How to cite this article:
Dutt TS, Biswas B, Dabkara D, Ganguli S, Moses, Midha D, Geetasheree, Dey D, Chatterjee A, Mukhopadhay S, Ghosh P, Basak S, Chatterjee S. Mediastinal Sampling with Endobronchial Ultrasound in Cancer Patients: Is It Always Metastatic?. Indian J Chest Dis Allied Sci 2020; 62 (4):193-196.
Objective: The overall management and prognosis of a cancer patient depends on the histopathology, molecular genetics and staging of the disease. Staging refers to the size and the spread of the cancer. Knowing the stage of the cancer helps us to determine the natural history of the disease and median survival. It also helps us plan the best treatment for the patient. Mediastinal staging with invasive modalities, like endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become important for appropriate tissue sampling in patients with mediastinal involvement in various benign and malignant diseases.
Methods: A retrospective, cross-sectional study was done in a single tertiary care cancer centre from January, 2018 to December, 2018.The patients were referred for mediastinal staging and/or for diagnostic evaluation. The procedure EBUS-TBNA with rapid on-site evaluation (ROSE) was done for 123 patients as a day-care procedure in the bronchoscopy suite of the institution.
Results: Out of the total of 123 cases that underwent EBUS, 119 patients had an EBUS-TBNA for lymph node assessment. Staging in lung cancer, breast cancer, colon cancer, renal cell carcinoma was done in 63 (52.9%) cases and diagnostic evaluation of either a mediastinal mass lesion or a lung mass with mediastinal extension of lymph nodal involvement was done in 56 (47.1%) cases. Out of the 63 cases those underwent EBUS-TBNA for staging, 39 (61.9%) cases were non metastatic; 15 (38.4%) were diagnosed with granulomatous inflammation and 24 (61.5%) cases had reactive lymphadenitis. The remaining 24 of 63 cases had metastatic disease. Out of the 56 cases for diagnostic evaluation, 17 (30.3%) had granulomatous inflammation, 7 (12.5%) had reactive lymphadenitis and 32 (57.1%) had malignant disease.
Conclusions: Tissue pathology is always the crux to label a patient with the appropriate diagnosis. Moreover, accurate tissue sampling is important for mediastinal nodes in a diagnosed malignant disease, like lung cancer and breast cancer. This will help in appropriate staging and choose the proper treatment strategy.
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Gaude G, Lolly M, Hattiholi J, Patil B. Reliability and Validity of Clinical COPD Questionnaire and Chronic Respiratory Questionnaire in Patients with COPD using Tiotropium Over a Period of 26 Weeks. Indian J Chest Dis Allied Sci 2020; 62 (4):197-201.
Objectives: Patient-centred outcomes, such as health-related quality-of-life (HRQoL) are as important as improvement in the lung function for the optimal management of the patients with chronic obstructive pulmonary disease (COPD). Questionnaires used to assess HRQoL of the patients with COPD should have good reliability, validity and responsiveness. The aim of this study was to investigate and compare the reliability, validity and responsiveness of the Clinical COPD Questionnaire (CCQ) and Chronic Respiratory Questionnaire (CRQ) in patients with mild-to-moderate COPD taking tiotropium.
Methods: Seventy-one newly diagnosed patients with mild-to-moderate COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included in the study and started on tiotropium (18mcg Transcaps/9mcg metered-dose inhaler), as tiotropium improves the quality-of-life in patients with COPD. Lung function tests were done with a spirometer. The CCQ and CRQ were completed for these patients along with a proforma. Patients were then followed up to 26 weeks with repeat questionnaires and spirometry.
Results: Sixty-six patients were analysed as five patients were lost to follow-up. The CCQ was found to be more reliable as compared to CRQ with a Crohnbach's alpha of 0.88. The total score of CCQ and CRQ at baseline were able to discriminate between the GOLD stages making both CCQ and CRQ valid. The CCQ and CRQ were responsive at 8 weeks, 16 weeks and 26 weeks in all domains after the administration of tiotropium as compared to baseline.
Conclusions: The CCQ was observed to be more reliable than CRQ. Moreover, the CCQ is easier to administer and interpret compared to CRQ. Therefore, CCQ is better than CRQ for the optimal management of COPD; however, both the questionnaires can be used for future studies involving patients with mild-to-moderate COPD.
Viraaj Pratap Singh Pannu,
Ranjan Kumar Behera
India has the ambitious plan to End TB by 2025 which is five years ahead of the global strategy. To emphasise the point and not to be complaisant, the earlier Revised National Tuberculosis Control Programme (RNTCP) has been renamed as the National Tuberculosis Elimination Programme (NTEP) since January 2020. In this comprehensive review, various issues, weaknesses, strategies and their associated problems have been discussed. Starting with the problems of tuberculosis (TB) magnitude particularly latent TB infection, co-morbid conditions, like human immunodeficiency virus (HIV), diabetes mellitus, smoking, over-crowding, under-nutrition, immune-suppression, occupations like silicosis, etc have been reviewed and highlighted. Case notification, participation of private sector, diagnostic and treatment issues are discussed. Drug resistant TB (DR-TB) has also been described. Newer advances like molecular testing and treatment modalities including short course treatment and standardised longer regimens with injection free protocols are followed by the programme so that it will be possible in future for the patients to be diagnosed early, become more compliant and the treatment success will improve. Issues regarding prevention of TB in India with chemoprophylaxis, airborne infection control and future of vaccines are discussed in brief. National Strategic Plan (NSP) for 2017-25 and the Draft NSP for 2020- 25 are also discussed with their possible impact to End TB by 2025.
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Grover K, Srishti, Saumya, Ahluwalia A. A Rare Cause of Complete Lung Collapse Due to Allergic Bronchopulmonary Aspergillosis. Indian J Chest Dis Allied Sci 2020; 62 (4):229-230.
Mucoepidermoid carcinoma of the tracheo-bronchial tree is a rare tumour. We report a case of mucoepidermoid carcinoma of the trachea presenting with symptoms of intractable cough and wheeze. Chest radiograph at presentation was normal and patient was evaluated with routine investigations. Contrast-enhanced computed tomography (CECT) of the chest revealed a tracheal tumour. Video-assisted bronchoscopy and biopsy revealed it as mucoepidermoid carcinoma. The tumour was excised by coring with rigid bronchoscope and total resection of the bed was done by the cardiothoracic surgeon.