Indocyanine green (ICG) is a fluorescent dye used for near-infrared (NIR) intraoperative imaging. In thoracic surgery, it is used to delineate intersegmental planes during anatomical segmentectomy, localizing small, nonpalpable lung lesions, assessing gastric conduit perfusion before esophageal anastomosis, and identifying the thoracic duct. A review of the latest literature (2020-2025) indicates that ICG significantly increases the precision of segmentectomy (allowing visualization of the intersegmental plane) and the effectiveness of lung nodule localization (> 95%), as well as enabling objective assessment of tissue perfusion in esophageal surgery (reduction of anastomotic leakage) and facilitating identification and management of thoracic duct injuries. The fluorescence technique with ICG has a favourable safety profile. Indocyanine green is currently a valuable complement to standard methods, increasing the predictability and effectiveness of minimally invasive procedures in the thoracic region.

Background/Objectives: Various conditions contribute to the development of postoperative pulmonary complications (PPCs) following thoracic surgery. In this study, the aim was to investigate whether preoperative diaphragm dysfunction is associated with an increased risk of PPCs after lung cancer resection. Methods: We prospectively examined 45 patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy or open thoracotomy. Relevant clinical data were retrieved from hospital database records, while diaphragm muscles were assessed using ultrasound. Results: Our results demonstrated that preoperative diaphragm muscle atrophy was significantly associated with a higher risk of developing PPCs compared to patients with normal diaphragm thickness. Diaphragm atrophy was also linked to prolonged hospital stays. Additionally, we observed a moderate correlation between expiratory diaphragm thickness and the number of PPCs. Conclusions: Low diaphragm expiratory thickness is associated with postoperative pulmonary complications after lobectomy for lung cancer. Importantly, unlike other predictive factors such as age, COPD, or smoking, diaphragmatic atrophy is a modifiable risk factor that can potentially be addressed through early therapeutic intervention.

Background/Objectives: Lung cancer is the second most prevalent cancer in the general population and the third most prevalent among women. STAS (Spread Through Air Spaces) is a term used in pathology, particularly in lung cancer. It refers to the spread of tumor cells through air spaces in the lung tissue. The aim of this study was to evaluate the utility of STAS as a predictive and prognostic factor, as well as to assess the impact of STAS detection on subsequent surgical and pharmacological treatment decisions. Methods: A comprehensive literature search was performed on PubMed, PMC, and Google Scholar between June and September 2024. Search terms included ‘STAS’, ‘lung cancer’, ‘NSCLC’, ‘SCLC’, ‘PET and STAS’, ‘histopathological STAS’, ‘treatment methods for STAS’, and ‘STAS prognosis’. A diverse range of study designs was included in our analysis—encompassing meta-analyses, case-control studies, literature reviews, cross-sectional studies, and prospective longitudinal studies. Results: Lobectomy remains standard, whereas sublobar resection significantly increases recurrence risk in STAS-positive patients. CT, PET/CT, and frozen section analysis offer emerging, reliable predictive markers, supporting optimized treatment selection; however, histopathological examination continues to serve as the standard method for confirming STAS. Conclusions: One of the most significant limitations of our work is the limited number of available studies addressing the topic of STAS, which is the reason why statistical analysis was not provided. To conclude, the presence of STAS is identified as a negative prognostic factor amongst patients with NSCLC; however further research is needed to establish specific treatment guidelines when STAS is identified.

