Research in treatment of non-small cell lung cancer (NSCLC) has shown promising results with stereotactic ablative radiotherapy (SABR) of oligometastatic disease, wherein distant disease may be ...limited to one or a few distant organs by host factors. Traditionally, PET/CT has been used in detecting metastatic disease and avoiding futile surgical intervention, however, sensitivity and specificity is limited to only 81 and 79%, respectively. Mediastinal staging still identifies occult nodal disease in up to 20% of NSCLC patients initially thought to be operative candidates. Endobronchial ultrasound and transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive tool for the staging and diagnosis of thoracic malignancy. When EBUS is combined with endoscopic ultrasound using the same bronchoscope (EUS-B), the diagnostic sensitivity and negative predictive value increase to 84 and 97%, respectively. Endoscopic staging in patients with advanced disease has never been studied, but may inform treatment if a curative SABR approach is being taken.
This is a multi-centre, prospective, cohort study with two-stage design. In the first stage, 10 patients with oligometastatic NSCLC (lung tumour ± hilar/mediastinal lymphadenopathy) with up to 5 synchronous metastases will be enrolled An additional 19 patients will be enrolled in the second stage if rate of treatment change is greater than 10% in the first stage. Patients will be subject to EBUS or combined modality EBUS/EUS-B to assess bilateral lymph node stations using a N3 to N2 to N1 progression. Primary endpoint is defined as the rate of change to treatment plan including change from SABR to conventional dose radiation, change in mediastinal radiation field, and change from curative to palliative intent treatment.
If a curative approach with SABR for oligometastatic disease is being explored, invasive mediastinal staging may guide treatment and prognosis. This study will provide insight into the use of endoscopic mediastinal staging in determining changes in treatment plan of NSCLC. Results will inform the design of future phase II trials.
Clinicaltrials.gov identifier NCT04852588. Date of registration: April 19, 2021.
1.1 on December 9, 2021.
About the Authors: Jason Rajchgot Affiliation: Department of Medicine, University of Toronto, Toronto, Canada Jean T. Coulibaly Affiliations Unité de Formation et de Recherche Biosciences, Université ...Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland Jennifer Keiser Affiliations Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland Jürg Utzinger Affiliations Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland Nathan C. Lo Affiliations Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America, Division of Epidemiology, Stanford University School of Medicine, Stanford, California, United States of America Michael K. Mondry Affiliation: Department of Mechanical Engineering, Stanford University, Stanford, California, United States of America Jason R. Andrews Contributed equally to this work with: ...Ivorian laboratory technicians used the Newton Nm1 handheld microscope with a mobile-phone attachment to detect Plasmodium falciparum in a community-based screening program in rural Côte d’Ivoire, with sensitivity and specificity of 80.2% and 100.0%, respectively, compared to “gold” standard microscopy 8. ...there is a need for innovative manufacturing pathways and viable business models. ...the devices must be shown to provide significant value to current models, such as ease of use, portability, and improving access to care.
A 73-year old woman was referred to our interventional pulmonology clinic for diagnosis and management of a large left sided pleural effusion. Her medical history included an early stage melanoma ...excised from her left shoulder 1 year prior. Medical thoracoscopy was performed for simultaneous tissue diagnosis, drainage of effusion and placement of a tunneled pleural catheter. Thoracoscopy revealed innumerable, black, nodular deposits along both visceral and parietal pleural. Pathology was positive for melanoma. She had dramatic improvement in dyspnea when reassessed in clinic one week later.
This is a multi-centre, prospective, cohort study with two-stage design. In the first stage, 10 patients with oligometastatic NSCLC (lung tumour + or - hilar/mediastinal lymphadenopathy) with up to 5 ...synchronous metastases will be enrolled An additional 19 patients will be enrolled in the second stage if rate of treatment change is greater than 10% in the first stage. Patients will be subject to EBUS or combined modality EBUS/EUS-B to assess bilateral lymph node stations using a N3 to N2 to N1 progression. Primary endpoint is defined as the rate of change to treatment plan including change from SABR to conventional dose radiation, change in mediastinal radiation field, and change from curative to palliative intent treatment. If a curative approach with SABR for oligometastatic disease is being explored, invasive mediastinal staging may guide treatment and prognosis. This study will provide insight into the use of endoscopic mediastinal staging in determining changes in treatment plan of NSCLC. Results will inform the design of future phase II trials.
Anemia remains a major public health issue in many African communities. We compared a novel, commercially available noninvasive hemoglobin (Hb)-measuring device to direct Hb measurements by ...finger-prick samples in a pediatric cohort in rural Côte d'Ivoire. Noninvasive Hb measurements were attempted in 191 children 2-15 years of age and obtained in 102 (53.5%) children. The median Hb for the 102 children was 12.0 g/dL (interquartile range IQR = 11.3-12.7 g/dL) for conventional absorptiometry and 13.3 g/dL (IQR = 12.1-14.2 g/dL) for noninvasive measurements. A Bland-Altman analysis demonstrated a median bias of +1.1 g/dL (IQR = 0.4-2.0 g/dL), with greater overestimation of Hb by noninvasive testing occurring at low Hb values. This overestimation of the noninvasive Hb-measuring device to direct Hb measurements persisted across preschool- and school-aged children, and both sexes. The Pearson correlation coefficient was 0.50 for children 4-9 years of age, and 0.33 for children 10-15 years of age. Further study and development of noninvasive Hb devices is necessary prior to implementation in African pediatric populations.
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