the other by 5 minutes. Follow-up CXR examinations were performed at 7 days, 30 days, 60 days and 90 days. 645s Abstract printing supported by. Visit Pfizer Vaccines at Stand Q.0

2 Poster Discussion Room 3.3-4:45-6:45 MONDAY, SEPTEMBER 9TH 03 RESULTS: There was no significant difference in the complete response rate of the 3 groups during the first 60 days days. At the end of the study at 90 days, Group 3 had a significantly higher complete response rate (65 %) compared with Groups and (7 % and 35 %, respectively).the rate of complications was nearly equal in the three groups. The most common complications were chest pain, fever and worsening dyspnea. CONCLUSIONS: Using a combination of bleomycin and tranexamic acid for pleurodesis in patients with malignant pleural effusion is more efficient than using each agent alone without significant increase in the cost or complications. P3073 Efficacy of cytology, cell blocks and thoracoscopic pleural biopsy in malignant pleural effusion diagnosis Edward Altman, Larisa Spiridonov, Sonkin Vadim 3, Livoff Alejandro 3, Gavrilov Alexei 4, Cohen I. Hector 3. Department of Thoracic Surgery, Western Galilee Hospital, Nahariya, Israel; Department of Internal Medicine A, Western Galilee Hospital, Nahariya, Israel; 3 Department of Pathology, Western Galilee Hospital, Nahariya, Israel; 4 Department of Anesthesiology, Western Galilee Hospital, Nahariya, Israel Introduction: Thoracocentesis and cytological examination with cell blocks are considered optimal for malignant pleural effusion (MPE) diagnosis. No study has separately evaluating efficacy of these two methods compared with thoracoscopic pleural biopsy. Objectives: To compare diagnostic efficacy of thoracocentesis with cytological examination of pleural fluid intensified by cell blocks with surgical thoracoscopic pleural biopsy and histological examination of specimen. To reduce diagnostic time. Methods: Retrospective review of 5 MPE patients in Western Galilee Hospital from MPE diagnosis was established by thoracocentesis, cytological examination of fluid with cell blocks. Thoracoscopy, pleural biopsy and histological examination were done in cases of false negative or inconclusive cytology. Results: Of 5 patients 60 were male, 55 female; mean age 67.8y. Cytological examination of pleural fluid was positive in 85.7% of 8 breast carcinoma cases, 79.5% of 39 bronchogenic carcinomas, 6.9% of other malignancies. Use of cell blocks increased positive results in 3-%. Mesothelioma (7 cases) cytological results were inconclusive. Thoracoscopy was performed in 64 patients. Histological diagnosis was done in 00 %. Mean duration of diagnostic process was.58 days in 85 patients., but longer in others due to repeated thoracocentesis, again with false negative results. Conclusions: Cytological examination of pleural fluid in MPE patients was diagnostically effective ( %) except for mesothelioma. Cell blocks increased positive results. Thoracoscopy with pleural biopsy in cases of negative or inconclusive cytological results was very effective (00%). P3074 Survival of mesothelioma patients after radical extrapleural pneumonectomy in the Nancy Biobank s database Fotis Vlastos, Georgios Kaltsakas, Jean-Michel Vignaud, Nadine Martinet Martinet 3, Nickolaos G. Koulouris. st Respiratory Medicine Dept, Athens University, Sotiria Hospital, Athens, Greece; Department of Pathology, CHU Nancy, Nancy, France; 3 Laboratory of Bioactive Molecules, Institute of Chemistry, University of Nice - Sophia Antipolis, Nice, France Radical extrapleural pneumonectomy (EPP) entails the complete removal of the ipsilateral lung along with the parietal pleura, pericardium and the majority of the hemidiaphragm. The Nancy Centre of Biologic Resources ( Centre des Ressources Biologiques ) is an ISO certified biobank with biologic material and follow-up data from French lung cancer and mesothelioma patients, collected for the last 0 years. This allows for a survey of mesothelioma survival rates and impact of EPP. Therefore, we