Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh

•Download as PPTX, PDF•

0 likes•7 views

Jindal Chest Clinic

"Ensuring tissue is not the issue - Exploring strategies for effective tissue management"

Health & Medicine

Making sure tissue is not the issue -
Pulmonologist’s perspective
Dr. Aditya Jindal
Interventional Pulmonologist & Intensivist
Jindal Clinics
SCO 21, Sec 20D, Chandigarh
DM Pulmonary and Critical Care Medicine (PGI Chandigarh),
FCCP

Why tissue is the issue!
• Histopathological diagnosis
• Ruling out alternate diagnoses
• Staging
• Molecular testing
• Rebiopsy
• Research

How to make sure?
Think before you do –
• Selection of correct site
• Choice of most appropriate procedure
• Size and number of biopsies/ other
procedures
• Pre-decide all you need from the tissue
• Availability of tissue for extended studies –
• mutations

• Procedures
– BAL (bronchoalveolar
lavage)
– EBB (endobronchial
biopsy)
– TBLB (trans bronchial
lung biopsy)
– TBNA (Trans bronchial
needle aspiration from
lymph nodes)
• EBUS-TBNA
• Thoracoscopic pleural
biopsy

Bronchoalveolar lavage
Endobronchial biopsy

Trans-bronchial lung biopsy
5-6 biopsies taken (5-20 sq mm)
Specimen should fill cup of forceps
More useful
• Diffuse lung involvement
• Large masses
• Peribronchial area
Less useful
• Small nodules
• Peripheral lesions

Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic
review and meta-analysis. Streinfort et al. Eur Respir J 2011; 37: 902–910

Comparison of Endobronchial Ultrasound, Positron Emission Tomography, and CT for Lymph
Node Staging of Lung Cancer. Yasufuku K et al. Chest 2006; 130:710-718
Characteristics of CT, PET, and EBUS TBNA in the Correct Prediction of
Mediastinal Lymph Node Staging

• Meta-analysis of almost 3000 patients
• EBUS-TBNA
– Sensitivity of 0.88–0.93 (95% CI, 0.79–0.94)
– Specificity of 1.00 (95% CI, 0.92–1.00)
– NPV of 91% (range, 83–96%)
• Sehgal et al. Endosonography Versus
Mediastinoscopy in Mediastinal Staging of Lung
Cancer: Systematic Review and Meta-Analysis. Ann
Thorac Surg 2016
• Cell block
– Immunohistochemistry
– Molecular testing success of >90%
– One of the lowest insufficiency rates (4%) for EGFR and KRAS
mutational analysis
• VanderLann et al. Endobronchial ultrasound-guided
transbronchial needle aspiration (EBUS-TBNA): an
overview and update for the cytopathologist. Cancer
Cytopathol. 2014
• Billah et al. EGFR and KRAS mutations in lung carcinoma:
molecular testing by using cytology specimens. Cancer
Cytopathol. 201

EBUS diagnosis Number Percentage
Sarcoidosis 137 55%
TB 41 16%
Malignancy 19 8%
Others 5 2%
Normal 14 5.6%
Total 249
EBUS yield
Positive 216 87%
Negative 33 13%

Malignant Pleural Effusions
12
Sensitivity of
different biopsy
methods (cytologic
and histologic
results combined)
for the diagnosis of
malignant pleural
effusions.
Patient with
malignant pleural
effusion due to
breast cancer. Small
whitish tumor
nodules on the
parietal (chest wall)
pleura are seen.
Tumor nodules and
whitish areas with
pleural thickening
on the parietal
(chest wall) pleura
are seen.

Bhatnagar R, Maskell NA. Medical pleuroscopy.
Clinics in chest medicine. 2013;34(3):487-500.
Thoracoscopy

Malignant mesothelioma presenting as parietal
pleural nodules
H&E, 100X showing tumour cells arranged
in sheets infiltrating the soft tissue.

Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh

This document summarizes a study on the role and accuracy of computed tomography (CT)-guided fine needle aspiration cytology (FNAC) of thoracic lesions. The study analyzed 55 patients with thoracic lesions who underwent CT-guided FNAC. It found high diagnostic accuracy of 94.2% for CT-guided FNAC, with a sensitivity of 92.5% and specificity of 100%. The most common lesions were lung cancers, with squamous cell carcinoma being the most frequent type. Complications from the procedure were minor. The study concluded that CT-guided FNAC is a highly sensitive and specific technique for diagnosing thoracic lesions, especially lung cancers.

Early Diagnosis of Lung Cancer - Presentation | Jindal Chest Clinic

Jindal Chest Clinic

Endobronchial Ultrasound Guidance of TBNA. Current Approach To Lung Cancer St...

Bassel Ericsoussi, MD

High Through-Put DNA Methylation Analysis of Lung Cancer: Plasma cfDNA for Bi...

Kate Barlow

Approach to pln guangxi 2019

Meredith Huang

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.

Etrapulmonary tuberculosis surgical management and recent advances

InduVanaparthi1

1) This document discusses recent advances in tuberculosis (TB) diagnostic modalities, management, and treatment. It covers microbiological, pathological, and radiological diagnostic tests as well as investigations for various forms of TB. 2) Recent advances include renaming the Revised National Tuberculosis Control Programme to the National Tuberculosis Elimination Programme in 2020 and a shift to treatment based on drug susceptibility testing rather than classification. 3) The document outlines standard drug resistant TB treatment regimens and management of TB in special populations like pregnant or breastfeeding women. It also covers surgical management of extrapulmonary TB sites like abdominal, renal, cervical, and anal TB.

Thoracic Malignancy.pdf

drperumal

This document discusses lung cancer screening and the workup and diagnosis of non-small cell lung cancer (NSCLC). It provides guidelines for lung cancer screening, including recommending low-dose CT screening for those aged 50-80 with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years. For solitary pulmonary nodules, it outlines algorithms for management based on size, symptoms, and risk calculators. The document then reviews the symptoms, diagnosis, staging workup and imaging findings of NSCLC, noting that chest X-ray and CT are used initially and invasive procedures may be needed to confirm diagnosis or stage the cancer.

1. Screening for lung cancer through low-dose helical CT is more sensitive than chest X-rays and can detect early-stage lung cancers when treatment may work better. 2. Early detection of lung cancer through screening improves survival rates as prognosis is better if the disease is detected before it has spread beyond early stages. 3. Biomarkers from sputum, blood, and other non-invasive sample types show promise as screening tools but require further validation before use in widespread screening.

MRI lungs

Subhajit Sen

MRI is useful for evaluating respiratory diseases in several ways: 1) It can replace CT scans for conditions like lung cancer screening, complicated chest masses, and pulmonary embolism in young or pregnant patients where reducing radiation exposure is important. 2) MRI provides better soft tissue contrast than CT, allowing more accurate assessment of conditions like mediastinal invasion by lung tumors or chest wall masses. 3) In addition to anatomical imaging, MRI can evaluate lung function by assessing perfusion, ventilation, and respiratory mechanics, which has benefits for diseases like cystic fibrosis and COPD. 4) However, CT remains better than MRI for imaging certain conditions like small pulmonary nodules, interstitial lung diseases, and emp

Investigations in Tuberculosis and advances

Nirish Vaidya

This document discusses various techniques for investigating Mycobacterium tuberculosis and advances in the field. It summarizes key characteristics of M. tuberculosis and the global burden of tuberculosis. It then describes several laboratory techniques for detecting and diagnosing tuberculosis, including sputum smear microscopy, mycobacterial culture methods, tuberculin skin testing, and newer molecular techniques such as nucleic acid amplification tests and interferon-gamma release assays. Advances in rapid molecular diagnostics and their applications for tuberculosis detection and drug resistance testing are also discussed.

Timing of surgery in mild biliary pancreatitis

Aravind TK

This study aimed to determine the optimal timing of cholecystectomy for patients with mild to moderate acute biliary pancreatitis. It was a prospective randomized controlled study conducted at a hospital in Malaysia between 2013-2014. 82 patients were randomly assigned to either early cholecystectomy within the index admission (n=38) or delayed cholecystectomy after 6 weeks (n=34). The study found significantly fewer recurrent biliary events like pain and infection in the early group compared to delayed group, with no significant difference in complication rates. The study concluded that for mild to moderate acute biliary pancreatitis, early laparoscopic cholecystectomy reduces risk of recurrence without increasing operative risks.