Background/Objectives: Lung carcinoma is the leading cause of cancer-related deaths globally, with lung adenocarcinoma being the most prevalent subtype. This study aims to review the clinical data and survival outcomes of patients diagnosed with lung adenocarcinoma who underwent surgical treatment. Methods: We retrospectively analyzed 471 patients (mean age 65.9 ± 7.81 years, range 38–86; 53.5% women) with histopathologically confirmed lung adenocarcinoma who underwent a lobectomy, bilobectomy, or pneumonectomy between May 2012 and December 2022. All patients were followed for up to five years post-surgery. Their medical histories, including previous neoplasms, comorbidities, tumor characteristics, and symptoms, were thoroughly reviewed. We calculated the overall survival rate and evaluated the impact of tumor grading and spread through air spaces (STAS) on patient outcomes. Results: The survival rate for the entire cohort was 76.23%. No significant survival differences emerged between G1 and G2 tumors, whereas both showed markedly better survival rates than G3 tumors. When these findings were applied to a simplified two-tier grading system (low grade vs. high grade), survival analyses showed a clear stratification of prognosis. Patients with STAS had a lower survival rate than those without STAS. Conclusions: Our findings indicate that a simplified grading system may improve prognostic evaluations for lung adenocarcinoma patients. Furthermore, STAS is a crucial factor affecting survival rates and should be considered in future treatment strategies. Expanding research in this area is essential to enhance treatment approaches for lung adenocarcinoma patients.

Introduction:Lung cancer is one of the most prevalent cancers worldwide. Dickkopf-1 (DKK-1) and -2 (DKK-2) are important proteins for the regulated Wnt signalling pathway. Alternations in the Wnt pathway are associated with tumour progression. The aim of the study was to analyse the concentration of DKK-1 and DKK-2 in tumour and matched non-tumour (NT) samples of 65 patients with non-small cell lung cancer (NSCLC), including 3 subtypes: adenocarcinoma (AC), squamous cell carcinoma (SCC), and large cell carcinoma (LCC).Material and methods:The protein concentration was measured by enzyme-linked immunosorbent assay (ELISA) in homogenates.Results:The difference between the level of DKK-1 in tumour and NT specimens was not significant for the whole NSCLC group and SCC and LCC subtype, while in AC samples they were significantly higher (p = 0.028). The highest concentration of DKK-1 was found in the advanced NSCLC samples, with the T4 parameter as well as stage III. Significantly decreased DKK-2 concentrations were detected in all NSCLC subtypes (p < 0.05). Moreover, the DKK-2 level was higher in non-smokers than in smokers. The results indicate that concentrations of DKKs were different in relation to subtypes as well as clinical and socio-demographic parameters. The concentration of DKKs could be associated with the progression of NSCLC.Conclusions:We suggest that DKK-1 could play an oncogenic role in AC, while DKK-2 could be a tumour suppressor in all NSCLC subtypes. Dickkopf-1 and DKK-2 proteins could have differential roles in the Wnt signalling pathway, which is important in many cellular processes, such as proliferation and apoptosis.

Introduction: Lung cancer is the most commonly diagnosed cancer with 2.2 million cases in 2020 and causes 1.8 million deaths. Early lung cancer often has no symptoms and can only be detected by medical imaging. When symptoms do appear, they are often respiratory problems —coughing, breathlessness or chest pain — and systemic problems — loss of appetite, weight loss, general weakness, fever and night sweats. There are two main types of lung cancer: small cell lung cancer (SCLC; 15% of cases) and non-small cell lung cancer (NSCLC; 85% of cases). Material and methods: This study included evaluation of CMKLR1, PD-1, B7H3, B7H4 and HHLA2 expression, along with CD8 + T-cell population, TILs and budding in H + E stained slides using IHC. Although there was no clear association between the analysed expressions and the T parameter, this study, which included 22 archived lung adenocarcinoma cases from patients undergoing radical lobectomy, revealed significant negative correlations between HHLA2 expression and tumour grade, as well as between CMKLR1 expression and tumour grade. Results: Furthermore, CMKLR1 expression among lymphocytes showed a positive correlation with TILs.

