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Interventional Pulmonology: A New World

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 April 2022) | Viewed by 29840

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Special Issue Editor

Prof. Dr. Lutz Freitag

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Guest Editor

Pulmonary Medicine, Ruhrlandklinik, University Hospital Essen, Essen, Germany
Interests: interventional pneumology; lung diseases; lung airway obstruction; lung cancer

Special Issue Information

Dear Colleagues,

Interventional bronchology has been established as an important sub-speciality of pulmonary medicine. It involves the clinical application of numerous procedures that are more invasive than prescribing inhalers, but not as invasive as open chest surgery. Advancements in the development, especially miniaturization, of instruments and devices have enabled pulmonary physicians to diagnose and treat many diseases through the working channels of bronchoscopes or thoracoscopes. It took a long time to convince the scientific community that endobronchial ultrasound (EBUS) guided needle biopsies are equally efficient as surgical mediastinoscopies. Oncologists have learnt that bronchoscopist can do more than providing tissue samples, and a properly placed valve helps an emphysema patient more than any drug. There is a mutually beneficial overlap between newer diagnostic and therapeutic procedures. Guided by imaging techniques such as cone-beam CT or endobronchial ultrasound and supported by navigation methods, almost every intrapulmonary lesion can be accessed bronchoscopically. It is a logical step to use these procedures not only for taking biopsies, but also for definitive treatment, e.g., by radiofrequency ablation. Specific drug treatments for interstitial lung diseases require representative tissue samples. Catheter cryo-biopsies have made open lung biopsies almost obsolete. The same cryo-catheter can be used to destroy endobronchial tumors or remove granulation tissue. Central airway obstructions, whether malignant or benign can be treated with immediate effects using various tools of interventional bronchoscopy. Depending on the type of stenosis, mechanical removal, laser photo-resection, electrocautery, argon-plasma coagulation, cryo-therapy, local drug injection, and photodynamic therapy are used to reopen obstructed airways and prevent suffocation. The effect can be stabilized by the insertion of airway stents, and newer developments including custom made 3D printed, bio-degradable, and drug-eluting stents have just recently been added to our armamentarium. For patients with lung cancer, these types of interventions are not only used as palliative measures in final stages. They can facilitate or even enable curative treatments by oncologists or radio-therapists or surgeons. Within the last ten years, interventional pulmonology has also gained an important role in treating patients with obstructive airway disease. Bronchial thermoplasty is indicated for severe asthma, targeted lung denervation, rheoplasty, and the application of cryo-spray relieves the symptoms of COPD patients and endoscopic volume reduction using valves, vapor, foam, or coils to help patients with emphysema.

In this Special Issue, we have asked experts in the field to provide a balanced overview, clarifying the possibilities and limitations of these exiting procedures. Besides reasonable patient selection, necessary institutional and technical requirements, as well as the required skills to apply these techniques, are discussed.

Prof. Dr. Lutz Freitag
Guest Editor

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Keywords

interventional pulmonary medicine
image guided, navigation guided, and robotic biopsy
malignant and benign airway stenosis
laser, APC, and cryo-therapy
airway stents
bronchial thermoplasty
endoscopic volume reduction

Published Papers (13 papers)

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11 pages, 4967 KiB

Open AccessArticle

COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?

by Grigoris Stratakos, Nektarios Anagnostopoulos, Rajaa Alsaggaf, Evangelia Koukaki, Katerina Bakiri, Philip Emmanouil, Charalampos Zisis, Konstantinos Vachlas, Christina Vourlakou and Antonia Koutsoukou

J. Clin. Med. 2022, 11(6), 1719; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061719 - 20 Mar 2022

Cited by 18 | Viewed by 2642

Abstract

During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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9 pages, 566 KiB

Open AccessArticle

Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience

by Nurul Yaqeen Mohd Esa, Siti Kamariah Othman, Mohd Arif Mohd Zim, Tengku Saifudin Tengku Ismail and Ahmad Izuanuddin Ismail

J. Clin. Med. 2022, 11(3), 676; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030676 - 28 Jan 2022

Cited by 2 | Viewed by 3711

Abstract

The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive ‘Acid-fast bacilli’ (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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11 pages, 3854 KiB