set out to investigate whether EPP can increase the survival in mesothelioma patients comparing to chemotherapy. Clinical and occupational data from 90 consecutive mesothelioma patients who underwent EPP, only chemotherapy, and palliative care were collected from the Nancy Database. Twenty seven of the patients underwent EPP (n=9 only EPP, Group A; n=6 EPP and chemotherapy, Group B; n= EPP and radiotherapy; n= EPP, chemotherapy, and radiotherapy). One hundred four patients had chemotherapy (Group C). Fifty nine patients had palliative care (Group D). The patients underwent EPP had mean survival time (SD±SE, months) 0.0±3.3. Group A had mean survival time 6.8±3.9. Group B had mean survival time 9.3±3.9. Group C had mean survival time 5.9±.8. Group D had mean survival time 0.8±.4. The survival curves of Group B and Group D were significant different (p=0.09). The survival curves of Group C and Group D were significant different (p<0.00). The survival curves of Group A or Group B were not significant different from Group C. EPP does not appear to increase the survival of mesothelioma patients compared to chemotherapy. P3075 High fluorescence cells in pleural fluid. Association with pleural malignancy Diana Badenes, August Supervía, Francisco Del Baño, Sabina Herrera 3, Carles Vilaplana 4, Teresa Torrella 4, Isabel Cirera, Oriol Pallás. Respiratory Medicine, Hospital Del Mar - PSMAR, Barcelona, Spain; Emergency Department, Hospital Del Mar - PSMAR, Barcelona, Spain; 3 Internal Medicine, Hospital Del Mar - PSMAR, Barcelona, Spain; 4 Emergency Laboratory, Laboratori De Referència De Catalunya, Barcelona, Spain Background: High fluorescence cells (HFC) are cells that are not sorted by the automatic cell counter Sysmex XT The significance of HFC in pleural fluid (PF) is not well known, but they could be related with non-haematological cells, including neoplasms. Aims and objective: To evaluate if the presence of HFC in PE is associated with neoplasms. Methods: Retrospective study carried out between February-May 0. Cell count, total protein, glucose, ph, microbiology and cytology were determined in PF. Hospital records of all patients were reviewed, and clinical, pathological, diagnostic and mortality data were recorded. X, Fisher s exact and Mann- Whitney U tests were used for statistical analysis. A cut-off point to discriminate neoplasms from other causes of pleural disease was carried out (ROC curves). Results: 48 samples of PF from 3 patients were analyzed. Age: 67 (0) years. 60% male. 44% of PF were transudates. 48 patients (3%) had an active neoplasm but a pleural cytology confirmed neoplasm in only (8%). Main etiology of pleural disease: 30.6% infection; 6% heart failure; 8% pleural malignancy. The number of HFC in PE was associated with a pleural cytology of malignancy (p=0.003). A cut-off point of 64 HFC in PF is proposed to discriminate neoplasm: only 4 % of positive cytologies for malignancy had <64 HFC. Otherwise, 37,5% had >64 HFC (p=0.00). The number of HFC in pleura was also related with inhospital mortality (p=0.0) and 30 th day mortality (p=0.03). Conclusions: There is an association between the number of HFC and the cytology confirming malignancy in PF. In addition, less than 64 HFC are seldom associated with pleural malignancy. P3076 A computed tomography score to predict malignant pleural effusions Silvia Bielsa, Marina Pardina, Antonio González, José Manuel Porcel. Pleural Diseases Unit, Internal Medicine, Arnau De Vilanova University Hospital, Lleida, Spain; Radiology, Arnau De Vilanova University Hospital, Lleida, Spain The computed tomographic (CT) appearance of malignant pleural effusions is varied. We aimed to assess whether a scoring system based on CT findings is useful to predict the likelihood of pleural malignancy. Methods This prospective study included 44 patients who underwent thoracentesis between 008 and 0. CT scans were reviewed by two radiologists who were blinded to the final diagnosis. Many CT features were evaluated, although a