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The diagnosis of lung cancer in the era of interventional pulmonology

Liam CK, Lee P, Yu CJ, Bai C, Yasufuku K

Int J Tuberc Lung Dis, 2021 01 01;25(1):6-15.
PMID: 33384039 DOI: 10.5588/ijtld.20.0588

Advances in bronchoscopic and other interventional pulmonology technologies have expanded the sampling procedures pulmonologist can use to diagnose lung cancer and accurately stage the mediastinum. Among the modalities available to the interventional pulmonologist are endobronchial ultrasound-guided transbronchial needles aspiration (EBUS-TBNA) and transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for sampling peribronchial/perioesophageal central lesions and for mediastinal lymph node staging, as well as navigational bronchoscopy and radial probe endobronchial ultrasound (RP-EBUS) for the diagnosis of peripheral lung cancer. The role of the interventional pulmonologist in this setting is to apply these procedures based on the correct interpretation of clinical and radiological findings in order to maximise the chances of achieving the diagnosis and obtaining sufficient tissue for molecular biomarker testing to guide targeted therapies for advanced non-small cell lung cancer. The safest and the highest diagnosis-yielding modality should be chosen to avoid a repeat sampling procedure if the first one is non-diagnostic. The choice of site and biopsy modality are influenced by tumour location, patient comorbidities, availability of equipment and local expertise. This review provides a concise state-of-the art account of the interventional pulmonology procedures in the diagnosis and staging of lung cancer.

Matched MeSH terms: Pulmonary Medicine*
Fulltext Application of phase congruency for discriminating some lung diseases using chest radiograph

Rijal OM, Ebrahimian H, Noor NM, Hussin A, Yunus A, Mahayiddin AA

Comput Math Methods Med, 2015;2015:424970.
PMID: 25918551 DOI: 10.1155/2015/424970

A novel procedure using phase congruency is proposed for discriminating some lung disease using chest radiograph. Phase congruency provides information about transitions between adjacent pixels. Abrupt changes of phase congruency values between pixels may suggest a possible boundary or another feature that may be used for discrimination. This property of phase congruency may have potential for deciding between disease present and disease absent where the regions of infection on the images have no obvious shape, size, or configuration. Five texture measures calculated from phase congruency and Gabor were shown to be normally distributed. This gave good indicators of discrimination errors in the form of the probability of Type I Error (δ) and the probability of Type II Error (β). However, since 1 - δ is the true positive fraction (TPF) and β is the false positive fraction (FPF), an ROC analysis was used to decide on the choice of texture measures. Given that features are normally distributed, for the discrimination between disease present and disease absent, energy, contrast, and homogeneity from phase congruency gave better results compared to those using Gabor. Similarly, for the more difficult problem of discriminating lobar pneumonia and lung cancer, entropy and homogeneity from phase congruency gave better results relative to Gabor.

Matched MeSH terms: Pulmonary Medicine/methods
Pediatric Flexible Bronchoscopy in Singapore: A 10-year Experience

Woodhull S, Goh Eng Neo A, Tang Poh Lin J, Chay OM

J Bronchology Interv Pulmonol, 2010 Apr;17(2):136-41.
PMID: 23168729 DOI: 10.1097/LBR.0b013e3181dc993a

To determine the results of children who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) in the Respiratory Medicine Service of Kandang Kerbau Women's and Children's Hospital from 1996 to 2005.

Matched MeSH terms: Pulmonary Medicine
Fulltext Sociodemographic factors associated with quality of life (QoL) among pulmonary tuberculosis patients in a Specialist Respiratory Hospital in Kuala Lumpur

Nurul Asyiqin Aziz, Anisah Baharom

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):88-88.
MyJurnal

Introduction: Tuberculosis negatively impacts the patients’ quality of life (QoL). Information on QoL among tuber-culosis patients may highlight gaps in the current management of the disease by identifying target groups with lower QoL. This study aimed to identify the sociodemographic factors associated with QoL among patients followed up in an urban tertiary hospital. Methods: A cross sectional study was conducted among adults with drug-sensitive pulmonary tuberculosis, selected using simple random sampling method, in the Institute of Respiratory Medicine, Kuala Lumpur. The WHOQOL BREF was utilised to evaluate the physical, psychological, social relationships and environment domains of QoL. Descriptive analysis and univariate analyses to test association between independent sociodemographic factors and QoL domain mean scores were done. Results: A total of 237 patients participated with a response rate of 96.34%. The factor associated with the physical domain was sex (t = 2.06, p = 0.04), whilst age (F = 3.77, p = 0.02), sex (t = 4.04, p < 0.001), marital status (F = 3.09, p = 0.04) and education level (F = 4.92, p = 0.008) were associated with the social relationships domain. Age (F = 3.55, p = 0.03), sex (t = 2.12, p = 0.03), edu-cation level (F = 7.97, p < 0.001) and monthly household income (F = 3.57, p = 0.03) were factors associated with the environment domain. No sociodemographic factors were associated with the psychological domain in this study. Conclusion: Patients who were younger, female, married, had tertiary education or monthly household income of more than RM6000 were associated with higher QoL. Targeted interventions among the sociodemographic groups with lower QoL could complement current clinical management to improve tuberculosis patients’ QoL.

Matched MeSH terms: Pulmonary Medicine
Usefulness of stable microbubble test of tracheal aspirate for the diagnosis of neonatal respiratory distress syndrome

Boo NY, Cheong KB, Cheong SK, Lye MS, Zulfiqar MA

J Paediatr Child Health, 1997 Aug;33(4):329-34.
PMID: 9323622

OBJECTIVES: To compare the overall accuracy of the stable microbubble test (SM test) with measurement of level of surfactant protein A (SP-A) of tracheal aspirate for the diagnosis of respiratory distress syndrome (RDS).
METHODOLOGY: Tracheal aspirates were obtained from neonates on ventilatory support. The SM test was carried out on specimens of tracheal aspirate immediately after collection. Levels of SP-A in tracheal aspirates were determined by enzyme-linked immunosorbent assay (ELISA) method. The results of the SM test and SP-A level of the tracheal aspirates were compared against the clinical diagnosis of RDS based on clinical, radiological and bacteriological findings.
RESULTS: Both the median microbubble counts (6 microbubbles/mm2, range = 0-90) and median SP-A levels (100 micrograms/L, range = 0-67447) of infants with RDS were significantly lower than those of infants with no obvious lung pathology (P < 0.0001), and pneumonia (P < 0.0001). The SM test of tracheal aspirates had higher overall accuracy for the diagnosis of RDS than measurement of SP-A levels (94.6% vs 82.4%). When the receiver operating characteristic (ROC) curves of both tests for RDS were compared, the area under the ROC curve of the SM test was larger (0.9689) than that of the SP-A method (0.8965).
CONCLUSIONS: This study showed that the SM test of tracheal aspirate was a useful bedside diagnostic test for RDS. It could be carried out at any time after birth on infants requiring ventilatory support.

Matched MeSH terms: Pulmonary Medicine/methods