This document discusses the approach to peripheral lung nodules (PLNs). It begins by outlining low-dose CT scanning protocols and radiation doses. It then summarizes data from the National Lung Screening Trial showing a 20% reduction in mortality from lung cancer screening. Principles for screening Asian populations are discussed due to differences from Western populations. Guidelines for evaluating solid and subsolid nodules on imaging are presented. Techniques for bronchoscopic biopsy like navigation bronchoscopy are described and compared to transthoracic needle biopsy. Real-time localization is emphasized to optimize bronchoscopic yield. A case example illustrates these principles. Local data showing high diagnostic yield from bronchoscopic biopsy with navigation is also presented.
UOG Journal Club: September 2013
Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis
C. E. Kleinrouweler, P. M. M. Bossuyt, B. Thilaganathan, K. C. Vollebregt, J. Arenas Ramírez, A. Ohkuchi, K. L. Deurloo, M. Macleod, A. E. Diab, H. Wolf, J. A. M. van der Post, B. W. J. Mol and E. Pajkrt
Volume 42, Issue 3, Date: September 2013, pages 257–267
Link to the free-access article:
onlinelibrary.wiley.com/doi/10.1002/uog.12435/abstract
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
UOG Journal Club: September 2013
Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis
C. E. Kleinrouweler, P. M. M. Bossuyt, B. Thilaganathan, K. C. Vollebregt, J. Arenas Ramírez, A. Ohkuchi, K. L. Deurloo, M. Macleod, A. E. Diab, H. Wolf, J. A. M. van der Post, B. W. J. Mol and E. Pajkrt
Volume 42, Issue 3, Date: September 2013, pages 257–267
Link to the free-access article:
onlinelibrary.wiley.com/doi/10.1002/uog.12435/abstract
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
Probability of cancer in pulmonary nodules detected on first screening CT scanShadab Ahmad
More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation.
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Research suggests that chemotherapy may be related to a decline in cognitive
functions such as memory and attention in some solid tumor cancer patients.
However, the presence, extent and course of any cognitive decline and whether or not
it causes observable difficulties for patients remain unclear. The majority of research studies to date have explored cognitive function in cancer patients after treatment has been completed. Few studies have measured patients’ cognitive function prior to the commencement of chemotherapy treatment and hence these studies do not have any baseline. Measuring cognitive function both before and after chemotherapy would make it possible to identify changes occurring during treatment and the duration of such treatment related changes. An additional limitation of existing studies is that they have often lacked a
comparison group (e.g. cancer patients who have not required chemotherapy) against
which to compare cognitive function scores. Furthermore, the majority of cognitive
research to date has focussed on female breast cancer patients. This has precluded an exploration of gender differences in relation to cognitive decline.
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Weight loss among patients with Head and Neck Cancer at St Vincent's Hospital...Cancer Institute NSW
Patients with Squamous cell carcinoma (SCC) of the Head and Neck (H&N) are often treated with curative intent using treatment protocols placing them at high risk of nutritional decline. Recently released COSA guidelines recommend that prophylactic enteral feeding should be considered for T4 upper aerodigestive tract tumours undergoing concurrent chemoradiotherapy. Evidence is yet to identify optimal method of nutrition intervention and timing across all tumour stages in this population.
Probability of cancer in pulmonary nodules detected on first screening CT scanShadab Ahmad
More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation.
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Research suggests that chemotherapy may be related to a decline in cognitive
functions such as memory and attention in some solid tumor cancer patients.
However, the presence, extent and course of any cognitive decline and whether or not
it causes observable difficulties for patients remain unclear. The majority of research studies to date have explored cognitive function in cancer patients after treatment has been completed. Few studies have measured patients’ cognitive function prior to the commencement of chemotherapy treatment and hence these studies do not have any baseline. Measuring cognitive function both before and after chemotherapy would make it possible to identify changes occurring during treatment and the duration of such treatment related changes. An additional limitation of existing studies is that they have often lacked a
comparison group (e.g. cancer patients who have not required chemotherapy) against
which to compare cognitive function scores. Furthermore, the majority of cognitive
research to date has focussed on female breast cancer patients. This has precluded an exploration of gender differences in relation to cognitive decline.
