Rapid On-site Lung Tissue Imprinted Cytology Clustering Analysis In Hematological Malignancy Patients With Pulmonary Complications

Objective Our study aimed to explore the diagnostic value of rapid on-site lung tissue imprinted cytology(ROLTIC)in hematological malignancy patients with pulmonary complications with the support of ultrathin bronchoscopy,endobronchial ultrasonography with a guide sheath(GS)(K201/K203 system),virtual bronchoscopic navigation(VBN)and rapid on-site evaluation(ROSE)namely UNRE.Methods We retrospectively analyzed the records of 20 consecutive hematological malignancy patients who developed pulmonary complications during treatment and after allogeneic hematopoietic stem cell transplantation and who underwent bronchoscopy at the Respiratory and Critical Medical Department of Tianjin Medical University General Hospital from January 2017 to February 2018.The final clinical diagnosis was obtained by comprehensive evaluation of the transbronchial lung biopsy(TBLB)histopathology,brush specific stain,bronchoscopic alveolar lavage(BAL)classified counting,microbial culture,centrifugal sediment microscopic examination,ROLTIC interpretation and treatment outcome.Clustering analysis is based on classify the results of the composition,quantity and background of the ROLTIC prints.The results are divided into eight categories,followed by suppurative infection,non-suppurative infection,granulomatous inflammation,organization and fibrosis,malignant lung invasion,immune inflammatory response,chronic inflammation,other or uncertain.The ROLTIC clustering results of the same patient were compared with the final clinical diagnosis and treatment outcome,so as to evaluate the diagnostic rate,sensitivity and specificity of ROLTIC treated by bronchoscopy.Results Among the 20 patients,bronchoscopy biopsy and brushing,ROLTIC imprint and alveolar lavage were performed according to virtual bronchoscopy and endobronchial ultrasound.All patients were well tolerated,and no complications such as pneumothorax and massive hemoptysis occurred.After case follow-up,combined with evaluation of postoperative pathology,microbiological results,ROLTIC clustering analysis and treatment outcome,11 of the 20 patients were finally clinically diagnosed with pulmonary infection,including 1 case of Pneumocystis carinii,3 cases of pulmonary infection combined with organizing pneumonia.There were 2 cases of organizing pneumonia,including 1 case of radiation pneumonitis,1 case of pulmonary tuberculosis(granulomatous inflammation),1 case of malignant lung invasion,and 2 cases of other or uncertain.The results of ROLTIC clustering analysis in 20 patients were as follows: 5 cases of suppurative infection,1 case of non-suppurative infection,1 case of granulomatous inflammation,8 cases of organization and fibrosis,1 case of malignant lung invasion,1 case of immune inflammatory reaction 1 case of chronic inflammation,and 2 cases of other or uncertainties.Compared with the final clinical diagnosis,the diagnosis rate of ROLTIC cluster analysis is 75%,the sensitivity is 72.22%,and the specificity is 100%.Conclusion Combined with ultrathin bronchoscopy,endobronchial ultrasonography,virtual bronchoscopic navigation,it can safely and effectively obtain interventional specimens of patients with pulmonary complications of hematological malignancy patients.Based on ROSE’s function,lung tissue was made into cytological imprints for rapid staining and interpretation by interventional methods.For the first time,our research introduces ROLTIC clustering analysis technology into the diagnosis of pulmonary lesions of hematological malignant diseases,ROLTIC technology can real-time guidance for interventional methods and modalities to obtain specimens of diagnostic value.Based on ROLTIC clustering,approaching a preliminary diagnosis or narrowing differential diagnosis spectrum,it has a clinical leading role and is mutually confirmed with the final clinical diagnosis.It has judged the accuracy of diagnosis and obtained gratifying results.The diagnostic rate is 75% and the sensitivity and specificity are not low.Therefore,it is of great clinical value to evaluate the pulmonary lesions during chemotherapy or after transplantation of hematological malignancy,especially in the treatment of critical and critical patients.