Open AccessArticle

The Effects of Rapamycin on the Proliferation, Migration, and Apoptosis of Human Tracheal Fibroblasts (HTrF) and Human Tracheal Epithelial Cells (HTEpiC)

by Yan Liu, Jie Zhang, Jianhai Long, Xiaojian Qiu, Ting Wang and Juan Wang

J. Clin. Med. 2022, 11(3), 608; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030608 - 25 Jan 2022

Viewed by 1857

Abstract

Background: Restenosis after airway stenting needs to be addressed urgently. Rapamycin has been proven to inhibit restenosis elsewhere. This study aimed at observing its effects on the respiratory tract. Methods: CCK-8, wound healing, Transwell and apoptosis assays were performed to detect the effects of rapamycin on the survival, migration, and apoptosis, respectively, of human tracheal fibroblasts (HTrF) and human tracheal epithelial cells (HTEpiC). Results: The effective concentrations of paclitaxel, mitomycin C and rapamycin on HTrF were 10⁻⁷–10⁻⁴ mol/L, 10⁻⁶–10⁻⁴ mol/L, and 10⁻⁵–10⁻⁴ mol/L, respectively. At the effective concentrations, the inhibition rates of paclitaxel on HTEpiC were (43.03 ± 1.12)%, (49.49 ± 0.86)%, (55.22 ± 1.43)%, and (93.19 ± 0.45)%; the inhibition rates of mitomycin C on HTEpiC were (88.11 ± 0.69)%, (93.82 ± 0.96)%, and (94.94 ± 0.54)%; the inhibition rates of rapamycin on HTEpiC were (10.19 ± 0.35)% and (94.55 ± 0.71)%. At the concentration of (1–4) × 10⁻⁵ mol/L, the inhibition rate of rapamycin on HTrF was more than 50%, and that on HTEpiC was less than 20% (p < 0.05). Conclusions: Compared to paclitaxel and mitomycin C, rapamycin had the least effect on HTEpiC while effectively inhibiting HTrF. The optimum concentration range was (1–4) × 10⁻⁵ mol/L. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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10 pages, 972 KiB

Open AccessArticle

Paclitaxel-Loaded PLGA Coating Stents in the Treatment of Benign Cicatrical Airway Stenosis

by Xiaojian Qiu, Yan Liu, Jie Zhang, Ting Wang and Juan Wang

J. Clin. Med. 2022, 11(3), 517; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030517 - 20 Jan 2022

Cited by 5 | Viewed by 1614

Abstract

Background: Airway stent implantation used in the treatment of benign cicatricial airway stenosis (BCAS) can lead to local granulation and scar formation, resulting in restenosis and treatment failure. Methods: We systematically investigated a paclitaxel-loaded PLGA-coating stent (PLPCS) and analyzed the safety and efficacy of the PLPCS in patients with BCAS. Patients were enrolled from four hospitals in China and observed for six months after implantation, by bronchoscopy performed weekly in the first month and monthly thereafter. The stent was removed immediately upon detection of granulation tissue proliferation, leading to immobility of the stent. Results: Granulation tissue was formed one week after stent implantation, most of which was located at the upper edge of the stent and the narrowest airway in the stent. All stents were removed in three months (mean: 6.51 + 4.67 weeks), with a curative outcome in one case and ineffective results in two. The remaining seven patients developed complications within three months, necessitating early stent removal. The main complication was granulation formation, resulting in difficulty in stent removal. Conclusion: Although PLPCS showed beneficial effects in basic and animal experiments, it cannot prevent airway restenosis in actual practice, mainly due to granulation formation. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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9 pages, 759 KiB

Open AccessArticle

Early Spirometry Following Bronchoscopic Lung Volume Reduction with Endobronchial Valves

by Pascal Bezel, Jasmin Wani, Gilles Wiederkehr, Christa Bodmer, Carolin Steinack and Daniel P. Franzen

