Performance and safety of endoscopic procedures in superior vena cava syndrome
Bibliographic record
Abstract
Rationale: Promptly obtaining a diagnosis is crucial in the management of patients with superior vena cava syndrome (SVCS) but endoscopic procedures in this population have not been well studied. Methods: We reviewed all patients presenting with a SVCS and referred for endoscopic procedures in our center over 5 years. Results: Forty-three patients underwent 64 procedures, including 23 EBUS. Most patients had a malignant diagnosis (93%). Twelve (19%) patients had a SVCS severity score > 3/4 and 22 (40%) had central airway obstruction > 50%. Diagnostic yield of standard bronchoscopy and EBUS were respectively 81.3% and 87.0%. Minor complications were reported in 8 (13%) procedures, consisting of 4 (6%) bleedings requiring topical treatments and 6 (9%) transient hypoxemias extending more than an hour after the procedure. Three patients had major complications, including a tension pneumothorax during positive pressure ventilation in a patient with a tracheoesophageal fistula, an emergent cricotomy in a patient with a tracheal tumor who could not be ventilated or intubated after induction of general anesthesia and unstable atrial fibrillation in a patient with a neoplastic pericardial effusion. Type of procedure, SVCS severity or presence of significant central airway obstruction were not associated with more frequent complications. Conclusions: Endoscopic procedures have a good diagnostic yield in patients with SVCS. Minor complications were not uncommon but did not alter patient trajectory. We feel that major complications in our cohort were not related to the SVCS, but rather to the underlying malignancy and its proximity to central vital structures. These factors must be considered when selecting diagnostic tests.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".