Common Bile Duct Stones: Leave Them Get Them or Refer Them

George S. Ferzli

The document discusses various approaches for managing common bile duct (CBD) stones, including: - Preoperative identification using blood tests, ultrasound, ERCP, MRCP, which have varying sensitivity and specificity - Intraoperative options like cholangiography, laparoscopic ultrasound, and indocyanine green injection - Postoperative ERCP can be used for diagnostic and therapeutic purposes but has risks of pancreatitis and cholangitis - The optimal management strategy depends on individual patient risk factors and circumstances.

1. difficult tb-heni retnowulan.pdf

teddykale

This document outlines diagnostic testing strategies for pulmonary and extrapulmonary tuberculosis. It recommends performing acid-fast bacilli smear microscopy, mycobacterial cultures, and nucleic acid amplification tests on respiratory samples from patients suspected of having pulmonary TB. For extrapulmonary TB, it suggests performing cell counts, chemistries, adenosine deaminase and interferon-gamma tests on fluid samples from suspected sites of infection. Several other tests are also discussed, including evaluations of serum proteins, microRNAs, volatile organic compounds, C-reactive protein, and their utility as diagnostic markers for tuberculosis.

Journal club

Priyatham Kasaraneni

This study evaluated the diagnostic utility of combined fine needle aspiration and core biopsy (CFNACB) in patients with prior non-diagnostic thyroid nodule FNAs. CFNACB was performed on 90 thyroid nodules in 82 patients with prior non-diagnostic FNAs. CFNACB yielded a diagnostic result in 87% of nodules, with core biopsy alone diagnostic in 77% of nodules. Core biopsy demonstrated superior diagnostic performance compared to repeat FNA. CFNACB was shown to be a safe procedure with no reported complications.

MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf

adhilaamariyil

1) Seminoma is the most common germ cell tumor in young males. The standard treatment for stage I seminoma is either surveillance, radiotherapy, or chemotherapy. 2) For stage IIA/B seminoma, treatment options are radiotherapy or 3-4 cycles of chemotherapy. Radiotherapy provides better outcomes for stage IIA. 3) Advanced or metastatic seminoma (stage IIC/III) is treated with chemotherapy, with 5-year survival rates of 95% for good prognosis patients and 87% for intermediate prognosis.

Indeterminate biliary stricture

Mahesh Raj

This document discusses diagnostic approaches for indeterminate biliary strictures. It notes that obtaining a histological diagnosis can be challenging due to low tumor cellularity and desmoplastic reactions. Multiple sampling techniques during ERCP like brush cytology, forceps biopsy, and needle biopsy have low and variable sensitivities ranging from 8-57% individually. Combining sampling methods can improve yields to around 63%. Newer devices like a scraping device and needle introducer with forceps have shown promise with sensitivities around 65-85% but require further study. Obtaining an adequate tissue sample remains a challenge in diagnosing these strictures.

chemotherapy for lung cancer by 001.pptx

sharifgbadamosi

medical thoracoscopy2022

rambhoopal1

Medical thoracoscopy (MT) is a minimally invasive procedure that uses rigid or semi-rigid thoracoscopes to directly visualize the pleural surfaces. It has diagnostic and therapeutic applications. The document discusses the history, techniques, indications, and innovations of MT. It notes that MT has a high diagnostic yield for conditions like tuberculosis and malignancies. Local anesthesia with conscious sedation is commonly used. Complications can include infection, bleeding, and re-expansion pulmonary edema. Ongoing studies are exploring modifications to MT techniques and applications in complex parapneumonic effusions.

what is new in prevention, diagnosis and treatment of tuberculosis tb short.pptx

PathKind Labs

Evaluation and imaging for lung SBRT

Naveen Mummudi

The document discusses the key steps in pre-SBRT workup including medical evaluation, tumor assessment, imaging, and motion management. It notes that patients with stage I lung cancer can be treated with surgery, sublobar resection, or SBRT depending on their risk level. For medically inoperable patients, imaging includes PET/CT and pathology confirmation if possible. Pulmonary function tests and cardiac evaluation are done. Tumor characteristics like size and location are assessed. During simulation, immobilization and respiratory motion management techniques like 4DCT are used to accurately define the tumor and organs at risk.