J. Clin. Med. 2022, 11(2), 440; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020440 - 15 Jan 2022

Viewed by 1285

Abstract

Bronchoscopic lung volume reduction (BLVR) by endobronchial valve (EBV) implantation has been shown to improve dyspnea, pulmonary function, exercise capacity, and quality of life in highly selected patients with severe emphysema and hyperinflation. The most frequent adverse event is a pneumothorax (PTX), occurring in approximately one-fifth of the cases due to intrathoracic volume shifts. The majority of these incidents are observed within 48 h post-procedure. However, the delayed occurrence of PTX after hospital discharge is a matter of concern. There is currently no approved concept for its prevention. Particularly, it is unknown whether and when respiratory manoeuvers such as spirometry post EBV treatment are feasible and safe. As per standard operating procedure at the University Hospital Zurich, early spirometry is scheduled after BLVR and prior to the discharge of the patient in order to monitor treatment success. The aim of our retrospective study was to investigate the feasibility and safety of early spirometry. In addition, we hypothesized that early spirometry could be useful to identify patients at risk for late PTX, which may occur after hospital discharge. All patients who underwent BLVR using EBVs between January 2018 and January 2020 at our hospital were enrolled in this study. After excluding 16 patients diagnosed post-procedure with PTX and four patients for other reasons, early spirometry was performed in 61 cases. There was neither a clinically relevant PTX during or after early spirometry nor a late PTX following hospital discharge. In conclusion, we found early spirometry, conducted not sooner than three days following EBV treatment, to be feasible and safe. Furthermore, early spirometry seems to be a useful predictor for successful BLVR, and it may help to decide whether a patient can be discharged. Given the small sample size and the retrospective design of our study, a prospective study that includes routine chest imaging after early spirometry to definitively exclude PTX is needed to recommend early spirometry as part of the standard protocol following EBV treatment. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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9 pages, 1830 KiB

Open AccessArticle

Crown-Cut Endobronchial Ultrasound Guided Transbronchial Aspiration Needle: First Real-World Experiences

by Filiz Oezkan, Woo Yul Byun, Clemens Loeffler, Udo Siebolts, Linda Diessel, Nina Lambrecht and Stephan Eisenmann

J. Clin. Med. 2022, 11(1), 163; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010163 - 29 Dec 2021

Cited by 5 | Viewed by 1623

Abstract

Advancements in personalized medicine have increased the demand for quantity and preservation of tissue architecture of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples. These demands may be addressed by the SonoTip TopGain^® needle, which has a 3-point crown-cut design that contrasts with the standard single bevel design of the ViziShot 2^®. The objective was to compare the SonoTip TopGain^® and ViziShot 2^® needles by considering biopsy sample characteristics, diagnostic accuracy, and patient safety. The primary endpoint of the study was the number of high-power fields (HPFs) in the center of the formalin-fixed paraffin-embedded cell block per sample. The lymph node with the highest probability for malignant infiltration based on size and sonographic appearance was chosen as the target lymph node for 20 patients. The same lymph node in each patient was sampled using both the ViziShot 2^® and SonoTip TopGain^® needles. The samples were measured, sliced, and analyzed by a pathologist. Sixteen patients were biopsied with both needles. Four patients could not be biopsied with the SonoTip TopGain^® needle since it could not penetrate cartilage or be repositioned to bypass cartilage. HPFs and sample dimensions were significantly greater in the patients where sampling with the SonoTip TopGain^® needle was possible (p = 0.007 and p = 0.005, respectively). Diagnostic accuracy and safety profiles were comparable. Significantly more material can be sampled using the SonoTip TopGain^® needle when cartilage penetration can be avoided. This improves the yield for molecular workup in the era of personalized medicine. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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12 pages, 2066 KiB

Open AccessArticle

Diagnostic Yield of Transbronchial Lung Cryobiopsy Compared to Transbronchial Forceps Biopsy in Patients with Sarcoidosis in a Prospective, Randomized, Multicentre Cross-Over Trial

by Maik Häntschel, Ralf Eberhardt, Christoph Petermann, Wolfgang Gesierich, Kaid Darwiche, Lars Hagmeyer, Thomas V. Colby, Falko Fend, Dirk Theegarten, Hanns-Olof Wintzer, Michael Kreuter, Werner Spengler, Annika Felicitas Behrens-Zemek, Richard A. Lewis, Henry C. Evrard, Ahmed Ehab, Michael Böckeler and Jürgen Hetzel

J. Clin. Med. 2021, 10(23), 5686; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10235686 - 2 Dec 2021

Cited by 4 | Viewed by 2232

Abstract

Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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13 pages, 1810 KiB

