Home CHEST Thought Leaders Hot in CHEST February 2017

Hot in CHEST February 2017

Dr. Deep RamachandranBy Dr. Deep Ramachandran

Each month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's February, so let's hear from Dr. Ramachandran as he outlines his highlights. After reviewing the issue, be sure to share your hot list on our Facebook wall, tweet with the hashtag #FebCHEST, or discuss in the CHEST LinkedIn group.

Fuzzy Logic and Ground-Glass Opacities

I usually refer to ground-glass nodules as fuzzy nodules because everything about them is a bit fuzzy. First off, the name: are they call semisolid, subsolid, or ground glass? See? Fuzzy. So too, the way we follow them. CHEST guidelines recommend following them for 3 to 5 years while the Fleischner Society recommendations vary from this, and the NCCN recommendations vary a bit more. We could use a bit more clarity here. Thus a group of Japanese researchers reported on the results of 243 patients with ground-glass opacities found on CT scanning which were < 3 cm. All of the patients in the study had been followed for at least 10 years. They found that those with a greater solid component (ie, less fuzzy) were more likely to be invasive cancer. Check out the accompanying editorial on this study, which explains things with a lot more clarity than I just did!

Lead author: Ssawada-ths@umin.ac.jp

Eosinophilia as a Marker for COPD Exacerbations

Reducing COPD readmissions has been a priority since Medicare has targeted COPD exacerbation readmission as a quality measure. In this study, researchers looked at patients who were noted to have eosinophilia of greater than 200 cells/uL or 2% at the time of admission for COPD exacerbation. They naturally excluded those who were already on steroids at the time of measurement as this can lower eosinophil counts. They found that patients with eosinophilia at the time of admission had a greater than 3-fold risk of readmission for COPD. This raises the possibility that eosinophilia could potentially be used as a biomarker to identify patients at high risk of readmission.

Lead author: Alain.vanasse@usherbrooke.ca

Using Cryobiopsy to Diagnose Lung Disease

Diffuse lung diseases can often be difficult to diagnose. The most definitive diagnosis is obtained through surgical biopsy, but less invasive alternatives have long been on the wish list for pulmonologists. Transbronchial biopsies have been used in the past, which involves an alligator-type forceps placed through a bronchoscope. Unfortunately the tissue samples obtained through this technique are usually too small and contain too much “crush artifact” to be useful. Enter cryobiopsy, which instead of forceps uses a cryoprobe that essentially freezes tissue to the probe, which can then be removed. In this article, researchers at the Mayo Clinic published their experience with the use of cryobiopsy in patients with diffuse lung disease. They found that the biopsies taken using the cryoprobe appeared to be helpful in 78% of the cases when used as part of a multidisciplinary approach.

Lead author: kamonpun@live.com

A First in Humans: Laser-Assisted Removal of Embedded Vena Cava Filters

Vena cava filters are often placed in patients at risk of pulmonary embolism but have a contraindication for anticoagulation. Their placement is often intended to be temporary but like an unwanted houseguest, the longer they linger, the more difficult it becomes to remove them. The long-term placement of these filters comes with known risks, including increased risk of clot. In this study, researchers at Stanford used a sheath with an excimer laser to remove embedded vena cava filters, which could not be removed otherwise. So to review, this issue of CHEST, to my incredible delight, features catheters with frickin’ laser beams attached to their heads!

Lead author: wkuo@stanford.edu 

Until next time!