Virtual Library

Start Your Search

Avinash Aujayeb



Author of

  • +

    P02 - Diagnostics and Interventional Pulmonology (ID 110)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Diagnostics and Interventional Pulmonology
    • Presentations: 4
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
    • +

      P02.12 - Is there a Need for Staging EBUS in Lung Cancer?  (ID 3098)

      00:00 - 00:00  |  Presenting Author(s): Avinash Aujayeb

      • Abstract
      • Slides

      Introduction

      Nodal sampling via endobronchial ultrasound (EBUS) is well established in the lung cancer pathway. A diagnostic EBUS provides tissue for a diagnosis whereas a staging EBUS involves targeted mediastinal and hilar lymph nodal sampling via a systematic approach of any lymph node greater than 5mm in maximum dimension and of smaller nodes which might be FDG-avid on PET-CT. There is a growing movement nationally that all patients with N1 or central disease on CT or PET-CT should undergo a staging EBUS prior to resection due to a concern about upstaging at resection in this patient group. This has cost and resource implications.

      Methods

      We performed a retropective review of all patients between January 2014 and December 2018 who had undergone surgical resection. We analysed their TNM stage based on CT/PET-CT and reviewed if their nodal stage had changed following surgery and if staging EBUS would have changed the pre-operative stage.

      Results

      189 patients had surgical resection between 2014-2018. 48 had central disease or N1 disease on PET/CT pre-operative staging. 5 of those had an EBUS based on clinical concerns and there was no upstaging either at EBUS or at resection in these 5 patients. No multi-station N2 or N3 disease was detected in the resection group. 4 patients in this group were found to have single station N2 disease at resection. 2 patients had positive station 8/9 nodes that would not have been detected at EBUS. 2 patients had positive station 7 nodes at resection. One patient was alive 3 years later with no disease evident (patient was given adjuvant chemo)- pre op stage was T3N1M0, post op stage was T2bN2M0. The second patient was alive 1 year later with no disease evident (also given adjuvant chemo)- pre op stage T2N1M0- post T2bN2M0.


      Conclusion

      Staging EBUS in all these patients would have meant 43 extra EBUS over 5 years with the potential pick-up of 2 N2 disease leading to and NO alteration of management in any patients. This has significant cost and resource implications as EBUS costs approximatel betweeny £1200 and £2000. Therefore, the cost to the health economy has been approximately £50-80K over 5 years in single centre.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      P02.13 - Pneumothorax and CT Guided Biopsy for the Investigation of Lung Cancer (ID 2965)

      00:00 - 00:00  |  Presenting Author(s): Avinash Aujayeb

      • Abstract
      • Slides

      Introduction

      CT guided biopsy is a well established diagnostic test in the lung cancer pathway. Established guidance from the British Thoracic Society in 2003 suggests reported pneumothorax rates between 0-61%; 3.3%-15% required chest drains and there was no relation between FeV1 and the incidence of pneumothorax, but those with COPD more likely to receive chest drain if a pneumothorax occurs. Care should be exercised with those with an FeV1 of less than 1L or less than 35% predicted.1 A recent review of 23,104 patients suggested an 25.9% pneumothorax rate; 6.9% required a drain and a pneumothorax was associated with larger calibre needle, multiple punctures and no pleural apposition of the mass being biopsied.2 We proposed to review our local practice to better inform any risk to patients.

      Methods

      The notes of all the patients who udnerwent a CT guided biopsy between April 2011 to December 2019 were analysed. Radiological and spirometric findings as well as pre and post procedural aspects were analysed. Any resultant pneumothorax was measured according to established international guidance and any interventions documented. Descriptive statistics were applied to the data.

      Results

      789 biopsies were performed during the period described, on 418 male (53.3%) and 271 (46.7%) female patients. The mean age was 73.3 years (IQR 68-80, range 35-96). The mean number of pleural passes was 1.7 ( range 1-3). 134 resulting pneumothoraces were identified (16.9%). 116 of those patients had a biopsy using an 18 French Gauge needle. British Thoracic Guidance was applied and 21 pneumothoraces were large by their definition. 5 of those were symptomatic and required intervention with a chest drain. 16 pneumothoraces were small and required intervention, 15 with chest drains and 1 with a pleural vent which is a novel device for ambulatory management. Of those patients, none of the masses had pleural contact and 90% of patients had radiological emphysema detected. 80% had spirometric evidence of COPD. The mean FeV1 was 1.89 litres (range 1.27-2.71) and no bullae or fissures were crossed during the biopsy.

      Conclusion

      This is one of the largest retrospective reviews of CT guided biopsy looking at the incidence of pneumothorax. Our rates are much lower than quoted in the literature and might be attributable to using a smaller calibre biopsy needle. There was no relationship between Fev1 and pneumothorax incidence, or the need for intervention. The main risk factor seems to be radiological detection of emphysema and the masses not having pleural contact. We thus provide a safe service. Ambulatory management of CT guided pneumothorax is an aspect of this to be studied further.

