CHEST Guidelines-FVC,-Total-Lung-Capacity,-and-the-Differential-Ass

FVC,-Total-Lung-Capacity,-and-the-Differential-Ass_8

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The correspondence section in the CHEST journal includes articles discussing issues related to pulmonary function and diagnostic procedures in lung cancer. Dr. Jon Andrew Hardie comments on a study by Pedone et al., which analyzes the correlations between total lung capacity (TLC), forced vital capacity (FVC), and mortality. He suggests an additional analysis to separate the hazard ratios for those with both FVC below the lower limit of normal (LLN) and TLC below LLN, versus those with FVC below LLN but normal TLC, proposing that mortality risk may be tied to true lung restriction. In response, the original authors present data supporting that those with reduced FVC but normal TLC do not have increased mortality risk, whereas those with reduced TLC face higher mortality.<br /><br />Another article by Dr. Raymond A. Dieter Jr. raises concerns regarding the false positives in endobronchial ultrasound (EBUS)-guided biopsies for diagnosing lymph node metastasis in lung cancer. He highlights a patient case where EBUS suggested metastatic disease, but surgical evaluation found no cancerous lymph nodes. The false-positive was attributed to the EBUS needle potentially sampling malignant tissue adjacent to the lymph node. The response to Dieter's article stresses that such false-positive results are rare, though they underscore the critical need for accuracy in biopsy sampling and reviewing results carefully to avoid unnecessary treatments. The correspondence emphasizes the challenges and nuances in interpreting diagnostic tests in pulmonology and oncology.

Keywords

pulmonary function

lung cancer

total lung capacity

forced vital capacity

mortality risk

lung restriction

endobronchial ultrasound

lymph node metastasis

false positives

diagnostic procedures