Quantitative Gallium Scanning in Pulmonary Sarcoidosis

Pulmonary parenchymal involvement in sarcoidosis is due to noncaseating granuloma, fibrosis or both. To assess the granulomatous activity in pulmonary sarcoidosis, we performed gallium-67 citrate scans in 41 patients with sarcoidosis and in 13 non-sarcoid patients, who were free of pulmonary disease and served as controls. Gallium score, a measure of gallium accumulation in lung parenchyma, was obtained from the sum of activity indices (ratio of accumulated gallium activity over a chest quadrant and soft tissues of the mid-thigh) from each of the quadrants over the anterior and posterior aspects of the chest. The gallium score in patients with sarcoidosis was significantly higher than the gallium score in controls. The gallium scores in patients with sarcoidosis, with radiographically apparent pulmonary infiltrate were significantly higher than the scores in the patients with no radiographic evidence of pulmonary parenchymal involvement. The gallium scores in patients not receiving corticosteroids were significantly higher compared to patients who were receiving corticosteroids, and furthermore, the gallium scores fell significantly when corticosteroids were initiated. There was a significant correlation between serum angiotensin-converting enzyme (SACE) activity and gallium score. In 11 patients, 27 sequential gallium scans were performed and changes in gallium score correlated well with the changes in SACE activity and clinical assessment. These findings suggest that quantitative evaluation of gallium scans may be useful in assessing granulomatous activity of pulmonary sarcoidosis and following its response to therapy

Ultrasound-guided fine needle aspiration biopsy of pleural-based intrathoracic lesions

BACKGROUND: Pleural-based intrathoracic lesions pose a diagnostic challenge. Image-guided percutaneous biopsy with fluoroscopy, computed tomography (CT) scan, and ultrasound (US) have been used to establish a diagnosis. We report the yield of US-guided fine needle aspiration biopsy (FNAB) of these lesions at our center. METHODS: Twenty patients with pleural-based intrathoracic lesions underwent US-guided FNAB. All were considered to have an unresectable malignant process based on clinical evaluation. Nineteen patients had pleural-based parenchymal lesion and 1 had an anterior mediastinal mass touching the chest wall. RESULTS: Twenty patients underwent 21 US-guided FNAB procedures. A final diagnosis was established in all the patients: 19 malignancies and 1 benign lesion. US-guided FNAB established a diagnosis of malignancy in 17 of 19 patients (89.5%) in the first attempt. In 1 patient, a diagnosis of malignancy was made on a repeat US-guided FNAB, increasing the overall yield to 18 of 19 (95%). In 1 patient with a nondiagnostic US-guided FNAB, a diagnosis of malignancy was established with CT scan-guided FNAB. US-guided FNAB was able to diagnose 15 of 16 cases of non-small cell carcinoma and 3 of 3 (100%) small cell carcinoma. In 1 patient with benign lesion, US-guided FNAB showed pulmonary macrophages. This patient was diagnosed as having pneumonia after antibiotic therapy and repeat CT scan showed complete resolution. For a diagnosis of malignancy, US-guided FNAB had 94.7% sensitivity, 100% specificity, 95% diagnostic accuracy, 100% positive predictive value, and 50% negative predictive value. There were no major complications. CONCLUSIONS: US-guided FNAB of pleural-based intrathoracic lesions is a rapid, simple, and safe procedure with a high yield for malignancy. © 2009 Lippincott Williams & Wilkins, Inc

Discordance in Recommendation Between Next-Generation Sequencing Test Reports and Molecular Tumor Boards in India

PURPOSEAccurate understanding of the genomic and transcriptomic data provided by next-generation sequencing (NGS) is essential for the effective utilization of precision oncology. Molecular tumor boards (MTBs) aim to translate the complex data in NGS reports into effective clinical interventions. Often, MTB treatment recommendations differ from those in the NGS reports. In this study, we analyze the discordance between these recommendations and the rationales behind the discordances, in a non–high-income setting, with international input to evaluate the necessity of MTB in clinical practice.METHODSWe collated data from MTB that were virtually hosted in Chennai, India. We included patients with malignancies who had NGS reports on solid tissue or liquid biopsies, and excluded those with incomplete data. MTB forms and NGS reports of each clinical case were analyzed and evaluated for recommendation concordance. Concordance was defined as an agreement between the first recommendation in the MTB forms and the therapeutic recommendations suggested in the NGS report. Discordance was the absence of the said agreement. The rationales for discordance were identified and documented.RESULTSSeventy MTB reports were analyzed with 49 cases meeting the inclusion criteria. The recommendation discordance was 49% (24 of 49). Discordant recommendations were mainly due to low level of evidence for the drug (75% of cases).CONCLUSIONThe discordance between MTB and NGS vendor recommendations highlights the clinical utility of MTB. The educational experiences provided by this initiative are an example of how virtual academic collaborations can enhance patient care and provider education across geographic borders