Although a growing body of evidence emphasizes the superiority of VATS over conventional thoracotomy, little is still known about early postoperative diaphragm muscle function after lobectomy via these two approaches. To fill the gap in existing literature, we conducted a comparative study between VATS and conventional thoracotomy in terms of postoperative diaphragm muscle function, assessing its contractility, strength, the magnitude of effort and potential risk of dysfunction such as atrophy and paralysis. A total of 59 patients (30 after VATS), who underwent anatomical pulmonary resection at our institution, were enrolled in this study. The control group consisted of 28 health subjects without medical conditions that could contribute to diaphragm dysfunction. Diaphragm muscle was assessed before and after surgery using ultrasonography. We found that both surgical approaches were associated with postoperative impairment of diaphragm muscle function—compared to baseline data. Postoperative reduction in diaphragm contraction was demonstrated in most of the 59 patients. In the case of the control group, the differences between measurements were not observed. We noted that lobectomy via thoracotomy was linked with a greater percentage of patients with diaphragm paralysis and/or atrophy than VATS. Similar findings were observed in referring to diaphragm magnitude effort, as well as diaphragm contraction strength, where minimally invasive surgery was associated with better diaphragm function parameters—in comparison to thoracotomy. Disturbance of diaphragm work was reported both at the operated and non-operated side. Upper-right and left lobectomy were connected with greater diaphragm function impairment than other segments. In conclusion, the VATS technique seems to be less invasive than conventional thoracotomy providing a better postoperative function of the main respiratory muscle.

Background: This This study, conducted between December 2015 and March 2018 at a single university hospital, explored the feasibility and safety of opioid-free anesthesia combined with preoperative thoracic paravertebral block (ThPVB) for patients undergoing elective video-assisted thoracoscopic surgery (VATS). The aim was to assess the impact of this approach on postoperative pain levels and opioid consumption. Methods: Sixty-four patients scheduled for elective VATS were randomly assigned to either the intervention group, receiving opioid-free anesthesia with ThPVB, or the control group, managed with standard general anesthesia. Postoperatively, both groups received oxycodone patient-controlled analgesia along with non-opioid analgesics. Pain intensity was measured using the Numeric Pain Rating Scale (NRS) and Prince Henry Hospital Pain Score (PHHPS). The total dose of postoperative oxycodone and the occurrence of opioidrelated adverse events were recorded during the 24-hour follow-up period. Results: Patients in the intervention group showed significantly lower pain levels at 20 and 24 hours post-procedure (P P = 0.015, P = 0.021, respectively) compared to the control group. Notably, oxycodone consumption at 24 hours was significantly higher in the control group (p p < 0.0001). No serious adverse events were observed during the study period. Conclusions: This study demonstrates the feasibility and safety of opioid-free anesthesia combined with ThPVB for elective VATS. The approach significantly reduces postoperative pain and the need for opioids, supporting its potential as an effective and balanced perioperative anesthetic strategy.

Non-small cell lung carcinoma (NSCLC) is the most common lung cancer worldwide. Secreted frizzled-related proteins (SFRPs) are important tumour suppressors and antagonists of the Wnt signalling pathway, which is linked with cancer development. The aim of this study was to evaluate the concentrations of SFRP1, SFRP2, and SFRP5 proteins in tumour and non-tumour (NT) samples obtained from 65 patients with primary NSCLC. An enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of SFRPs in the tissue homogenates. A significantly lower SFRP2 protein concentration was found in the total NSCLC tumour samples and the following NSCLC subtypes: squamous cell carcinoma (SCC) and adenocarcinoma (AC) (p > 0.05, p = 0.028 and p = 0.001, respectively). AC tumour samples had a higher SFRP1 level than NT samples (p = 0.022), while the highest SFRP1 concentration was found in NSCLC samples from patients with clinical stage T4 cancer. Increased concentrations of SFRP1 and SFRP5 were present in stage III NSCLC samples, while the tumour samples with high pleural invasion (PL2) had an increased level of SFRP2. The results from this study suggest that the tumour suppressor or oncogenic roles of SFRPs could be connected with the NSCLC subtype. The levels of SFRPs varied according to the clinicopathological parameters of NSCLC.

