Clinician's Roundtable

Cytology via thoracentesis remains the first-line approach for diagnosing malignant pleural effusion (MPE), yet its sensitivity is limited. leaving many patients undiagnosed or delayed in treatment. In this expert-led discussion, Dr. David Feller-Kopman explores the limitations of current diagnostic methods and the evolving role of biomarkers in enhancing both diagnostic accuracy and prognostic insight. Dr. Feller-Kopman is a Professor of Medicine at the Geisel School of Medicine at Dartmouth and the Chief of Pulmonary and Critical Care Medicine at Dartmouth-Hitchcock Medical Center, and he discussed this topic at the 2025 CHEST Annual Meeting.

Discussing weight with pediatric patients and families is a nuanced challenge shaped by stigma, culture, and access—but it’s also a vital opportunity for early intervention. Dr. Jaime Moore shares how to build confidence, counter bias, and leverage practical tools and partnerships that support long-term, personalized care. Dr. Moore is an Assistant Professor of Pediatric Nutrition at the University of Colorado Anschutz School of Medicine and part of the Children’s Hospital Colorado Lifestyle Medicine Program. She also spoke about this topic at the 2025 American Academy of Pediatrics (AAP) National Conference and Exhibition.

About 40 percent of patients with metastatic HR+/HER2- breast cancer have an activating mutation in the PIK3CA gene,1,2 which plays a key role not only in tumor growth, but also in driving resistance to endocrine therapy.3-5 And while there are several FDA-approved PI3K pathway-targeted agents for patients with PIK3CA tumor mutations,6-8 they come with challenges, like modest efficacy and on-pathway effects.9-12 Given this unmet need, the ReDiscover trial evaluated the investigational agent RLY-2608 in combination with fulvestrant in in patients with PIK3CA-mutated HR+/HER2- aBC previously treated with a CDK4/6 inhibitor.13 Joining Dr. Charles Turck to share updated safety and efficacy data from the trial is Dr. Sarah Sammons, a Senior Physician at the Dana-Farber Cancer Institute and an Assistant Professor of Medicine at Harvard Medical School in Boston.

References:

1. Vasan N, Cantley LC, Vasan N, Cantley LC. At a crossroads: how to translate the roles of PI3K in oncogenic and metabolic signalling into improvements in cancer therapy. Nat Rev Clin Oncol. 2022;19(7):471-485. doi:10.1038/s41571-022-00633-1
2. Network TCGA. Comprehensive molecular portraits of human breast tumours. Nature. 2012;490(7418):61-70. doi:10.1038/nature11412
3. Saal LH, Johansson P, Holm K, et al. Poor prognosis in carcinoma is associated with a gene expression signature of aberrant PTEN tumor suppressor …

In a 2025 study investigating salivary metabolites as potential biomarkers in cystic fibrosis, researchers identified distinct metabolic patterns linked with key complications as well as correlations with lung function. In this AudioAbstract, Ryan Quigley discusses how a simple saliva sample could provide clinicians with an accessible, non-invasive tool to stratify patients, monitor therapies, and advance personalized care in cystic fibrosis. This topic was also discussed at the 2025 CHEST Annual Meeting.

Recognizing how inequities can significantly impact pediatric care outcomes is essential to improving access, trust, and long-term health. Dr. Shelina Ramnarine is joined by Dr. Yolanda Evans to discuss actionable strategies that can help us deliver more inclusive care, from social determinant screeners to equity-focused frameworks. Dr. Evans is a board-certified pediatrician and adolescent medicine specialist practicing in Seattle, Washington, and she spoke about this topic at the 2025 American Academy of Pediatrics National Conference and Exhibition.

Early genetic evaluation plays a vital role in identifying potential causes of neurodevelopmental disorders and guiding families on next steps, expectations, and recurrence risks. Dr. Jennifer Kalish joins us to share practical insights for recognizing when to initiate testing, selecting the right tests, and addressing barriers such as insurance and interpretation. Dr. Kalish is an Assistant Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine and the Director of the Beckwith-Wiedemann Syndrome Program at the Children's Hospital of Philadelphia. She also spoke about this topic at the 2025 American Academy of Pediatrics (AAP) National Conference and Exhibition.

Childhood trauma can profoundly alter brain and behavioral development, making it essential to recognize how trauma differs from other diagnoses like ADHD. Ryan Quigley sits down with Drs. Heather Forkey and Wynne Morgan, who presented on this topic at the 2025 American Academy of Pediatrics National Conference and Exhibition, to better understand how to identify trauma responses, avoid misdiagnosis, and implement supportive treatment strategies that prioritize safety, routine, and caregiver connection. Dr. Forkey is a Professor of Pediatrics and Vice Chair of Pediatrics and Dr. Morgan is an Assistant Professor in the Departments of Psychiatry and Behavioral Sciences at UMass Chan Medical School in Worcester, Massachusetts.

Neonatal food protein-induced enterocolitis syndrome (N-FPIES) is an underrecognized condition often misdiagnosed as necrotizing enterocolitis, despite distinct clinical and lab features that demand a different treatment approach. In this AudioAbstract, ReachMD's Ryan Quigley explores the early signs, immune pathways, and diagnostic markers of N-FPIES, offering essential insights to help pediatric clinicians identify this condition and initiate appropriate dietary management to avoid unnecessary interventions.

Pediatricians are often the first to encounter eye conditions that can range from common to life-threatening. Hear from Dr. Laura Enyedi as she shares highlights from her presentation on diagnosing childhood ocular disorders from the 2025 American Academy of Pediatrics (AAP) National Conference and Exhibition. Dr. Enyedi is a Professor of Ophthalmology and an Associate Professor in Pediatrics at Duke University School of Medicine in Durham, North Carolina.

IgA nephropathy (IgAN) presents with a wide range of clinical signs, making timely detection and coordinated care essential. This multidisciplinary approach to diagnosis and management can manifest in a number of ways, from clinical evaluation and laboratory testing to emerging biomarkers and evolving treatment options. Joining Dr. Gates Colbert to discuss how we can use these strategies to optimize IgAN care are Drs. Abdallah Geara and Ellie Kelepouris. Dr. Geara is an Associate Professor of Clinical Medicine, the Clinical Director of the Glomerular Diseases Program, and Director of Onconephrology at Penn Medicine in Philadelphia, and Dr. Kelepouris is a Professor of Clinical Medicine, the Vice Chief of Clinical Affairs, and the Medical Director of Outpatient Dialysis Programs at Penn Medicine.