8th edition AJCC and imaging TNM: Time to break-in and assert in the staging process!

The current practice of oncology focuses not only on early diagnosis, staging, and treatment of cancer but also defies the concept of “One size fits all.” This paradigm shift of the 8th edition American Joint Committee on Cancer (AJCC) manual to a “personalized medicine” approach sets the stage for introducing Imaging TNM (iTNM). The iTNM would provide physicians with a clear assessment of the disease extent derived exclusively from a combination of anatomical and functional imaging modalities and simplify decision-making in practice. Introduction of iTNM will complement the existing cTNM and pTNM and help to guide a personalized approach to patient management.

Potential role of whole-body diffusion magnetic resonance imaging in tumor staging for pregnant patients with cancer

Malignancy during pregnancy poses a serious threat to the growing fetus. In this special situation, the diagnostic procedures and treatment to cancer will be more damaging to the developing fetus than the cancer itself. However, to safeguard the health of the mother from cancer, appropriate diagnostic and therapeutic tools are to be used that would minimize risk to fetal health. Diffusion-weighted whole-body imaging with background body signal suppression has the potential to answer most of these diagnostic dilemmas in the case of malignancy in pregnancy. This is one of the first such reports highlighting the role of a noninvasive, nonionizing whole-body imaging technique which does not require external contrast injection and can also be used for monitoring treatment response.

A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one‑lung ventilation.

Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric‑sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double‑blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12‑month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.