Electromagnetic Navigation Bronchoscopy (ENB): Clinical Review

Bassel Ericsoussi, MD

Specimen Handling IOMC.pptx

aguseriawan1

This document discusses specimen handling and biomarker testing for non-small cell lung cancer. It emphasizes the importance of proper specimen handling and fixation to ensure accurate biomarker results. Key drivers of lung adenocarcinoma are discussed, including mutations in KRAS, EGFR, ALK, and other genes. The biomarker testing process requires multidisciplinary collaboration between pulmonologists, pathologists, oncologists, and other specialists to ensure timely and successful testing that guides personalized treatment selection.

NSCLC housestaff

derosaMSKCC

This document provides an overview of non-small cell lung cancer (NSCLC). It discusses that NSCLC is the leading cause of cancer death, with the majority of cases diagnosed at an advanced stage. Smoking accounts for 90% of lung cancers. Screening trials have shown a 20% reduction in lung cancer mortality with low-dose CT scans. Surgical resection is the main treatment for early stage disease, while chemotherapy, chemoradiation, targeted therapies, and immune checkpoint inhibitors are used for advanced disease based on mutation status and histology. New targeted therapies and immunotherapies have improved outcomes for subsets of NSCLC patients.

Approach to a patient with respiratory infection

Srikant Mohta

This document provides an overview of acute respiratory infections including etiology, classification, clinical presentation, diagnostic evaluation and treatment approaches. It discusses the major syndromes of community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. Evaluation involves history, examination, hematological and microbiological testing. Severity is assessed using CURB-65 or Pneumonia Severity Index to determine site of care. Treatment selection is based on syndrome, severity and likely pathogens.

Small cell lung cancer staging and management

SatyajitPradhanMPMMC

This document provides information on the management of small cell lung cancer (SCLC). It begins with defining SCLC and describing its typical clinical presentation and features. It then discusses the epidemiology and etiology of SCLC, noting that it is caused primarily by tobacco smoking. The document outlines the recommended workup, staging, and prognostic factors for SCLC. It provides details on the evidence-based management of limited-stage and extensive-stage SCLC, including the use of chemotherapy, radiotherapy, surgery, and protocols for concurrent and sequential chemo-radiotherapy treatment.

Efficacy and safety of radiosurgery in patients with intracranial dural arter...

MQ_Library

This document summarizes a presentation on the efficacy and safety of radiosurgery for patients with intracranial dural arteriovenous fistulae. The presentation analyzed 13 studies including over 800 patients, finding a complete obliteration rate of 64% at 3.5 years follow up, but with a morbidity rate of around 4.5% from hemorrhage, radiation necrosis or neurological deficit. The presentation concluded that while radiosurgery can treat these fistulae, it may not be very effective for fistulae with cortical venous drainage and is not suitable as a first-line treatment strategy due to the moderate success and morbidity rates.

Lung Cancer Screening

Gamal Agmy

Lung cancer remains a leading cause of cancer death. While early detection improves survival rates, past screening studies using chest x-rays and sputum analysis failed to reduce mortality. New screening methods using low-dose CT scans have shown promise in detecting early-stage cancers. However, limitations include high false positive rates and the need for improved methods to assess growth of small nodules over time. Further research is still needed to determine if lung cancer screening using low-dose CT can reduce mortality and be cost-effective.