logistic regression model selected 8 findings which entered into a scoring system ranging from 0 to 0. CT prediction score CT findings Odds ratio (95% IC) Score Kappa index Pleural nodules >cm 4 (-383) Lung mass 8 (7-47) Abdominal tumor 8 (5-64) Lack of pericardial effusion 0 (-96) Lack of enlarged cardiac silhouette 3 (3-63) 0.64 Liver metastases 3 (3-5) 0.95 Lack of loculated pleural effusion 4 (-8) 0.56 Volume of pleural effusion >L 3 (-7) 0.77 Results A score of 7 or higher was seen in 5 (%) of 5 benign effusions and 96 (83%) of 5 malignant effusions confirmed cytohistologically, which yielded a positive likelihood ratio (LR) of 7.5 (95% CI 5.-). The validation group consisted of 4 benign and 33 malignant pleural effusions. Two of 4 (5%) and 30 of 33 (9%) of the benign and malignant pleural effusions 646s Abstract printing supported by. Visit Pfizer Vaccines at Stand Q.0

3 Poster Discussion Room 3.3-4:45-6:45 MONDAY, SEPTEMBER 9TH 03 had a 7 or higher score. A score of 7 or higher had a sensitivity of 9% (95% CI 76-97); specificity of 95% (95% CI 84-99); positive LR of 9 (95% CI 5-7) and negative LR of 0. (95% CI ) to identify malignant effusions. There was a substantial interobserver agreement concerning the identification of the radiological findings (Table). Conclusions A simple CT scoring system can reliably identify pleural malignancy. P3077 Pleural eicosanoids in patients with lung cancer Jae Hwa Cho, Sunghyouk Park, Haesung Nam, Seungmin Kwak, Jeongseon Ryu, Honglyeol Lee. Internal Medicine, Inha University Hospital, Incheon, Republic of Korea; College of Pharmacy, Seoul National University, Seoul, Republic of Korea Introduction: Malignant pleural effusion can be diagnosed by cytology and biopsy. The accuracy of pleural cytology was 96.5%, but diagnostic discrepancies were 3.5%. The prostaglandins and leukotrienes involved in cancer progression. We investigated the possibility of biomarkers of malignant pleural effusion using NMR-based metabolomics approach. Materials and methods: We prospectively collected pleural effusion fluids from patients with lung cancer and benign lung diseases (tuberculosis and pneumonia) at Inha University Hospital (Incheon, Republic of Korea) between January 0 and September 0. Liquid chromatography-tandem mass spectrometry was used for analysis. We detected DHA, AA, 0-carboxy-LTB4, 6-keto-PGEa, 0-hydroxy LTB4, PGE, TXB, LXA4, LTE4, PGA, 0-HRTR, -dehydro- TXB. Results: Eleven patients with lung cancer and twelve with benign were analyzed. The 0-hydroxy LTB4, LXA4, DHA, AA in pleural fluid were increased in cancer group (p<0.05, respectively). Conclusion: Some of eicosanoids such as AA, 0-carboxy LTB4 might be a role in cancer progression. Further large scaled study will be needed to confirm this findings. P3079 Prognostic impact of histology and treatment modalities in malignant mesothelioma Torsten Blum, Jens Kollmeier, Sergej Griff, Timo Weiss, Wim Ammenwerth, Sandra Delis, Wiebke Nehls, Tarek Sabha, Sebastian Thiel, Nicolas Schönfeld, Torsten T. Bauer. Department of Pneumology, Lungenklinik Heckeshorn, Berlin, Germany; Department of Pathology, Lungenklinik Heckeshorn, Berlin, Germany Introduction: Malignant mesothelioma is a rare and heterogenous malignancy concerning histology and the variety of approaches to its management. Aims: In times of individualized treatments for most tumour entities, this monocentric study evaluated a retrospective cohort in order to subdivide the disease into prognostic subgroups. Methods: All patients with a malignant mesothelioma between January 004 and December 0 were prospectively recorded within our tumour registry and retrospectively evaluated with regard to histology, stage, treatment modalities (surgical resection [RES]: pleurectomy/decortication, extrapleural pneumonectomy; chemotherapy [CTX]; radiotherapy [RTX]) and survival. Results: A total of 70 patients were identified: 7 men (74.7%) and 43 women (5.3%). Mean age was 68.7 yrs. Histological subtyping revealed: epithelial 78.8%, sarcomatoid 8.