Objective: In lung cancer screening practice low-dose computed tomography, diameter, and volumetric measurement have been used in the management of screen-detected lung nodules. The aim of this study was to compare the performance of nodule malignancy risk prediction tools using diameter or volume and between computer-aided detection (CAD) and radiologist measurements.Methods: Multivariable logistic regression models were prepared by using data from two multicenter lung cancer screening trials. For model development and validation, baseline low-dose computed tomography scans from the Pan-Canadian Early Detection of Lung Cancer Study and a subset of National Lung Screening Trial (NLST) scans with lung nodules 3 mm or more in mean diameter were analyzed by using the CIRRUS Lung Screening Workstation ). In the NLST sample, nodules with cancer had been matched on the basis of size to nodules without cancer.Results: Both CAD-based mean diameter and volume models showed excellent discrimination and calibration, with similar areas under the receiver operating characteristic curves of 0.947. The two CAD models had predictive performance similar to that of the radiologist-based model.

Background: Rapid on site examination (ROSE) is encouraged at endobronchial ultrasound transbronchial needles aspiration (EBUS-TBNA) to improve diagnostic yield. Due to new therapeutic options in lung cancer, it is not sufficient to merely distinguish between non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). Immunohistochemistry (IHC) distinction is now standard practice, as well as additional molecular testing where clinically indicated. We investigated the diagnostic yield of on-site smears vs. cell block and the provision of cellular material for ancillary testing at our centre.Methods: A retrospective audit of all EBUS-TBNA procedures performed until July 2012 was undertaken.Diagnostic yield on smears versus cell block was recorded. Cell blocks were reviewed by an experienced pathologist to determine diagnostic accuracy and whether IHC and molecular testing were possible. Results: In total, 234 procedures were recorded with 101 (43.2%) malignant cases, 107 (45.7%) benign cases and an initial 26/234 (11.1%) insufficient for diagnosis of which 11/234 (4.7%) were false negatives for malignancy after further follow up. The average number of passes was 4.5. For malignancies, smear diagnosis was possible in 95% (96/101) of cases and cell block diagnosis in 93.5% (87/93) of cases. There was sufficient material for IHC in 97.7% (85/87) of malignant cases. In 79.3% (69/87) of NSCLCs molecular testing for epidermal growth factor receptor (EGFR) mutation analysis was theoretically possible on samples obtained. Conclusions: Cell blocks are not inferior to smears for diagnostic accuracy and provide sufficient samples for histology. However, ROSE assists the physician on how best to manage samples for ancillary testing.

Linear endobronchial ultrasound was first described in 2003. Since then the technique has spread rapidly and has now become an established practice in many centres as the first-line mediastinal investigation for the diagnosis and staging of lung cancer. In combination with endoscopic ultrasound, the majority of the mediastinum can be assessed and this approach has been shown to have equivalent accuracy to surgical staging. This strategy is also cost-effective. New tissue processing techniques using liquid-based thin-layer cytology and cell blocks have increased diagnostic yield using immunohistochemical staining and molecular diagnostics. Several meta-analyses of case series and, more recently, randomised controlled trials have provided high-level evidence of efficacy leading to incorporation into national lung cancer staging guidelines. In addition, linear endobronchial ultrasound is increasingly used in the investigation of mediastinal lymphadenopathy for suspected sarcoidosis, tuberculosis and lymphoma. While undoubtedly endobronchial/endoscopic ultrasound has reduced the need for surgical staging in lung cancer, the latter still has an important role to play in certain scenarios. The challenge now facing clinicians is to learn to apply the appropriate test or sequence of tests in each patient while ensuring that operators are appropriately trained in order to ensure optimal outcomes.

<b><i>Background:</i></b> Pleural effusions remain a common medical problem which often requires diagnostic pleurocentesis to determine the underlying cause. Pleurocentesis is a frequently performed procedure worldwide with improved safety using ultrasound (US) technology. <b><i>Objectives:</i></b> This prospective, single-center study evaluated the use of an ultraportable handheld (UPHH) US compared with standard point-of-care (SPOC) US in determining a safe site for pleurocentesis. In addition, US image quality and factors impacting on image quality were assessed using both UPHH and SPOC US. <b><i>Methods:</i></b> Paired US assessments were performed by thoracic physicians using UPHH and SPOC US on patients with unilateral pleural effusions to determine a safe site for pleurocentesis (defined as &#x3e;2 cm of pleural fluid, &#x3e;2 cm from a solid organ/diaphragm, and &#x3c;7 cm chest wall depth). Distance measurements for key structures and image quality scores (using a 5-point Likert rating scale) were obtained at the time of US assessment. Factors affecting image quality were analyzed using univariate analysis. <b><i>Results:</i></b> In 52 of the 54 included patients (96.3%), UPHH US was able to identify a safe site for pleurocentesis. Distance measurements between UPHH and SPOC US were not statistically different (all &#x3c;0.5 cm with values of <i>p</i> &#x3e; 0.05), but image quality was reduced in UPHH compared with SPOC US by 1 point on a 5-point Likert rating scale (<i>p</i> &#x3c; 0.002). Increasing body mass index was associated with a reduction in image quality in both UPHH and SPOC US (all <i>p</i> &#x3c; 0.01). <b><i>Conclusions:</i></b> Although image quality was lower in UPHH than SPOC US, a safe site was found in 96.3% of patients, which suggests that UPHH US may be a useful tool for diagnostic pleuro­centesis when SPOC US is not available (http://www.anzctr.org.au/, Australia New Zealand Clinical Trials Registry, No. ACTRN12618001592235).