Open AccessArticle

Influence of Pharyngeal Anaesthesia on Post-Bronchoscopic Coughing: A Prospective, Single Blinded, Multicentre Trial

by Maik Häntschel, Mariella Zahn-Paulsen, Ahmed Ehab, Michael Böckeler, Werner Spengler, Richard A. Lewis, Hubert Hautmann and Jürgen Hetzel

J. Clin. Med. 2021, 10(20), 4773; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10204773 - 18 Oct 2021

Cited by 1 | Viewed by 1369

Abstract

Background: Local anaesthesia of the pharynx (LAP) was introduced in the era of rigid bronchoscopy (which was initially a conscious procedure under local anaesthetic), and continued into the era of flexible bronchoscopy (FB) in order to facilitate introduction of the FB. LAP reduces cough and gagging reflex, but its post-procedural effect is unclear. This prospective multicentre trial evaluated the effect of LAP on coughing intensity/time and patient comfort after FB, and the feasibility of FB under propofol sedation alone, without LAP. Material and methods: FB was performed in 74 consecutive patients under sedation with propofol, either alone (35 patients, 47.3%) or with additional LAP (39 patients, 52.7%). A primary endpoint of post-procedural coughing duration in the first 10 min after awakening was evaluated. A secondary endpoint was the cough frequency, quality and development of coughing in the same period during the 10 min post-procedure. Finally, the ease of undertaking the FB and the patient’s tolerance and safety were evaluated from the point of view of the investigator, the assistant technician and the patient. Results: We observed a trend to a shorter cumulative coughing time of 48.6 s in the group without LAP compared to 82.8 s in the group receiving LAP within the first 10 min after the procedure, although this difference was not significant (p = 0.24). There was no significant difference in the cough frequency, quality, peri-procedural complication rate, nor patient tolerance or safety. FB, including any additional procedure, could be performed equally well with or without LAP in both groups. Conclusions: Our study suggests that undertaking FB under deep sedation without LAP does to affect post-procedural cough duration and frequency. However, further prospective randomised controlled trials are needed to further support this finding. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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11 pages, 1144 KiB

Open AccessArticle

Monitored Anesthesia Care with Dexmedetomidine Supplemented by Midazolam/Fentanyl versus Midazolam/Fentanyl Alone in Patients Undergoing Pleuroscopy: Effect on Oxygenation and Respiratory Function

by Andreas Kostroglou, Emmanouil I. Kapetanakis, Paraskevi Matsota, Periklis Tomos, Konstantinos Kostopanagiotou, Ioannis Tomos, Charalampos Siristatidis, Michail Papapanou and Tatiana Sidiropoulou

J. Clin. Med. 2021, 10(16), 3510; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163510 - 9 Aug 2021

Cited by 3 | Viewed by 1878

Abstract

Although pleuroscopy is considered a safe and well tolerated procedure with a low complication rate, it requires the administration of procedural sedation and analgesia. The purpose of this study was to assess the effects of dexmedetomidine administration on oxygenation and respiratory function in patients undergoing diagnostic or therapeutic pleuroscopy. Through a prospective, single center, cohort study, we studied 55 patients receiving either a dexmedetomidine intravenous infusion supplemented by midazolam/fentanyl (Group DEX + MZ/F) or a conventional sedation protocol with midazolam/fentanyl (Group MZ/F). Our primary outcome was the changes in lung gas exchange (PaO₂/FiO₂ ratio) obtained at baseline and at predetermined end points, while changes in respiratory mechanics (FEV1, FVC and the ratio FEV1/FVC) and PaCO₂ levels, drug consumption, time to recover from sedation and adverse events were our secondary endpoints (NCT03597828). We found a lower postoperative decrease in FEV1 volumes in Group DEX + MZ/F compared to Group MZ/F (p = 0.039), while FVC, FEV1/FVC and gas exchange values did not differ between groups. We also found a significant reduction in midazolam (p < 0.001) and fentanyl consumption (p < 0.001), along with a more rapid recovery of alertness postprocedure in Group DEX + MZ/F compared to Group MZ/F (p = 0.003), while pain scores during the postoperative period, favored the Group DEX + MZ/F (p = 0.020). In conclusion, the use of intravenous dexmedetomidine during pleuroscopy is associated with a smaller decrease in FEV1, reduction of the consumption of supplementary sedatives and analgesics and quicker awakening of patients postoperatively, when compared to midazolam/fentanyl. Therefore, dexmedetomidine administration may provide clinically significant benefits in terms of lung mechanics and faster recovery of patients undergoing pleuroscopy. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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10 pages, 394 KiB