% and biphasic.9%. Treatment consisted of: RES 96 pts. (56.5%), CTX 8 pts. (75.3%), RTX 6 pts. (5.3%), including multimodal approaches. Best supportive care only was applied in pts. (.4%). Median overall survival (OS) for all pts. was 6. months (95% CI months). OS was positively correlated with certain predictors including epithelial subtype and RES. P3078 Detection of mesothelin in the pleural effusion has a higher diagnostic utility than in serum for diagnostic of malignant mesothelioma Massimiliano Sivori, Paola Ferro, Pieraldo Canessa, Enrico Battolla, Paolo Dessanti, Maria Cristina Franceschini, Luigi Chiaffi, Anna Morabito, Vincenzo Fontana, Riccardo Pezzi, Franco Fedeli, Maria Pia Pistillo, Silvio Roncella. asl 5 La Spezia, Ospedale San Bartolomeo, Sarzana, Italy; asl 5 La Spezia, Ospedale San Bartolomeo, Sarzana, Italy; asl 5 La Spezia, Ospedale San Bartolomeo, Sarzana, Italy; asl 5 La Spezia, Ospedale Sant Andrea, La Spezia, Italy; asl 5 La Spezia, Ospedale Sant andrea, La Spezia, Italy; asl 5 La Spezia, Ospedale Sant andrea, La Spezia, Italy; asl 5 La Spezia, Ospedale San Bartolomeo, Sarzana, Italy; San Martino -ist, Tumor Genetics and Epigenetics, Genova, Italy; San Martino -ist, Unit of Epidemiology and Biostatistics and IRCCS, Genova, Italy; San Martino -ist, Unit of Epidemiology and Biostatistics and IRCCS, Genova, Italy; asl 5 La Spezia, Ospedale Sant andrea, La Spezia, Italy; San Martino -ist, Tumor Genetics and Epigenetics, Genova, Italy; asl 5 La Spezia, Ospedale San Bartolomeo, Sarzana, Italy BACKGROUND: Soluble mesothelin-related peptide(smrp) is a biomarker approved by the U.S. Food and Drug Administration for diagnosing and monitoring of malignant pleural mesothelioma (MPM).We compared the diagnostic performances of SMRP levels in the pleural effusion (PESMRP) and in serum (SSMRP) of MPM patients. METHODS:We assessed 0 thoracoscopies performed for a pleural effusion (PE) of unknown origin.pe and serum were drawn at the same time from each patient.smrp levels were measured by the MesoMark ELISA assay.the diagnostic performance of SMRP were estimated through the ROC analysis,the SMRP cut-off discrimination point was obtained by using the Youden index and the association between dichotomized SSMRP or PESMRP with disease status was evaluated through tha diagnostic odds ratio(dor). RESULTS:The study comprised 43 patients affected by MPM, 3 patients with metastatic cancers and 36 patients suffering from benign diseases.we found that the best cut-off point discrimination level for MPM was.70 nm in PESMRP and.08 nm in SSMRP.At these cut-off levels,pesmrp showed better diagnostic performance than SSMRP (area under the ROC curve %=8.6 vs 70.5;Sensitivity % =69.8 vs 46.5; Specificity %=88. vs 84.7; DOR=7. vs 4.8).In SSMRPnegative patients,pesmrp conserved acceptable diagnostic performances. In contrast,in PESMRP-negative patients,the diagnostic paaraameters were not significant (Sensitivity %=47.8 vs 5.4; DOR=8.3 vs.;p-value=0.00 vs 0.858). CONCLUSIONS:Both PESMRP and SSMRP may help in the diagnosis of MPM but,in maatched serum and PE,the diagnostic accuracy of PESMRP is superior to that of SSMRP. Conclusion: This study confirms histologically driven survival differences in mesothelioma reported before. The favourable median OS of our cohort might be influenced by the high rate of RES. P3080,5-dihydroxyvitamin D in malignant and non-malignant pleural effusions Marios Panagiotou, Andriana I. Papaioannou, Filia Diamantea, Styliani Giannakaki, Elvira Markela Antonogiannaki, Sofia Pouriki, Alexandros Kalkanis, Anna Takou, George D. Maropoulos, Emmanuel Kastanakis, Vlassios Polychronopoulos, Konstantinos Kostikas 3, Napoleon Karagianidis. 