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Weight loss among patients with Head and Neck Cancer at St Vincent's Hospital...Cancer Institute NSW
Patients with Squamous cell carcinoma (SCC) of the Head and Neck (H&N) are often treated with curative intent using treatment protocols placing them at high risk of nutritional decline. Recently released COSA guidelines recommend that prophylactic enteral feeding should be considered for T4 upper aerodigestive tract tumours undergoing concurrent chemoradiotherapy. Evidence is yet to identify optimal method of nutrition intervention and timing across all tumour stages in this population.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. MELVIN TAY CK MBBS (S’pore), MMed (Int Med), MRCP (Lond)
DIRECTOR OF INTERVENTIONAL PULMONOLOGY
DEPT OF RESPIRATORY & CRITICAL CARE MEDICINE, SINGAPORE GENERAL HOSPITAL
SINGHEALTH DUKENUS LUNG CENTRE
ADJ ASST PROFESSOR, DUKE-NUS MEDICAL SCHOOL
How to approach the
PERIPHERAL LUNG NODULE (PLN)
2. 2
• No IV contrast
• Scanned at full inspiration (1 –1.5mm slice cuts)
• Radiation exposure 0.65 – 1.5mSv (6 m*)
• Comparison
Low Dose CT
CXR 0.1 mSv 10 h *
CT thorax 3.5 – 7 mSv Up to 2 yrs *
CTPA 10 – 15 mSv 5 yrs *
CTAP 15 – 30 mSv Up to 10 years *
* Time equivalent of environmental radiation exposure
4. 4
• 15,792 patients
– Current/former smokers 50 - 75 yrs
– ≥ 15 pack-year smoking history
– Former smokers quit < 10 yrs
• Screening
– baseline, year 1, 3, 5.5
• Volumetric nodule identification
strategy
• CT scanning decreased mortality over
a 10-year period
– 26% in high-risk men
– 61% in high-risk women
NELSON Trial
De Koning H et al: Effects of volume CT lung cancer screening: Mortality results of the NELSON randomized-controlled
population based trial. 2018 World Conference on Lung Cancer. Abstract PL02.05. Presented September 25, 2018.
5. 5
• Risk assessment of malignancy in West
not applicable
– High TB prevalence
– Non-smoking females & adenoCA
• PET caveats
– False +ve: TB & other infections
(fungal, parasitic)
– False -ve: slow growing tumors e.g.
adenoCA
• Shared discussion
– Patient’s preference & risk appetite
Principles in Approach to the Asian PLN
6. 6
Solid Nodule
1. 8mm cut-off
– >8 mm then evaluate
2. Estimate risk of malignancy
– clinical or validated region-specific tool
3. Biopsy if moderate risk (5-60%) & accessible
– non-surgical vs. surgical
4. Can consider PET if
a. Non-surgical biopsy –ve
b. To decide whether for surveillance vs.
surgical biopsy
Qn 1 – Watch or Act?
Radiology. 2017 Jul;284(1):228-243.
Surveillance if
a. Risk of malignancy < 5%
b. Non-diagnostic biopsy & PET –ve
c. Patient’s choice
Low dose CT 3-6, 9-12, 18-24 months
Fleischner 2017 Guideline
Chest. 2016 Oct;150(4):877-893.
7. 7
Qn 1 – Watch or Act?
Chest. 2016 Oct;150(4):877-893. Radiology. 2017 Jul;284(1):228-243.
In certain suspicious nodules < 6 mm, consider follow-up at 2 & 4
years. If solid component(s)/ growth develops, consider resection.
Subsolid Nodule
6 mm
13. 13
US - Probe Within Lesion
Chest. 2007 Aug;132(2):603-8.
Probe within lesion
83%
Probe outside lesion
4%
Probe adjacent to lesion
61%
14. 14 Herth FJ et al. Bronchoscopic transparenchymal nodule access (BTPNA): first in human trial of a novel procedure for
sampling solitary pulmonary nodules. Thorax. 2015 Apr;70(4):326-32.
Bronchoscopic Transparenchymal Nodule Access
(BTPNA)
Archimedes®
LUNGPRO
15. 15
1. Pre-procedure planning
2. Endoscopic navigation
3. Real-time localization
4. Adequacy of sampling
Qn 3 – How to Optimize Bronchoscopic Yield?
16. 17
• 47 yo Malay woman
• Never smoker, IT manager
• Chronic neck and back pain seeing chiropractor
• Spine XRs: well-circumscribed nodule, 1.6cm
• Asymptomatic
Case Illustration
23. 27
• 56-year-old woman
• Non-smoker
• Cough x 3 months
• CXR: nodular infiltrates in right mid and lower zones
• Referred to oncology for suspected pulmonary metastases
• CT TAP: 2 thin-walled cavities in RLL, 11 x 18mm and 16 x 26mm
• Induced sputum: AFB smear, TB cultures, TB PCR all -ve
My 1st case in 2011
