Background: Lung cancer (LC) is the leading cause of cancer-related death for veterans cared for by the US Veterans Health Administration. The LC burden among veterans is almost double that of the general population. Before implementation of an LC screening program, we set out to assess the role of beliefs and attitudes toward LC screening among veterans. Methods: Veterans presenting to the Ralph H. Johnson VA Medical Center were invited to complete a self-administered survey. The survey comprised questions about demographics, smoking status, health status, and knowledge about LC and willingness to be screened. Responses from veteran ever and never smokers were compared. Results: A total of 209 veterans completed the survey. Smokers were signifi cantly ( P , .05) more likely than never smokers to be less educated, have a lower income, and report poorer health. Smokers were more likely than never smokers to have two or more comorbidities, which trended toward signifi cance ( P 5 .062). Smokers were more likely to have been told by a physician that they were at high risk for LC and to believe that they were at risk. Nearly all veterans surveyed (92.8%) would have a CT scan for LC screening, and 92.4% would have surgery for a screendetected LC. Conclusions: Veterans are overwhelmingly willing to undergo screening for LC, and it seems that participation will not be a barrier to implementation of an LC screening program. The mortality benefi t of LC screening, however, may not be generalizable to the veteran population because of a higher number of comorbid conditions.

Background Endobronchial Ultrasound Guided Transbronchial Fine Needle Aspiration (EBUS-FNA) has gained acceptance as the diagnostic procedure of choice to sample hilar and mediastinal lymph nodes (LN) for diagnosing and staging lung cancer. Studies have shown that EBUS has a high positive predict value, however its negative predict value (NPV) varies significantly. The present study attempts to evaluate the clinical outcome surrounding negative and non-diagnostic EBUS-FNA of mediastinal LN. Methods A retrospective chart review of cases of EBUS-FNA performed between 2008 to the mid of 2011 conducted. Mediastinal LN with cytologic diagnosis of Negative for Malignant Cells and Unsatisfactory were selected for the study. Each LN was followed for up to one year with imaging or biopsy/resection. True negative was defined as a LN that did not enlarge on repeat imaging or were negative for malignancy on repeat biopsy or surgery during the follow-up period. Results Among1418 LNs sampled, 479 from 228 patients met the search criteria, including 394 (82.3%) with the cytologic diagnosis of Negative for Malignant Cells and 85 (17.8%) with Unsatisfactory. One hundred and four (45.6%) patients were followed up with imaging, and 124 (54.3%) patients underwent repeat biopsy/surgery. A total of 451 nodes met the definition of true negative, resulting in an overall NPV of 92.9% (CI= 90.6%– 95.2%). The NPVs of a Negative and Unsatisfactory diagnosis were 93.9% (CI=91.6%–96.3%), and 88.2% (81.4%–95.1%), respectively. Conclusions The vast majority of LNs with a cytologic diagnosis of Negative and Unsatisfactory were likely to be truly negative. In these patents a more conservative approach to follow up may be appropriate.

A malignant pleural effusion (MPE) from lung cancer represents stage IV disease and portends a poor prognosis. Routine mutational analysis of tissue samples is the standard of care in advanced lung cancer management because it has treatment implications. Sampling of MPE is minimally invasive, safe, repeatable, and provides both diagnostic and therapeutic value. Mutational analysis on MPE has been shown to be feasible and correlates with a response to targeted therapy with tyrosine kinase inhibitors (TKIs). Guidelines recommend mutational testing in MPE, however there is no one standardized method for testing. There are several testing methods available for mutational analysis in pleural fluid including PCR, mutant-enriched PCR, DNA & RNA sequencing, and immunohistochemistry the sensitivity of which are dependent upon tumor cell heterogeneity. The advantages and disadvantages of each will be reviewed here. Keywords Epidermal growth factor receptor (EGFR). Malignant pleural effusion. Non-small cell lung cancer (NSCLC). Tyrosine kinase inhibitors (TKIs). Molecular testing [9]. This article will review the pathophysiology of MPE, the role of targeted TKIs, methods for EGFR mutational analysis in MPEs, guidelines for mutational analysis testing, and will discuss future directions. Pathophysiology A pleural effusion develops when the production of pleural fluid exceeds its removal. One of the most common causes of effusion associated with impaired removal of pleural fluid

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