3rd Respiratory Medicine Department, Sismanogleio General Hospital, Athens, Greece; Department of Biochemistry, Laiko General Hospital, Athens, Greece; 3 nd Respiratory Medicine Department, University of Athens Medical School, Attikon Hospital, Athens, Greece Background:Vitamin D (VitD) is a key modulator of host immune response and is raised in patients with lung cancer. However, there are no studies evaluating the levels of VitD in malignant pleural effusions. Objectives:To evaluate the diagnostic role of VitD levels in pleural effusions of various etiologies. Methods:Prospective study of consecutive patients with a new diagnosis of pleural effusion. Exclusion criteria included previous diagnostic/therapeutic attempts or no definite diagnosis after at least 6-month follow up. Pleural fluid and serum samples were collected, protected from light exposure and immediately stored in -0 C until testing for VitD with Chemiluminescent Immunoassay. 647s Abstract printing supported by. Visit Pfizer Vaccines at Stand Q.0

4 Poster Discussion Room 3.3-4:45-6:45 MONDAY, SEPTEMBER 9TH 03 Results:Fifty patients were studied. Pleural VitD was higher than serum VitD(p<0.00). Pleural VitD did not differ between exudates and transudates(p=0.3) but was significantly higher in malignant compared to benign effusions (p=0.037). VitD levels >.6 ng/ml were diagnostic for malignant effusions (Sensitivity=68%,Specificity=73%,PPV=8%,NPV=58%). Malignant effusions with positive cytology had higher levels of VitD than those with negative cytology (p=0.007). Pleural VitD did not differ between effusions caused by lung cancer versus non-lung cancer (p=0.7). VitD levels in malignant effusions above the upper quartile (i.e. 4.5 ng/ml) were related to better survival during the 6-month follow up compared to lower levels (p<0.00,log rank test). Conclusions:Malignant pleural effusions present increased levels of VitD and higher levels of pleural VitD were associated to positive cytology, plausibly reflecting a greater local immune response. Increased levels of VitD were associated with better survival in this small population. P308 A novel pleural-bladder pump for management of pleural effusion Philippe Astoul, Y.C. Gary Lee, Nick A. Maskell 3, Charles-H. Marquette 4, Noel Johnson 5, Steve Whittaker 5, Edouard Fonck 5. Thoracic Oncology - Pleural Diseases - Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France; Respiratory Dpt., University of Western Australia, Perth, Australia; 3 Respiratory Unit, University of Bristol, Bristol, United Kingdom; 4 Service De Pneumologie, Centre Hospitalier Universitaire De Nice, Nice, France; 5 Sequana Medical, Sequana Medical, Zurich, Switzerland Recurrent pleural effusions are common. Pleurodesis has a suboptimal success rate and is unsuitable for patients with trapped lung. The alfapump system is a battery-powered, fully implantable pump system, designed to move peritoneal fluid to the urinary bladder for excretion. Its safety and effectiveness have been shown in patients with liver disease. Whether the alfapump can be applied to drain pleural effusions warrants investigation. This is a pilot feasibility study to explore the use of the alfapump system in pigs with normal pleura. The animal ethics committee in Hôpital Nord, Marseille, approved the study. Female pigs (30kg, n=) were anesthetised and ventilated mechanically. A pleural drainage catheter was inserted under pleuroscopic assistance. A second catheter was inserted in to the urinary bladder. Both catheters were tunneled subcutaneously and attached to the pump, which was implanted 6 cm below the costal border. A range of ventilation parameters were tested to create variety of physiological conditions. Fluid was introduced into the pleural space to create multiple effusions to assess the efficacy of the alfapump to remove fluid to the bladder. The alfapump successfully transported fluid from the pleural cavity to the bladder at an average rate of 3.3 ± 0.3 ml/sec. The pressure variations caused by the respiratory cycles and the variations in the amount of fluid (from 0 to 39ml) in the pleural cavity had no impact on the pumping. We confirmed that pumping automatically stopped when the pleural cavity was empty. This study demonstrated that the alfapump could be used successfully in anesthetised pigs. Its safety and