      References

      1. Manhire A, Charig M, Clelland C (et al) Guidelines for Radiologically Guided Lung Biopsy. British Thoracic Society Guidelines. Thorax 2003; 58: 920 – 936

      2. Huo YR, Chan MV, Habib AR et al. Pneumothorax rates in CT-Guided lung biopsies: a comprehensive systematic review and meta-analysis of risk factors. Br J Radiol. 2020;93(1108):20190866. doi:10.1259/bjr.20190866

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      P02.16 - Rigid Medical Thoracoscopy in a Large UK District General Hospital (ID 2961)

      00:00 - 00:00  |  Presenting Author(s): Avinash Aujayeb

      • Abstract
      • Slides

      Introduction

      Medical thoracoscopy (MT) is a well established diagnostic and theurapeutic intervention for malignant as well as benign pleural effusions. National guidelines were established in 2010 and standards set for diagnostic sensitivity and pleurodesis rates. We report ourexperience in a district general hospital.

      Methods

      We performed a retrospective analysis of 296 patients having MT between January 2010 and October 2019. Basic demographics were collected alongside procedural and post procedural complications. Biopsy findings were analysed and completed follow up of any patients described. Descriptive statistics were used to summarize the data.

      Locally, MT is performed in theatre, under conscious sedation and pre-operative prophylactic antibiotics are given. We use a rigid thoracoscope.

      Results

      78.5% of the patients were male, median age being 72yrs. Diagnoses were malignant mesothelioma (124), lung cancer (35), breast cancer (17), empyema (7), chronic inflammation/pleuritis (83), other diagnoses such as melanoma, lymphomas, thymomas and aytpical proliferative processes (30).Histological confirmation by MT was 97% sensitive, above averages. 5 patients with atypia on histology had a cancer diagnosis via either surgical or image guided biopsies. 2 patients with pleuritis on histology had clinical evidence of cancer but were not investigated further. Complications included pleural infection [5(1.6%)], wound infection[4(1.4%)], air leaks more than 5 days [9(3%)], surgical emphysema [n=10(3.3%)], death due to procedure within 30 days [n=1(0.3%)] and tumour extension [n=1(0%)]. There was 1 displaced drain, 1 skin reaction secondary to the dressing and 1 wound leak requiring re-suturing in theatre. Median length of stay was 3.96 days (national average 4.6). The death was due to pre-op antibiotic induced acute kidney injury;local policy has changed since then. Pleurodesis was performed in 166 patients, and successful in 86%,in the absence of trapped lung (national average 80%); success being defined by patients not requiring another procedure within 30 days. 78(28%) patients had trapped lung, reflecting higher incidence of mesothelioma and 27 of those had a repeat procedure. 6 patients have had a simultaneous indwelling pleural catheter at the time of thoracoscopy and discharged the same day.

      Conclusion

      MT is a safe and effective procedure. Our higher diagnostic sensitivity and lower complication rates are probably down to 3 experienced practitioners, prophylactic antibiotics and using a rigid thoracoscope. We are actively trying to reduce our length of stay by practising day case thoracoscopy with the simultaneous insertion of an indwelling pleural catheter. We follow all patients with chronic fibrinous pleuritis over 2 years and 12 patients have currently not completed this follow up period.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      P02.18 - Indwelling Pleural Catheter Placement in a Large UK District General Hospital (ID 2963)

      00:00 - 00:00  |  Presenting Author(s): Avinash Aujayeb

      • Abstract
      • Slides

      Introduction

      Indwelling pleural catheters (IPC) have become the main stay for patient centred treatment of malignant pleural effusions. They can be inserted as day case procedures, have very low complication rates and improve quality of life. They also reduce inpatient lengthof stay in respect to the malignant effusion. We have an established pleural service and analysed our practice over 4 years.

      Methods

      All the notes of patients requiring IPC insertion between 2015 and 2019 were reviewed

      Results

      159 patients had an IPC inserted. 130 had died; mean survival 162 days. Mean age was 72.3 years and 39% of patients were female (n=62). 78 IPCs were done for mesothelioma, 61 done for other malignancies (29 lung, 24 breast, rest varied : melanoma, prostate cancer, ovarian cancer, colorectal cancers amongst others). 20 were done for non-malignant indications such as fibrinous pleuritis, cardiac amyloidosis, effusions of unknown cause, liver cirrhosis, heart failure.

      146 IPCs were inserted as a day case, the rest were already inpatients. IPCs are done in theatre with a one off dose of prophylactic antibiotics.

      Complications included 4 infections (3 of pleural space by staph epidermidis and gram negative bacilli, 1 of site: site infection by staph. aureus {MSSA} – 2.5% (lower than national average in the UK), 6 blockages- 3.8 %, requiring removal (less than national average) and 2 small pneumothoraces post insertion. 1 patient had fast AF and hypotension post insertion.13 patients had loculations requiring intervention (8%- lower than national average) with intra-fibrinolytics, All of these patients had died by the time of data collection and we have stopped this practice in light of recent evidence that palliative care is more apporpriate. 57 IPCs were removed (36%- at a national average) for spontaneous pleurodesis.

