Screening for Lung Cancer in India: Expert Opinion Statement.

Lung cancer (LC) has the highest rate of disability-adjusted life years (DALY) of all cancers in India. A large majority of patients with LC present with advanced disease, resulting in poor survival rates. Early diagnosis can improve survival outcomes as the patients can be treated with curative intent. The National Lung Screening Trial (NLST), in 53,454 persons at high risk for LC in the US, showed a 20% (95% confidence interval of 6.8-26.7; p = 0.004) relative reduction in LC-specific mortality in the patients screened with low-dose computed tomography (LDCT) compared with chest X-ray. To date, India does not have a formal LC screening (LCS) program. As a panel of experts, we reviewed a synthesis of a targeted literature search on the burden of LC, the current status of diagnosis of LC, barriers to early diagnosis, current referral pathways, LC risk patterns, use of artificial intelligence (AI) and risk calculators for risk assessment, and a multidisciplinary team (MDT) approach to diagnosis LC. We used the existing international LCS guidelines, data from published literature, and clinical experience to depict the characteristics of the population at risk of LC in India-young age (<40 years), smoking, especially the predominance of bidi smoking (an indigenous form of tobacco smoking), exposure to biomass fuel smoke, especially in rural women, and air pollution being the prominent features. LC in India is characterized by a higher rate of driver mutations and adenocarcinomatous histology. Here, we present the expert opinion on risk-based LCS in India and discuss the challenges, facilitators, and research priorities for the effective rollout of LCS in India.

Community-acquired round Pneumonia in a 63-year-old Female.

Round pneumonia is a radiological manifestation of pulmonary lesion. This is found as spherical or oval-shaped radio-opacity on chest X-ray. Round pneumonia has been reported in literature uncommonly. Round pneumonia was first time reported in the radiology literature in 1954 (Wagner et al., 1998). It was first recognized in children. In 1973, Rose and Ward reviewed 21 cases of round pneumonia in children. Radiological findings resembled pulmonary and mediastinal masses. Since then, time and again, round pneumonia has been reported in children; but, this is also found rarely in adults. There are many causes of round pneumonia in adults, for example, infectious and noninfectious. It may mimic pulmonary neoplasms due to its radiological appearance. Hence, the usual diagnostic challenge of round pneumonia is to differentiate pneumonia from bronchogenic carcinoma. Here we present an interesting case of round pneumonia in an adult female.

Endoscopic Ultrasound: Indian Perspective.

Mediastinoscopy is a minimally invasive surgical procedure that allows visualization and tissue sampling of mediastinal nodes. Mediastinoscopy has been extremely valuable in the evaluation and staging of lung cancer and therefore has been considered the gold standard for this purpose for over 30 years. Historically, this procedure has been associated with a low morbidity and mortality and a high sensitivity for diagnosing lung cancer with certain procedural limitations. Recently, it has been reported that not only is mediastinoscopy use limited in community practice, concomitant biopsy rates are limited as well.1 While mediastinoscopy does provide a tissue diagnosis, the procedure has its limitations. Cervical mediastinoscopy allows access to nodal stations 2, 3, 4 and 7, leaving out commonly involved pulmonary ligament and aortopulmonary window nodes.1 It requires general anesthesia and has a morbidity of 1% and a mortality of 0.2%. The procedure adds considerable expense to the staging workup. The estimated current cost is $1,700 for the procedure alone and $7,500 for a mediastinoscopy with a 2-day hospital stay. This prompted the development of endobronchial ultrasound(EBUS) in the 1990s.2.