Arvind Kate

Endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging.

Lung cancer is one of the most prevalent types of cancer in the world. A complete diagnosis of lung cancer involves tissue acquisition for pathological subtype, molecular diagnosis and accurate staging of the disease to guide appropriate therapy. Real-time endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is minimally invasive and relatively safe procedure, which can be done on an outpatient basis under moderate sedation. EBUS-TBNA has been shown to be a safe modality to obtain tissue for diagnosis, staging and molecular profiling in lung cancer. EBUS-TBNA stands out in comparison with other modalities for tissue acquisition in lung cancer. EBUS-TBNA performed with the patient under moderate sedation yields sufficient tissue for sequential molecular analysis in most patients. In this review, we describe the role of EBUS-TBNA in various aspects of diagnosis and staging of lung cancer in the present era along with its future aspects.

Infraclavicular sensor site: A new promising site for transcutaneous capnography

Background. Transcutaneous measurement of carbon dioxide is routinely done at the earlobe site. In patients receiving non invasive ventilation or in the intensive care setting with necklines, an alternate measurement site would be useful. We started to use the infraclavicular site for transcutaneous measurements of carbon dioxide using a new digital sensor. Aim. Comparison of transcutaneous carbon dioxide with arterial carbon dioxide at the infraclavicular site. Methods. We retrospectively compared transcutaneous carbon dioxide at the infraclavicular site with arterial carbon dioxide in 50 samples. The Sentec Digital Monitoring System (Sentec AG, Therwil, Switzerland) was used. The V-Sign digital sensor was placed on the infraclavicular site at the medial two third and one third point from the sternoclavicular joint and acromioclavicular joint. Results. When comparing PcCO2 with PaCO2 values, the Bland-Altman analysis revealed a bias of 0.02 kPa (95% CI: [− 0.1; 0.14]) with a precision of 0.42 kPa. Linear regression analysis describes the relationship between the two methods. The slope of the linear model was 0.85 ± 0.04 and the intercept was 0.77 ± 0.21 (RSE = 0.37 , R2 = 0.91). Conclusion. The measurement of transcutaneous carbon dioxide at the infraclavicular site is feasible with a digital sensor and has a good correlation with the carbon dioxide values obtained from the arterial blood gas. The findings of the current study form the basis for further clinical studies for its regular application in clinical use.

Primary pleural synovial sarcoma: A rare cause of hemorrhagic pleural effusion in a young adult.

This is a case report of a young adult presenting with hemorrhagic pleural effusion. Chest CT scan showed loculated pleural effusion with pleural nodule. Whole body PET scan showed thickening of pleura with multiple enhancing pleural nodules with different metabolic activity. Pleural nodule was biopsied which on histopathology showed pleural synovial sarcoma.

Bronchoscopic and surgical management of rare endobronchial tumors

Pure endobronchial neoplasms are a rare entity, and they may present with diverse pathological findings. Malignant diseases are more common than benign ones, and they mostly originate from the surface epithelium. Endobronchial tumors usually present with symptoms such as cough, hemoptysis, recurrent pneumonia, wheezing, and chest pain. Flexible bronchoscopy is necessary for diagnosis and evaluation of these endobronchial tumors. Advance bronchoscopy or definitive surgery is the modality of treatment for these tumors based on the presentation. We present a case series of patients suffering from different rare endobronchial tumors and their management along with the review of literature.

ALK positivity on pleuroscopic pleural biopsy in lung adenocarcinoma

Lung cancer is the leading cause of cancer deaths worldwide, and around 75% to 80% of lung cancers are detected in advanced stage. Multiple genetic mutations are identified and reported in adenocarcinoma of the lung. Various pulmonary samples can be tested for molecular mutations in lung cancer. However, feasibility of molecular profiling of pleuroscopic pleural biopsies in lung adenocarcinoma is not reported. We describe a case of advanced adenocarcinoma of lung with positive anaplastic lymphoma tyrosine kinase mutation on pleuroscopic pleural biopsy and improved with oral crizotinib. The current case highlights the feasibility of pleuroscopy.-guided pleural biopsies in molecular profiling of lung adenocarcinoma.