Wstęp Poszukiwanie czynników wpływających na przeżycie chorych z nowotworami płuc jest stale aktualne. Takim potencjalnym czynnikiem jest polimorfizm genu CLPTM1L (cleft lip and palate transmembrane 1-like), włączony w proces karcynogenezy. Celem pracy była ocena rozkładu genotypów i alleli wybranych polimorfizmów genu CLPTM1L – rs401681 i rs402710 – w tkance zmienionej nowotworowo i w tkance zdrowej płuc u chorych z gruczolakorakiem płuca oraz ich związku z przeżyciem chorych. Materiał i metody Badaniami objęto 133 chorych w wieku ujawnienia nowotworu płuca wynoszącym średnio 65 lat, u których w przeszłości dokonano usunięcia gruczolakoraka płuc. Z zabezpieczonych w parafinie próbek tkanki zdrowej płuc i z tkanki zmienionej chorobowo wyizolowano materiał genetyczny – kwas deoksyrybonukleinowy (DNA) – oraz przeprowadzono genotypowanie polimorfizmów CLPTM1L. Uzyskane wyniki poddano analizie wraz z danymi demograficznymi, wywiadem dotyczącym palenia tytoniu, wywiadem rodzinnym obciążonym nowotworowo, stadium choroby w klasyfikacji TNM (tumor, node, metastasis), zaawansowaniem klinicznym nowotworu i czasem przeżycia chorych. Wyniki Średni czas obserwacji wynosił 44,5 miesiąca. Chorzy, którzy zmarli, żyli średnio 22,6 miesiąca od czasu postawienia diagnozy nowotworu. Nie stwierdzono znamiennych różnic pomiędzy rozkładem genotypów ani alleli w tkankach chorej i zdrowej płuc oraz ich związku z przeżyciem chorych. Czynnikami wpływającymi na przeżycie chorych były wiek w czasie postawienia diagnozy nowotworu, kategoria N w klasyfikacji TNM oraz wysokie zaawansowanie kliniczne nowotworu. Wnioski Nie stwierdzono związku pomiędzy zmiennością polimorficzną rs401681 i rs402710 w tkance chorej i zdrowej płuc a przeżyciem chorych.

One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on 10 December 2022. Primary outcomes included the quality of lung collapse. Secondary outcome measures included: the success of the first intubation attempt, malposition rate, time for device placement, lung collapse and adverse events occurrence. Twenty-five studies with 1636 patients were included. Excellent lung collapse among DLT and BB groups was 72.4% vs. 73.4%, respectively (OR = 1.20; 95%CI: 0.84 to 1.72; p = 0.31). The malposition rate was 25.3% vs. 31.9%, respectively (OR = 0.66; 95%CI: 0.49 to 0.88; p = 0.004). The use of DLT compared to BB was associated with a higher risk of hypoxemia (13.5% vs. 6.0%, respectively; OR = 2.27; 95%CI: 1.14 to 4.49; p = 0.02), hoarseness (25.2% vs. 13.0%; OR = 2.30; 95%CI: 1.39 to 3.82; p = 0.001), sore throat (40.3% vs. 23.3%; OR = 2.30; 95%CI: 1.68 to 3.14; p < 0.001), and bronchus/carina injuries (23.2% vs. 8.4%; OR = 3.45; 95%CI: 1.43 to 8.31; p = 0.006). The studies conducted so far on comparing DLT and BB are ambiguous. In the DLT compared to the BB group, the malposition rate was statistically significantly lower, and time to tube placement and lung collapse was shorter. However, the use of DLT compared to BB can be associated with a higher risk of hypoxemia, hoarseness, sore throat and bronchus/carina injuries. Multicenter randomized trials on larger groups of patients are needed to draw definitive conclusions regarding the superiority of any of these devices.