Therapeutic plasma Exchange (TPE ) | Jindal chest clinic

Jindal Chest Clinic

Acute Asthma Exacerbations | Jindal Chest Clinic

Jindal Chest Clinic

Similar to Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh

Screening and early detection of lung cancer

Mahmoud Elhusseiny Abolmagd

MRI lungs

Subhajit Sen

Investigations in Tuberculosis and advances

Nirish Vaidya

Timing of surgery in mild biliary pancreatitis

Aravind TK

Common Bile Duct Stones: Leave Them Get Them or Refer Them

George S. Ferzli

1. difficult tb-heni retnowulan.pdf

teddykale

Journal club

Priyatham Kasaraneni

MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf

adhilaamariyil

Indeterminate biliary stricture

Mahesh Raj

chemotherapy for lung cancer by 001.pptx

sharifgbadamosi

medical thoracoscopy2022

rambhoopal1

what is new in prevention, diagnosis and treatment of tuberculosis tb short.pptx

PathKind Labs

Evaluation and imaging for lung SBRT

Naveen Mummudi

Electromagnetic Navigation Bronchoscopy (ENB): Clinical Review

Bassel Ericsoussi, MD

Specimen Handling IOMC.pptx

aguseriawan1

NSCLC housestaff

derosaMSKCC

Approach to a patient with respiratory infection

Srikant Mohta

Small cell lung cancer staging and management

SatyajitPradhanMPMMC

Efficacy and safety of radiosurgery in patients with intracranial dural arter...

MQ_Library

Lung Cancer Screening

Gamal Agmy

Similar to Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh (20)

Screening and early detection of lung cancer

MRI lungs

Investigations in Tuberculosis and advances

Timing of surgery in mild biliary pancreatitis

Common Bile Duct Stones: Leave Them Get Them or Refer Them

1. difficult tb-heni retnowulan.pdf

Journal club

MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf

Indeterminate biliary stricture

chemotherapy for lung cancer by 001.pptx

medical thoracoscopy2022

what is new in prevention, diagnosis and treatment of tuberculosis tb short.pptx

Evaluation and imaging for lung SBRT

Electromagnetic Navigation Bronchoscopy (ENB): Clinical Review

Specimen Handling IOMC.pptx

NSCLC housestaff

Approach to a patient with respiratory infection

Small cell lung cancer staging and management

Efficacy and safety of radiosurgery in patients with intracranial dural arter...

Lung Cancer Screening

More from Jindal Chest Clinic

Therapeutic plasma Exchange (TPE ) | Jindal chest clinic

Jindal Chest Clinic

Acute Asthma Exacerbations | Jindal Chest Clinic

Jindal Chest Clinic

Acute Severe Asthma | Jindal chest clinic

Jindal Chest Clinic

Guidelines for asthma management | Jindal Chest Clinic

Jindal Chest Clinic

Thrombo-prophylaxis in Critical Care | Jindal chest clinic

Jindal Chest Clinic

Indian consensus statement for the diagnosis and management of IPF | Jindal c...

Jindal Chest Clinic

Presentation on "Diagnosis of ILD" | Jindal Chest Clinic

Jindal Chest Clinic

Physiology of the Respiratory System | Jindal chest clinic

Jindal Chest Clinic

Non respiratory functions of the respiratory system_by Dr. Aditya Jindal | Ji...

Jindal Chest Clinic

Molecular Diagnosis of Tuberculosis by Dr. Aditya Jindal | Jindal Chest Clinic

Jindal Chest Clinic

Difficult Airway Management | Jindal Chest Clinic

Jindal Chest Clinic

A difficult airway is a clinical situation in which a medical professional with training in airway management finds it difficult to use the recommended techniques. This presentation gives an overview on the topic "Difficult airway Management" including: difficult mask ventilation, preoxygenation, thyromental distance, laryngoscopy, cricothirotomy, etc. For more information, please contact us: 9779030507.

Difficult airway in ICU by Dr. Aditya Jindal | JIndal Chest Clinic

Jindal Chest Clinic

Anesthesia and sedation during flexible bronchoscopy | Jindal chest clinic

Jindal Chest Clinic

Recurrent Pneumothorax and Pleural Effusion Role of Pleuroscopy Thoracoscopy ...

Jindal Chest Clinic

Tuberculosis pathophysiology and diagnosis | Jindal Chest Clinic

Jindal Chest Clinic

Silicosis in India: Defining the problem and developing solutions | By Dr. S....

