890-891 / 1578
Post-SABR bronchial assesment
•
Necrotic tissue in central airways should only be biopsied with caution as it may cause injury to
exposed blood vessels or worsen the necrosis. Avoid also a bronchial brushing procedure in
the first instance.
•
Review contrast-enhanced diagnostic CT scan for information on the area behind the necrosis
(bulky tumor, no big vessels in proximity).
•
Commence with saline lavage and suctioning. If this results in removal of mucus or necrosis
and if exophytic tumor is visualized, a biopsy could be considered in cases where the
diagnostic CT suggests that it could be safe.
•
If endobronchial appearance remains unchanged after saline lavage and suctioning
(
appearance of necrosis, unidentified tissue
), the bronchoscopy procedure should stop, and
clinical or PET-CT follow-up performed as appropriate.
Personal communication, Dr. J.M.A. Daniels, interventional pulmonologist, VU University Medical Center Amsterdam