Changes in smoking trends and changes in lifestyle, together with worldwide data regarding the incidence of lung cancer in the group of patients with no previous history of smoking, leads to consideration of the differences in the course of the disease, the time of cancer diagnosis, the survival rate, and the occurrence of comorbidities in this group of patients. This study aimed to determine the occurrence of non-smokers among patients undergoing anatomical resection of the lung tissue due to lung carcinoma and to investigate the differences between the course of lung cancer, survival, and the comorbidities in the groups of patients with lung cancer depending on the history of tobacco smoking. The study included a cohort of 923 patients who underwent radical anatomical resection of the lung tissue with lung primary adenocarcinoma or squamous cell carcinoma. The Chi2 Pearson's test, the t-test, the Mann-Whitney U test, the Kaplan-Meier method, the Log-rank test with Mantel correction, and the Cox proportional hazard model were used for data analysis. We observed a significantly higher mean age of smoking patients compared to the mean age of non-smoking patients. The coexistence of former neoplastic diseases was significantly more frequent in the group of non-smokers compared to the group of smoking patients. We did not observe differences depending on smoking status in the tumor stage, grade, vascular and pleural involvement status in the diagnostic reports. We did not observe differences in the survival between smokers vs. non-smokers, however, we revealed better survival in the non-smoker women group compared to the non-smoker men group. In conclusion, 22.11% of the patients undergoing radical anatomical resection of the lung tissue due to lung cancers were non-smokers. More research on survival depending on genetic differences and postoperative treatment between smokers and non-smokers is necessary.

Introduction. Non-small-cell lung carcinoma (NSCLC) constitutes 80% of all lung cancer cases, of which 25–30% are squamous-cell carcinoma (SCC). We investigated the impact of comorbidities and other risk factors on the survival of patients with SCC, including the correlation between symptoms and the maximum tumor size. Materials and methods. The study cohort included 417 patients. The Kaplan-Meier method, the Log-rank test, Gehan’s generalized Wilcoxon test, the Mann-Whitney U test, the t-test and Cox’s model of proportionality of hazards were applied. Results. The maximum tumor size exhibited a significant correlation with the presence of symptoms such as cough, hemoptysis, and weight loss. Patients who presented with a positive family history of cancer, a prior history of cancer, respiratory diseases, or hypertension experienced a notably reduced survival time. Conclusions. Patient’s symptoms and their medical history are important in predicting survival.

BACKGROUND Studies have demonstrated a lower incidence of complications after video-assisted thoracoscopic surgery (VATS) lobectomy compared with thoracotomy, but the data on in-hospital and 90-day mortality are inconclusive. This study analyzed whether surgical approach, VATS or thoracotomy, was related to early mortality of lobectomy in lung cancer and determined the differences between in-hospital and 90-day mortality. METHODS Data of all patients with non-small cell lung cancer who underwent lobectomy between January 1, 2007, and July 30, 2018, were retrieved from Polish National Lung Cancer Registry. Included were 31 433 patients who met all study criteria. After propensity score matching, 4946 patients in the VATS group were compared with 4946 patients in the thoracotomy group. RESULTS Compared with thoracotomy, VATS lobectomy was related to lower in-hospital (1.5% vs 0.9%, P [ .004) and 90-day mortality (3.4% vs 1.8%, P < .001). Mortality at 90 days was twice as high as in-hospital mortality in both the VATS (1.8% vs 0.9%, P < .001) and thoracotomy groups (3.4% vs 1.5%, P < .001). Postoperative complications were less common after VATS compared with thoracotomy (23.6% vs 31.8%, P < .001). CONCLUSIONS VATS lobectomy is associated with lower in-hospital and 90-day mortality compared with thoracotomy and should be recommended for lung cancer treatment, if feasible. Patients should also be closely monitored after discharge from the hospital, because 90-day mortality is significant higher than in-hospital mortality.