Jindal Chest Clinic

Pathology of tuberculosis of lung | Jindal Chest Clinic

Jindal Chest Clinic

Thoracic-oncology round | Jindal chest clinic

Jindal Chest Clinic

Pulmonary Vasculitis | Jindal Chest Clinic

Jindal Chest Clinic

Treatment of ILDs by Dr. S.K Jindal | JIndal Chest Clinic

Jindal Chest Clinic

More from Jindal Chest Clinic (20)

Therapeutic plasma Exchange (TPE ) | Jindal chest clinic

Acute Asthma Exacerbations | Jindal Chest Clinic

Acute Severe Asthma | Jindal chest clinic

Guidelines for asthma management | Jindal Chest Clinic

Thrombo-prophylaxis in Critical Care | Jindal chest clinic

Indian consensus statement for the diagnosis and management of IPF | Jindal c...

Presentation on "Diagnosis of ILD" | Jindal Chest Clinic

Physiology of the Respiratory System | Jindal chest clinic

Non respiratory functions of the respiratory system_by Dr. Aditya Jindal | Ji...

Molecular Diagnosis of Tuberculosis by Dr. Aditya Jindal | Jindal Chest Clinic

Difficult Airway Management | Jindal Chest Clinic

Difficult airway in ICU by Dr. Aditya Jindal | JIndal Chest Clinic

Anesthesia and sedation during flexible bronchoscopy | Jindal chest clinic

Recurrent Pneumothorax and Pleural Effusion Role of Pleuroscopy Thoracoscopy ...

Tuberculosis pathophysiology and diagnosis | Jindal Chest Clinic

Silicosis in India: Defining the problem and developing solutions | By Dr. S....

Pathology of tuberculosis of lung | Jindal Chest Clinic

Thoracic-oncology round | Jindal chest clinic

Pulmonary Vasculitis | Jindal Chest Clinic

Treatment of ILDs by Dr. S.K Jindal | JIndal Chest Clinic

Recently uploaded

Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad

NephroTube - Dr.Gawad

- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0 - Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc - Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html - Link to NephroTube website: www.NephroTube.com - Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html

THERAPEUTIC ANTISENSE MOLECULES .pptx

70KRISHPATEL

Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun

chandankumarsmartiso

Light House Retreats: Plant Medicine Retreat Europe

Lighthouse Retreat

Cell Therapy Expansion and Challenges in Autoimmune Disease

Health Advances

There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities. In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions. Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved. Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.

Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...

chandankumarsmartiso

Netter's Atlas of Human Anatomy 7.ed.pdf

BrissaOrtiz3

Aortic Association CBL Pilot April 19 – 20 Bern

suvadeepdas911

8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx

Holistified Wellness

We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.

A Classical Text Review on Basavarajeeyam

Dr. Jyothirmai Paindla

Adhd Medication Shortage Uk - trinexpharmacy.com

reignlana06

The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com

OCT Training Course for clinical practice Part 1

KafrELShiekh University

REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx

LaniyaNasrink

How STIs Influence the Development of Pelvic Inflammatory Disease.pptx

FFragrant

Does Over-Masturbation Contribute to Chronic Prostatitis.pptx

walterHu5

CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf

rishi2789

The Best Ayurvedic Antacid Tablets in India

Swastik Ayurveda

Chapter 11 Nutrition and Chronic Diseases.pptx

Earlene McNair

Tests for analysis of different pharmaceutical.pptx

taiba qazi

Integrating Ayurveda into Parkinson’s Management: A Holistic Approach

Ayurveda ForAll

Recently uploaded (20)

Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad

THERAPEUTIC ANTISENSE MOLECULES .pptx

Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun

Light House Retreats: Plant Medicine Retreat Europe

Cell Therapy Expansion and Challenges in Autoimmune Disease

Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...