      Conclusion

      We provide an safe and effective indwelling pleural catheter service. Our lower rates of infection might be due to prophylactic antibiotic usage and insertion in theatre.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P25 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Mesothelioma Preclinical, Prognostic and Predictive Factors (ID 139)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
    • +

      P25.05 - The Brims Decision Tree Model for Prognosis in a UK Malignant Mesothelioma Group (ID 2962)

      00:00 - 00:00  |  Presenting Author(s): Avinash Aujayeb

      • Abstract
      • Slides

      Introduction

      Malignant Mesothelioma has traditionally carried a poor prognosis. A number of prognostic tools have been developed to try explain these variations and to guide clinicians and patients to the most appropriate therapy and to try answer difficult questionsregarding survival time.The BTS 2018 guideline recommends the Brim’s decision tree analysis as the most useful guide.

      Prior partial presentation: British Thoracic Oncology group in January 2020

      Methods

      We conducted a local retrospective database analysis to identify patients diagnosed with malignant pleural mesothelioma (MPM) and evaluate the usefulness of the Brims score. Patients with an MDT diagnosis of MPM were included in the study (including thosewithout histological confirmation) between January 1st 2011 until December 31st 2019. Results were compared against the Brims’ decision tree analysis to assess how survival groups compared in a different geographical cohort.

      Results

      There were 233 patients, 82% (n=192) male, with a median diagnostic age of 76.7 (IQR 71-83) years. Epithelioid was the most common histological diagnosis (34%) followed by sarcomatoid (12%), and biphasic (10.1%). 26.2% of patients had no definite pathology and 18% just a radiological diagnosis.The overall median survival was 11.3 months compared to 9.7 in the Brims validation cohort and 12.7 months in the Brims derivation cohort.Table 1 shows the median survival of each predicted Brims group in comparison to the predicted survival, as well as the proportion of patients whose survival fell with +/- 33% of that prediction.

      Table 1
      MPM risk group Number of patients Median survival, months, IQR Predicted survical % within +/- 33% predicted
      1 5 13.6 (9.1-18.5) 34 (22.9-47) 0
      2 68 15.1 (4.6-19.9) 17.7 (11.6-25.9) 25.7
      3 47 13.9 (5.5-19) 12 (6-20.6) 36.7
      4 113 5 (1.2-9) 7.4 (3.3-11.1) 23.1

      Conclusion

      The Brim’s decision tree aid can be a clinically useful tool using readily available clinical information to help clinicians identify those patients at highest risk of dying within 6 months of diagnosis. However, its ability to give accurate prognostic advice in our cohort is limited as due to the wide variation and the low proportion of patients within 33%+/- the predicted survival.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P30 - Palliative and Supportive Care (ID 163)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Palliative and Supportive Care
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
    • +

      P30.08 - The Evaluation of Fatigue in Malignant Pleural Effusion (ID 2998)

      00:00 - 00:00  |  Presenting Author(s): Avinash Aujayeb

      • Abstract
      • Slides

      Introduction

      Cancer-related fatigue is well described and can have a significant negative impact on patient quality of life. The prevalence of fatigue in patients with a malignant pleural effusion (MPE) and whether interventions for MPE could have an impact on fatigue has not previously been explored. FACIT-F (Figure 1) is a validated tool for assessing patient-reported fatigue. fig 1.jpg

      Methods

      30 patients with MPE or presumed MPE presenting to the regional pleural clinic were surveyed. Consent was verbally obtained and local governance approval was sought. Basic demographics were collected as well as co-morbidities and relevant haematological results. Patients self-reported fatigue levels by completing the FACIT-F tool.

      Results

      The median patient age 74.8 years, IQR 16, range (46-87). Diagnoses were 15 pleural mesotheliomas, 9 lung carcinomas, 4 breast cancers and 2 ovarian cancers. Patients had a wide range of co-morbidities from hypertension, previous myocardial infarctions, diabetes and previous resected cancers. 5 patients had more than 2 co-morbidities (hypertension being the commonest one). Median BMI was 26.5, range 21.3-34.3. All haemoglobin and kidney function were within the normal range. ECOG performance status was between 1 and 3 (1: n= 16, 2: n= 12, 3: n=2). Figure 2 shows the responses for each point of the FACIT-F tool.figure 2.jpg

      Conclusion

      This is a small cohort which showed significant fatigue levels with a negative impact on daily living and quality of life. Patients presented to clinic and had generally good performance status. Further statistical analysis for confounding factors is warranted but this is enough data for a prospective study to examine whether interventions to manage MPE could improve patient-reported fatigue levels. A wider range of patients with multiple confounding comorbidities will be recruited and patients will fill the form with an investigator present to improve the number of responses.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.