Introduction: Puncturing a lesion localized behind a vessel is considered as a contraindication for EBUS-TBNA. Although invasive, endobronchial ultrasound guided transvascular needle aspiration (EBUS-TVNA) seems to be reasonable alternative or even may occur the only option. Data about safety and efficacy of this technique is highly limited. Objectives: A usefulness and safety profile of EBUS-TVNA for lung tumor diagnosis Methods: Retrospective analysis of EBUS-TVNA results. Considering risk-benefit ratio EBUS-TVNA was performed in selected cases, under conscious sedation, with no intubation. All biopsies were performed through interlobar or segmental pulmonary arteries. Patients were monitored for 24 hours after biopsy. Antibiotic prophylaxis and on site cytology were no used. Results: EBUS-TVNA was performed in 21 patients (8 females and 13 males) of mean age 71 in 5 centers over last year. Mean size of lesion was 32mm. BF-UC-190F EBUS scope (Olympus, Japan) and cytological 22G needles were used to biopsy lesions in left upper (7), lower (2), and right upper (8), middle (1) lower (3) lobe. NSCLC was found in 17 (81%) cases. Adenocarcinoma in 12 (70.6%) and material was suitable for IHC and molecular analysis in 15 (88.2%) of them. Silicoma and aspergilloma were diagnosed in one case each and 2 biopsies were non diagnostic. No procedure related complications including moderate or severe bleeding were noted. Conclusions: EBUS-TVNA in carefully selected patients is a feasible alternative to more invasive procedures with a high yield. Appropriate monitoring and care must be available in the case of severe bleeding.

Background: Chest surgery is associated with significant pain, and potent opioid medications are the primary medications used for pain relief. Opioid-free anaesthesia (OFA) combined with regional anaesthesia is promoted as an alternative in patients with an opioid contraindication. Methods: Objective: To assess the efficacy of OFA combined with a paravertebral block in pain treatment during video-assisted thoracic surgery. Design: A randomized, open-label study. Setting: A single university hospital between December 2015 and March 2018. Participants: Sixty-six patients scheduled for elective video-assisted thoracic surgery were randomized into two groups. Of these, 16 were subsequently excluded from the analysis. Interventions: OFA combined with a paravertebral block with 0.5% bupivacaine in the OFA group; typical general anaesthesia with opioids in the control group. Main outcome measures: Intraoperative nociceptive intensity measured with a skin conductance algesimeter (SCA) and traditional intraoperative monitoring. Results: Higher mean blood pressure was observed in the control group before induction and during intubation (p = 0.0189 and p = 0.0095). During chest opening and pleural drainage, higher SCA indications were obtained in the control group (p = 0.0036 and p = 0.0253), while in the OFA group, the SCA values were higher during intubation (p = 0.0325). SCA during surgery showed more stable values in the OFA group. Pearson analysis revealed a positive correlation between the SCA indications and mean blood pressure in both groups. Conclusions: OFA combined with a paravertebral block provides effective nociception control during video-assisted thoracic surgery and can be an alternative for general anaesthesia with opioids. OFA provides a stable nociception response during general anaesthesia, as measured by SCA.

INTRODUCTION:Lung cancer patients (LCP) require invasive evaluation of left adrenal glands (LAG) if distant metastases (M1b/1c) are suspected in CT or PET-CT. Only few studies showed utility of endosonography and particularly EUS-b-FNA as minimally invasive endoscopic method of LAG analysis.MATERIAL AND METHODS:A retrospective study of consecutive LCP was conducted in two pulmonology centers between January 2010 and December 2019. Records of complete endosonographic staging with use of single ultrasound bronchoscope or two scopes were overviewed. The analysis included cases of enlarged LAG (body size or limbs > 10 mm) examined and sampled by EUS-b-FNA or EUS-FNA.RESULTS:142 of 2596 LCP staged by complete endosonography (M: 88, F: 54 mean age 64.7) had enlarged LAG, which were biopsied by conventional EUS-FNA (52) and/or by EUS-b-FNA (90). Strong correlation with gland diameter (P < 0.001) was observed. The incidence of LAG metastases in analyzed group was 52.1% (74/142) and regarding histology: SCLC 76.9% (10/13), adenocarcinoma 66.7% (44/66), NSCLC 56.3% (9/16) and SCC 17.5% (7/40). A specificity and PPV for both methods were 100%. A sensitivity, accuracy and NPV for EUS-FNA were 91.7%, 96.2%, 93.3% and for EUS-b-FNA 88%, 93.3% and 87%, respectively and no significant differences for both methods were noted (P = 0.62, 0.44, 0.35). No severe complications afterall biopsies were observed. A six months clinical follow up included all negative LCP with enlarged LAG.CONCLUSIONS:After our study EUS-b-FNA seems to be a reasonable method of choice for LAG assesssment in LCP.