IntroductionThis is a phase 1, open-label, single-centre, uncontrolled, dose-escalation study to evaluate the feasibility, tolerability and pharmacokinetic profiles of a single dose of liposomal curcumin, administered via an existing tunnelled indwelling pleural catheter (TIPC) directly to the tumour site in individuals with diagnoses of malignant pleural effusion. Primarily, we aim to determine a maximum tolerated dose of liposomal curcumin administered via this method.Methods and analysisWe will use a 3+3 expanded cohort for predefined dose-escalation levels or until a predefined number of dose-limiting toxicities are reached. Participants will be administered a single dose of liposomal curcumin (LipoCurc, SignPath Pharma) via their existing TIPC as a sequential enrolling case series with the following dose cohorts: 100, 200 and 300 mg/m2. Primary endpoints are determination of the maximum tolerated dose within the predetermined dose range, and determination of the feasibility of intrapleural administration of liposomal curcumin via an existing TIPC. Secondary endpoints include determination of the safety and tolerability of intrapleural administration of liposomal curcumin, median overall survival, effects on quality of life and on feelings of breathlessness, and the pharmacokinetics and concentrations of curcumin from the plasma and the pleural fluid. Important inclusion criteria include age ≥18 years, an existing TIPC, a pleural biopsy or pleural fluid cytology-proven diagnosis of malignant pleural effusion and for whom no antitumour therapy of proven benefit is available or has been previously declined, eastern cooperative group performance status <2.Ethics and disseminationThe study protocol has been approved by the Southern Adelaide Local Health Network Human Research Ethics Committee (HREC) (approval number: HREC/20/SAC/11). Study results will be published in peer-reviewed journals, and presented at conferences, in field of medical oncology and respiratory medicine.Trial registration numberACTRN12620001216909.Protocol version numberV.1.0.

Pulmonary carcinoid tumours are a rare form of malignancy that often present with clinical heterogeneity and are challenging to diagnose. Diagnosis during pregnancy is further complicated by delays in imaging and procedures to minimise harm to the fetus. This case describes a primigravid healthcare worker who was diagnosed with pulmonary carcinoid in her first trimester of pregnancy, with particular focus on the unique radiological findings of subpleural blebs as a feature.

trust for the same time period. From this data we could estimate the proportion of lung cancer patients from each trust that were referred for mediastinal staging with EBUS. Results In 2012, 2302 patients were diagnosed with lung cancer in this Network. In the same period, 193 patients were referred for EBUS mediastinal staging (8.4%). The proportion of lung cancer patients referred for mediastinal staging with EBUS varied significantly across the ten trusts ranging from 3.4% to 30.2% (p < 0.0001). The spearman co-efficient was 0.60 (p = 0.07) suggesting a possible relationship between the proportion of patients referred for EBUS and surgical resection (Figure 1). However, this may be due to a very high rate of staging EBUS at one trust, which if excluded yields a spearman co-efficient of 0.45 (p = 0.22). Discussion It is highly concerning that only 8% of lung cancer patients underwent EBUS nodal staging in our network given 52% of UK patients with histologically confirmed NSCLC are stage I-III at the time of diagnosis. It is of note that the Trust with the highest proportion of patients undergoing EBUS nodal staging have the highest surgical resection rate and three of the four Trusts with the lowest resection rates refer <5% of patients for EBUS nodal staging. Standardisation of referral practice across the Network is a key future goal for the EBUS Sub-group. Introduction Endobronchial ultrasound (EBUS) is increasingly used in investigating mediastinal lymphadenopathy. A recent Thorax paper suggested EBUS should only be performed in large centres to ensure quality. A recently established EBUS service at Broomfield Hospital appeared to reduce the time taken to obtain results compared to the regional service previously used. The service was audited to ensure quality and evaluate changes to pathway times. Objectives Compare time from decision for EBUS to test result between local and regional service and ensure safety and accuracy. Methods Data were collected prospectively for all EBUS cases after the local service was established in August 2013. Accuracy and safety of the service were audited based on the first 8.5 months of operation. Data were extracted from the MDT database for patients referred to the regional service between November 2013 and January 2014. Time from MDT decision for EBUS referral and subsequent MDT discussion of results were compared between both services. Data were compared using the Mann-Whitney U test using the statistics package in R. Results Average time from decision to EBUS result was 19 days in the local service based on the first 21 cases performed. There was a 40 day average turnaround for the regional service based on the 10 cases referred between November 2013 and January 2014. This represented a statistically significant reduction in waiting time of 21 days (p = 0.0001). The local service was safe and accurate with no reported complications in 42 cases over the first 8.5 months and an overall accuracy of 88% increasing to 94% (31/33) in suspected cancer cases. Conclusions Our r...

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