efficacy in the management of pleural effusion requires clinical evaluation. P308 Exposure assessment and co-morbidity in females with malignant mesothelioma referred to an occupational clinic Øyvind Omland, Tine Malling, Jens Peter Johansen, Johnni Hansen. Occupational Medicine, Aalborg University Hospital, Aalborg, Denmark; Institute for Epidemiology, The Danish Cancer Society, Copenhagen, Denmark Aim. To describe asbestos exposure and to identify co-cancer morbidity in 4 consecutive female patients (987-0) with malignant mesothelioma (MM). Method. From medical records we identified age, asbestos exposure, localisation and subtypes of MM, and other cancer forms involving only pathological verified diagnosis. Results. Median age was 6 years (min 43 - max 8). We identified in cases (4%) both occupational and domestic exposure, in 4 (9%) occupational exposure, in 4 (9%) domestic exposure, while in 4 cases (9%) no asbestos exposure was identified. Domestic exposure was cleaning husband or sons working clothes. 9 cases of MM (7%) were localized to pleura and 5 (9%) to peritoneum. 7 (59%) of the cases were epitheloid subtype, and (4%) were biphasic. 5 cases (36%) missed subtype description. In 6 cases (43%) of MM other cancer forms were diagnosed prior to MM diagnose; in 3 localized to peura cases of breast cancer and case of colon cancer were diagnosed and in 3 localized to peritoneum case of lung cancer, case of breast cancer and in case both cervix cancer and lung cancer were diagnosed. A non significant reduced survival time (43 days vs. 068 days) was observed for cases with MM and another cancer compared to cases with MM alone. Conclusion: Occupational and domestic asbestos exposure was an equal contributor to MM and in 9% of the cases no asbestos exposure was identified. The prevalence of cancers diagnosed prior to MM in the patients exceeds the Danish life prevalence of breast- (0%), colon- (5.5%), cervix (.5%), and lungcancer (4%). Reduced immune system surveillance and radiation- and chemotherapy might be involved. P3083 Pleural ultrasound the pulmonologist s toolkit Burhan Khan. Respiratory Medicine, Darent Valley Hospital, Dartford, Kent, United Kingdom Background: The timely and safe investigation,intervention and management of pleural effusions remains discrepant with varying practices; possibly impacting upon quality of care and patient safety. Following the National Patient Safety Agency 008 report highlighting deaths from intercostal chest drain, the BTS recommended using ultrasound guidance when inserting chest drains. Moreover,patients with a pleural effusion conventionally have either diagnostic/therapeutic thoracentesis without any image guidance or an X mark the spot in the radiology department and then transferred back to the wards for the actual procedure; also posing potential for patient harm. Methods: A retrospective analysis of 3 years experience in a DGH of providing a chest physician deliver inpatient pleural service with bedside pleural ultrasound. Results: Since 00 over 600 pleural ultrasounds have been performed; with only 3 dry taps and clinically insignificant iatrogenic pneumothoraces. 43% were therapeutic thoracentesis,5% diagnostic,8% ultrasound only with no intervention,and 4% pre chest drain insertion or thoracoscopy, and X marks the spot are now obsolete. Conclusions: Pleural ultrasound is becoming an essential component in the pulmonologist s armanentarium, enabling prompt assessment and management of pleural effusions. Though it requires work planning and resources it does result in substantial qualitative and quantitative improvements in patient care.though not all pleural effusions need be aspirated under ultrasound guidance, it is not an exact science to ascertain which effusions can be safely aspirated without imaging. Not infrequently, with the benefit of pleural ultrasound, an invasive pleural intervention may be avoided altogether. P3084 Ultrasound-guided cutting-needle biopsy for diagnosing pleural disease: Experience in Oxford R.J. Hallifax, J.P. Corcoran, H. Rostom, N.M. Hassan, M. Nagendran, A. Manuel, N.M. Rahman. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom Introduction: Definitive diagnosis of pleural disease (particularly malignancy) depends upon histological proof obtained via pleural biopsy. Image-guided sampling is now standard practice. Local anaesthetic thoracoscopy has a high diagnostic yield for pleural disease. Thoracoscopy is not always possible in frail patients, if pleural fluid is heavily loculated, or where lung is adherent to the chest wall. Such cases can be converted on the table to cutting-needle biopsy. Aim: The present study was conducted to determine the diagnostic yield of a physicianlead service in both planned biopsies and cases of failed thoracoscopy. Methods: Retrospective review of all ultrasound-guided cutting-needle biopsies performed in the Pleural Unit between January 00 and November 0. The histological results were assessed for the yield of pleural tissue. Results: A total of 3 biopsies were undertaken. Overall, 9 (90.6%) successfully obtained sufficient tissue for histological diagnosis. 4 of 3 were biopsies conducted after failed thoracoscopy (6.8% of 05 the attempted thoracoscopies): /4 (85.7%) obtained sufficient tissue. 8/9 (7.6%) demonstrated pleural malignancy on histology (despite previous negative cytology), while /9 (7.4%) were benign. Of the benign cases, six were pleural tuberculosis (TB), two were pleural sarcoidosis and the remaining thirteen were benign pleural thickening/fibrosis. All were true negatives (at an average of 7 months of follow-up). Conclusion: Ultrasound-guided cutting needle pleural biopsy in the hands of physicians obtains pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy. 648s Abstract printing supported by. Visit Pfizer Vaccines at Stand Q.0

5 Poster Discussion Room 3.3-4:45-6:45 MONDAY, SEPTEMBER 9TH 03 P3085 Change in LDH assay can affect classification of pleural effusions using Light s criteria Matthew Evison, Mohamed Al-Aloul, Andrew Bentley, Nazia Chaudhuri, Ed Hinchliffe, Anne-Marie Kelly, Jayne Holme. North West Lung Centre, University Hospital of South Manchester, Manchester, United Kingdom INTRO: Following a change in assay ref range for LDH in pleural fluid (from Roche to Abbott), we noted a greater proportion of exudates using Light s criteria, necessitating invasive investigation. METHOD: Pleural fluid from Nov 0 to Sep (Roche cohort [RC]) and Sep to Jul (Abbott cohort [AC]) were identified. Only samples with full Lights criteria and an established diagnosis were included. The proportion of exudates using Lights criteria (full set and components) were determined and related to the final diagnosis to examine any differences between cohorts. RESULTS: 498 samples were identified. 4 (75 RC, 66 AC) were included. Using full Light s criteria, 56/75 (75%) RC and 53/66 (80%) AC were exudates. Using LDH criteria alone, a greater proportion [5/75 (69%)] RC were classed as exudates compared with AC [5/66 (77%)], mainly because the proportion with fluid LDH>/3 ULN was greater in AC(49/66=74%) than RC(4/75=56%). Using protein criteria alone, only 49% RC and 44% AC were exudates. There was disagreement between protein and LDH criteria in 3/75 (3%) of the RC, and 6/66 (39%) of the AC. In the RC, 9/75 (5%) effusions were classed as a transudate by protein criteria but as an exudate by LDH criteria, compared with 4/66 (36%) of the AC. Using final diagnosis as gold standard for cause of effusion, 57/75 (76%) of the RC and 48/66 (73%) of the AC were expected to result in an exudate, and the sensitivity (9%) and accuracy (80%) of the AC method were greater than the RC method (84% and 77% respectively), but specificity was less (50% v. 56%). CONCLUSION: Different LDH assays can result in changes in the classification of pleural effusions which could affect further management. 649s Abstract printing supported by. Visit Pfizer Vaccines at Stand Q.0

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