INTRODUCTION Patients with resectable lung cancer require invasive evaluation of the enlarged left adrenal gland (LAG). Few studies showed the utility of endoscopic ultrasound using ultrasound bronchoscope (EUS-B) in LAG assessment. Moreover, little is known on the combination of computed tomography (CT), positron emission tomography-computed tomography (PET-CT), and EUS-B for predicting left adrenal metastasis. PATIENTS AND METHODS In this retrospective cohort study performed from 2012 to 2019, patients with left adrenal enlargement were evaluated by CT, PET-CT, and EUS-B, followed by complete endoscopic mediastinal staging. The adrenal glands were sampled by EUS-B-guided fine-needle aspiration. Patients were followed for 6 months. RESULTS During the staging of lung cancer in 2176 patients, 113 enlarged LAGs (5.19%) were biopsied. Malignancy was reported in 51 LAGs (45.13%). Endoscopic ultrasound upstaged 7 patients (6.2%) and downstaged 11 patients (9.37%) after false CT or PET-CT findings. There were no biopsy-related complications. Radiologic predictors of left adrenal metastases had the highest yield at the following cutoff points: Hounsfield units >23, standardized uptake value >4.2, and LAG size >25 mm. Hypoechogenic LAGs with loss of sea-gull shape on EUS-B were associated with a 28.67-fold higher likelihood of metastases. The sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for all ultrasound predictors were 86.21%, 85.45%, 85.84%, 85.45%, and 86.21%, respectively. When combined with radiologic features, the respective values were 93.10%, 94.55%, 93.81%, 92.86%, and 94.74%. CONCLUSIONS Hypoechogenicity and loss of sea-gull shape on EUS-B are the most reliable predictors of left adrenal metastasis. The combination of CT, PET-CT, and EUS-B improves the noninvasive diagnosis of left adrenal metastases in lung cancer patients.

Introduction: According to the most popular approach transbronchial lung cryobiopsy (TBLC) is performed in intubated patient under fluoroscopic control. The histological yield of TBLC reaches 80%. Complications of this procedure are pneumothorax and bronchial bleeding. Objectives: In our pulmonology centers TBLC is guided by radial EBUS, and intubation and fluoroscopy are not used. 5 years after introducing this methodology we wanted to examine efficacy and safety profile of this approach and to find out how much the type of interstitial lung disease (ILD) influences the diagnostic yield of TBLC. Methods: A multicenter Polish retrospective study was conducted to analyze the influence of biopsy on the final diagnosis and complications in patients with granulomatous and other ILDs. Results: 167 patients (M:82,F:85) of mean age (SD) 54.5 (13.5) years underwent TBLC since March 2017 to January 2022. 85 due to suspicion of granulomatous ILD (sarcoidosis, HP, TBC) and 82 due to other ILDs. Sensitivity and accuracy of TBLC in both groups were 93.8%, 94.1% and 63%, 63.4%, respectively and significantly higher for granulomatous ILDs (p<0,05); overall were: 78.3% and 79%. Pneumothorax occurred in 4.7% in the first and 4.9% in the second group. No severe or moderate bleeding was reported in all. Conclusions: TBLC guided by radial EBUS miniature probe without intubation and fluoroscopy control is safe and has similar yield to other modalities. The type of suspected disease has the biggest impact on biopsy efficacy.