Open AccessArticle

Validity of Lung Ultrasound: Is an Image Worth More Than a Thousand Sounds?

by Cristina Ramos-Hernández, Maribel Botana-Rial, Marta Núñez-Fernández, Irene Lojo-Rodríguez, Cecilia Mouronte-Roibas, Ángel Salgado-Barreira, Alberto Ruano-Raviña and Alberto Fernández-Villar

J. Clin. Med. 2021, 10(11), 2292; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112292 - 25 May 2021

Cited by 2 | Viewed by 2081

Abstract

Introduction: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). Results: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B-lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. Conclusions: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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Review

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9 pages, 3602 KiB

Open AccessReview

How Bronchoscopic Dye Marking Can Help Minimally Invasive Lung Surgery

by Matthieu Sarsam, Jean-Marc Baste, Luc Thiberville, Mathieu Salaun and Samy Lachkar

J. Clin. Med. 2022, 11(11), 3246; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11113246 - 6 Jun 2022

Cited by 5 | Viewed by 1808

Abstract

In the era of increasing availability of high-resolution chest computed tomography, the diagnosis and management of solitary pulmonary nodules (SPNs) has become a common challenging clinical problem. Meanwhile, surgical techniques have improved, and minimally invasive approaches such as robot- and video-assisted surgery are becoming standard, rendering the palpation of such lesions more difficult, not to mention pure ground-glass opacities, which cannot be felt even in open surgery. In this article, we explore the role of bronchoscopy in helping surgeons achieve successful minimally invasive resections in such cases. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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10 pages, 5396 KiB

Open AccessReview

Linear Endobronchial Ultrasound in the Era of Personalized Lung Cancer Diagnostics—A Technical Review

by Filiz Oezkan, Stephan Eisenmann, Kaid Darwiche, Asmae Gassa, David P. Carbone, Robert E. Merritt and Peter J. Kneuertz

J. Clin. Med. 2021, 10(23), 5646; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10235646 - 30 Nov 2021

Cited by 5 | Viewed by 2744

Abstract

Major advances in molecular profiling for available targeted treatments and immunotherapy for lung cancer have significantly increased the complexity of tissue-based diagnostics. Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA) are commonly performed for diagnostic biopsies and lymph node staging. EBUS-TBNA has increasingly become one of the main sources of tumor cells for molecular analyses. As a result, there is a growing need for high quality EBUS-TBNA samples with adequate cellularity. This has increased the technical demands of the procedure and has created additional challenges, many of which are not addressed in the current EBUS guidelines. This review provides an overview of current evidence on the technical aspects of EBUS-TBNA in light of comprehensive sample processing for personalized lung cancer management. These include sonographic lymph node characterization, optimal needle choice, suction biopsy technique, and the role of rapid on-site evaluation. Attention to these technical details will be important to maximize the throughput of EBUS-TBNA biopsies for molecular testing. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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7 pages, 505 KiB

Open AccessReview

Malignant Pleural Effusions—A Review of Current Guidelines and Practices

by Prarthna Chandar Kulandaisamy, Sakthidev Kulandaisamy, Daniel Kramer and Christopher Mcgrath

J. Clin. Med. 2021, 10(23), 5535; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10235535 - 26 Nov 2021

Cited by 8 | Viewed by 3154

Abstract

Malignant pleural effusion (MPE) occurs in 15% of all cancer patients and usually portends poor prognosis while also serving to limit the patient’s quality of life. Palliation of symptoms has been the goal for the management of these effusions while keeping the patient’s hospital stay to a minimum. Traditionally, this has been achieved by chest tube drainage followed by the instillation of sclerosing agents, such as talc, in the pleural space. A recent increase in evidence for the effectiveness and convenience of indwelling pleural catheters has changed the management of MPE, which is reflected in the guidelines released by the American Thoracic Society as well their European Counterpart (ERS/BTS). In this article, we aim to review the current management practices and guidelines for MPE. Full article

(This article belongs to the Special Issue Interventional Pulmonology: A New World)

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