Diagnostic value of core biopsy histology and cytology sampling of mediastinal lymph nodes using 21-gauge EBUS-TBNA needle

INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the initial modality of choice in sampling mediastinal lymphadenopathy. It is possible to obtain both cytological and histological samples using both 21-gauge and 22-gauge EBUS-TBNA needles. The current study was undertaken to compare the diagnostic yield of cytology and histology samples obtained by the same EBUS-TBNA 21-gauge needle. PATIENTS AND METHODS One hundred sixty-six consecutive patients who underwent EBUS-TBNA with a 21-gauge EBUS-TBNA needle over a period of 3 years were included in this retrospective analysis. The diagnostic yields of EBUS-TBNA histology (EBUS-TBNA-H) and EBUS-TBNA cytology (EBUS-TBNA-C) specimens were compared using the McNemar test. RESULTS The overall sensitivity and specificity of EBUS-TBNA were 89% and 100%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA were 100% and 53%, respectively. The overall sensitivity and specificity of EBUS-TBNA-H were 85% and 100%, respectively. The PPV and NPV of EBUS-TBNA-H were 100% and 43%, respectively. The overall sensitivity and specificity of EBUS-TBNA-C were 65% and 100%, respectively. The PPV and NPV of EBUS-TBNA-C were 100% and 14%, respectively. The diagnostic yield of EBUS-TBNA-H over EBUS-TBNA-C was statistically significant (P < 0.0001). CONCLUSION EBUS-TBNA-H with 21-gauge needle significantly improves the diagnostic yield of EBUS-TBNA. EBUS-TBNA-H improves the NPV of EBUS-TBNA. The combination of EBUS-TBNA-H and EBUS-TBNA-C improves the overall diagnostic yield of EBUS-TBNA.

Role of Bronchoscopy in Hemoptysis

Hemoptysis is a common and alarming symptom. There are no accepted volume-based definitions of non-massive or massive hemoptysis. For practical purposes, massive hemoptysis is better defined on the basis of magnitude of effect rather than the amount of expectorated blood. Acute bronchitis is the most common cause of non-massive hemoptysis. The common causes of massive hemoptysis include bronchiectasis, tuberculosis, lung cancer, and mycetoma. Bronchoscopy plays a central role in the evaluation and management of hemoptysis. Direct inspection allows localization of the bleeding site and isolation of bleeding segment to prevent flooding of non-bleeding lung and asphyxiation. Rigid bronchoscope is preferred over flexible bronchoscope for management of massive hemoptysis but its utility is limited by lack of trained personnel in majority of medical centers. In the absence of facilities for rigid bronchoscopy, it is prudent to secure airway with a large endotracheal tube, perform early flexible bronchoscopy, and initiate aggressive resuscitative measures. Several bronchoscopic techniques such as balloon tamponade, topical application of cold saline, vasoconstrictors, and pro-coagulant substances may be applied for temporary control of bleeding. Interventional techniques such as laser photoresection and argon plasma coagulation may be helpful in selected cases. Temporary control of bleeding may facilitate institution of definitive therapies such as bronchial artery embolization and surgery in selected patients.

Neoadjuvant bronchoscopic intervention: Bridge to lung parenchyma sparing surgery

Sir, The role of interventional bronchoscopy with laser, bronchial dilatation or stent insertion is well-established for the palliative treatment of malignant endobronchial lesions as well as for the management of benign central airway lesions. Therapeutic bronchoscopy has also been reported in patients with malignant disease followed by surgery with Additionally, we seek to know the mode of data collection with the use of the EORTC-QLC-C30 questionnaire. It is unlikely that the patients were provided the original version of the questionnaire, which is available in the English language. If translated versions were used, it is of prime importance that validated translations were used.

Resistance pattern to WHO category IV anti tuberculous drugs in patients suspected of multidrug resistance tuberculosis presenting to a specialist clinic in Maharashtra, India

Rationale: Patients with suspected multi drug resistant tuberculosis (MDR TB) may be empirically started/maintained on WHO category 4 regimen. We retrospectively analyzed the drug sensitivity pattern to CAT IV anti TB drugs in patients suspected to have MDR TB. Methods: 67 consecutive patients suspected to have MDR TB & subsequently having sputum or BAL for TB culture positive with drug sensitivity tests were retrospectively analysed. Results: 43/67 patients (64.1%) had MDR TB. 4/67 patients (5.9%) had extremely drug resistant tuberculosis (XDR TB). 22/67 patients (32.8%) had resistance to all first line anti TB drugs. Out of the 5 drugs tested in CATEGORY IV: 4/67 patients (5.9%) had resistance to all 5 drugs, 10/67 patients (14.9%) to 4 drugs, 11/67 patients (16.4%) to 3 drugs, 17/67 patients (25.3%) to 2 drugs & 10/67 patients (14.9%) to one drug. View this table: View this table: Conclusion: In vitro drug resistance to CATEGORY IV anti TB drugs is high in our region in patients suspected to have MDR TB. All patients with suspected MDR TB do not exhibit resistance to rifampicin or isoniazid.This poses challenges to administering empiric anti-TB treatment in the management of MDR TB. Should empiric treatment of MDR TB (whenever administered) include rifampicin and isoniazid?