Netter's Atlas of Human Anatomy 7.ed.pdf

Aortic Association CBL Pilot April 19 – 20 Bern

8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx

A Classical Text Review on Basavarajeeyam

Adhd Medication Shortage Uk - trinexpharmacy.com

OCT Training Course for clinical practice Part 1

REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx

How STIs Influence the Development of Pelvic Inflammatory Disease.pptx

Does Over-Masturbation Contribute to Chronic Prostatitis.pptx

CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf

The Best Ayurvedic Antacid Tablets in India

Chapter 11 Nutrition and Chronic Diseases.pptx

Tests for analysis of different pharmaceutical.pptx

Integrating Ayurveda into Parkinson’s Management: A Holistic Approach

Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh

1. Making sure tissue is not the issue - Pulmonologist’s perspective Dr. Aditya Jindal Interventional Pulmonologist & Intensivist Jindal Clinics SCO 21, Sec 20D, Chandigarh DM Pulmonary and Critical Care Medicine (PGI Chandigarh), FCCP

2. Why tissue is the issue! • Histopathological diagnosis • Ruling out alternate diagnoses • Staging • Molecular testing • Rebiopsy • Research

3. How to make sure? Think before you do – • Selection of correct site • Choice of most appropriate procedure • Size and number of biopsies/ other procedures • Pre-decide all you need from the tissue • Availability of tissue for extended studies – • mutations

4. • Procedures – BAL (bronchoalveolar lavage) – EBB (endobronchial biopsy) – TBLB (trans bronchial lung biopsy) – TBNA (Trans bronchial needle aspiration from lymph nodes) • EBUS-TBNA • Thoracoscopic pleural biopsy

5. Bronchoalveolar lavage Endobronchial biopsy

6. Trans-bronchial lung biopsy 5-6 biopsies taken (5-20 sq mm) Specimen should fill cup of forceps More useful • Diffuse lung involvement • Large masses • Peribronchial area Less useful • Small nodules • Peripheral lesions

7. EBUS (Endobronchial ultrasound)

8. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Streinfort et al. Eur Respir J 2011; 37: 902–910

9. Comparison of Endobronchial Ultrasound, Positron Emission Tomography, and CT for Lymph Node Staging of Lung Cancer. Yasufuku K et al. Chest 2006; 130:710-718 Characteristics of CT, PET, and EBUS TBNA in the Correct Prediction of Mediastinal Lymph Node Staging

10. • Meta-analysis of almost 3000 patients • EBUS-TBNA – Sensitivity of 0.88–0.93 (95% CI, 0.79–0.94) – Specificity of 1.00 (95% CI, 0.92–1.00) – NPV of 91% (range, 83–96%) • Sehgal et al. Endosonography Versus Mediastinoscopy in Mediastinal Staging of Lung Cancer: Systematic Review and Meta-Analysis. Ann Thorac Surg 2016 • Cell block – Immunohistochemistry – Molecular testing success of >90% – One of the lowest insufficiency rates (4%) for EGFR and KRAS mutational analysis • VanderLann et al. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): an overview and update for the cytopathologist. Cancer Cytopathol. 2014 • Billah et al. EGFR and KRAS mutations in lung carcinoma: molecular testing by using cytology specimens. Cancer Cytopathol. 201

11. EBUS diagnosis Number Percentage Sarcoidosis 137 55% TB 41 16% Malignancy 19 8% Others 5 2% Normal 14 5.6% Total 249 EBUS yield Positive 216 87% Negative 33 13%

12. Malignant Pleural Effusions 12 Sensitivity of different biopsy methods (cytologic and histologic results combined) for the diagnosis of malignant pleural effusions. Patient with malignant pleural effusion due to breast cancer. Small whitish tumor nodules on the parietal (chest wall) pleura are seen. Tumor nodules and whitish areas with pleural thickening on the parietal (chest wall) pleura are seen.

13. Bhatnagar R, Maskell NA. Medical pleuroscopy. Clinics in chest medicine. 2013;34(3):487-500. Thoracoscopy

14. Malignant mesothelioma presenting as parietal pleural nodules H&E, 100X showing tumour cells arranged in sheets infiltrating the soft tissue.

Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh

Recommended

Recommended

More Related Content

Similar to Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh

Similar to Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh (20)

More from Jindal Chest Clinic

More from Jindal Chest Clinic (20)

Recently uploaded

Recently uploaded (20)

Making sure tissue is not the issue - Pulmonologist’s perspective | Jindal Clinic Chandigarh