CHEST Guidelines-Endobronchial-Ultrasound-Guided-Transbronchial-Nee

Endobronchial-Ultrasound-Guided-Transbronchial-Nee

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The document discusses two medical topics. The first part focuses on the risks and implications of using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to biopsy thyroid nodules. The technique, typically used to collect samples from beyond the airway for diagnosing and staging various conditions such as lung cancer and tuberculosis-infected nodes, was used to biopsy a thyroid nodule in a 49-year-old woman. This led to complications, as the patient developed a thyroid abscess eight days post-procedure, attributed to contamination during the procedure since EBUS-TBNA cannot maintain sterility through the human mouth and oropharynx. This highlights concerns over expanding the use of EBUS-TBNA without further evidence, as ultrasound-guided fine-needle aspiration (US-FNA) is the standard with lower complication rates. <br /><br />The second part addresses intronic boundary mutation rs430397 in the glucose-regulated protein 78 (GRP78) gene, related to non-small cell lung cancer (NSCLC). Despite attempts to validate the impact of this polymorphism on alternative splicing—an essential process affecting protein production—studies found no functional alteration. However, the mutation remains an intriguing area for further research due to its potential association with cancer risk and GRP78's role in endoplasmic reticulum stress responses. The authors highlight the need for further studies to investigate the variant's effect on protein localization and cell function, suggesting broader relevance in genetic research and disease understanding.<br /><br />Overall, the correspondence underscores the importance of cautious expansion of medical techniques like EBUS-TBNA and encourages further investigation into genetic markers like rs430397 for better clinical outcomes.

Keywords

EBUS-TBNA

thyroid nodule biopsy

thyroid abscess

US-FNA

intronic boundary mutation

GRP78 gene

NSCLC

alternative splicing

endoplasmic reticulum stress

genetic research