This commentary attempts to discuss the required standardization of circulating tumor DNA (ctDNA) analyses and thereby improve the clinical validity of ctDNA monitoring in the metastatic setting of solid tumors.
<b><i>Background:</i></b> Lung cancer is the leading cause of cancer-related death worldwide. Early diagnosis is crucial to increased survival rates. Radial endobronchial ultrasound (rEBUS) and electromagnetic navigation bronchoscopy (ENB) have been developed for the diagnosis of small lung lesions. The aim of this systematic review was to evaluate whether the combination of rEBUS and ENB is superior to ENB alone. <b><i>Method:</i></b> A systematic search was performed using MEDLINE, Embase, and Cochrane Library databases on “ENB,” and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The project was registered with PROSPERO, number CRD42020214682. <b><i>Results:</i></b> In total, 2,092 studies were identified through a literature search. Five studies were included in the final review. One study found that the addition of rEBUS increased diagnostic yield, while another concluded the converse. Three studies did not have significant results. Meta-analysis was not feasible due to heterogeneity and the small number of studies. <b><i>Conclusion:</i></b> As the current evidence on the topic is sparse and heterogeneous, it is not possible to conclude whether the addition of rEBUS to ENB has a significant impact on diagnostic yield. Further studies are needed to illuminate this question in order to ensure optimal choice of endoscopic technique as well as used time and resources. The project received funding from the Region of Southern Denmark’s PhD fund.
BackgroundIatrogenic pneumothorax is a common and clinically important transbronchial cryobiopsy (TBCB) complication. A study was conducted to assess the diagnostic accuracy and clinical impact of immediate postprocedure lung ultrasound for diagnosing iatrogenic pneumothorax in patients suspected of interstitial lung disease (ILD) undergoing TBCB.Study design and methodsIn patients undergoing TBCB due to suspected ILD, LUS of the anterior surface of the chest was performed immediately after the TBCB procedure prior to extubation. Presence of lung point was used as a definite sign of pneumothorax. Chest X-ray (CXR) performed routinely 2 h after TBCB was used as reference standard.ResultsA total of 141 consecutive patients were included. Postprocedure LUS identified definite pneumothorax in 5 patients (3.6%)(95%CI: 1.5–8.3%). 2-hour CXR identified 19 patients (13.5%)(95%CI: 8.7–20.2%) with pneumothorax following TBCB. The diagnostic accuracy of LUS for diagnosing pneumothorax was: sensitivity 21.1% (95% CI: 6.1–45.6%), specificity 99.2% (95% CI: 95.5–100.0%), positive predictive value 80.0% (95%CI: 28.4–99.5%), and negative predictive value 89.0% (95%CI: 82.5–93.7%). Postprocedure LUS had a clinical impact in 5 patients (3.6%) (95%CI: 1.5–8.3), in which 4 had pleural drain inserted prior to extubation and 1 patient had prolonged observation prior to extubation.InterpretationLUS performed immediately following TBCB have a clinical impact by identifying patients with pneumothorax in need of immediate treatment prior to extubation, and to monitor pneumothorax size during in the operating room. Supplementary imaging prior to patient discharge is however still needed since the majority of pneumothoraxes develop later in the postprocedure period.
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