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Diagnostics
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Advances in Interventional Pulmonology
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Advances in Interventional Pulmonology

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 35700

Special Issue Editors

Dr. Kassem Harris

E-Mail Website
Guest Editor
Interventional Pulmonology Section, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA
Interests: bronchoscopy; transbronchial; endobronchial
Special Issues, Collections and Topics in MDPI journals
Dr. Samjot Singh Dhillon

E-Mail Website
Co-Guest Editor
Department of Pulmonary and Critical Care Medicine/Interventional Pulmonary, the Permanente Medical Group, Kaiser Permanente Roseville and Sacramento Medical Center, Roseville and Sacramento, CA, USA
Interests: cancer; bronchoscopy; lung; endobronchial ultrasound

Special Issue Information

Dear Colleagues,

Patients with thoracic diseases, especially those with multiple comorbidities, prefer minimally invasive procedures that are easier to tolerate. These procedures lead to fewer complications, shorter hospital stays, and lower costs. Since interventional pulmonology was first defined as a field in 2001, there have been remarkable changes related to innovations and the performance of procedures. Many diagnostic and therapeutic modalities have been introduced.

Endobronchial ultrasound and various navigational bronchoscopy systems are the most noticeable inventions, in addition to other developments in bronchoscopic tools. Recently, robotic bronchoscopy was introduced, promising to expand the limits of what can be done by proceduralists to achieve higher diagnostic yield and new therapeutic interventions.

In the last decade, there were several breakthroughs in the management of lung cancers.  These were mainly led by identifying driver mutations such as the epidermal growth factor (EGFR) and translocations in anaplastic lymphoma kinase (ALK). Acquiring more tissue specimens during lung biopsies was a real challenge that was overcome by identifying the optimal approach, including the adequate tools to use and the number of biopsies to be performed. Rapid on-site evaluation played a crucial role in the determination of specimens’ adequacy.

The use of ultrasound for the diagnosis of lung and pleural diseases has expanded and became the standard of care. Pleuroscopy has also become more popular, especially for the diagnosis of exudative pleural effusion.

The aim of this Special Issue is to present state-of-the-art articles discussing recent advances in interventional pulmonology. For this purpose, we are selecting authors who share the same goal of caring for patients using the least invasive techniques. We believe that this will provide our readers with the latest updates that are useful in caring for their patients.

Dr. Kassem Harris
Guest Editor
Dr. Samjot Singh Dhillon
Co-Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bronchoscopy
  • pleural intervention
  • airway management
  • endobronchial ultrasound

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Published Papers (7 papers)

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Research

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12 pages, 2750 KiB  
Article
The Feasibility of Interventional Pulmonology Methods for Detecting the T790M Mutation after the First or Second-Generation EGFR-TKI Resistance of Non-Small Cell Lung Cancer
by Wen-Chien Cheng, Yi-Cheng Shen, Chieh-Lung Chen, Wei-Chih Liao, Hung-Jen Chen, Te-Chun Hsia, Chia-Hung Chen and Chih-Yen Tu
Diagnostics 2023, 13(1), 129; https://doi.org/10.3390/diagnostics13010129 - 30 Dec 2022
Cited by 2 | Viewed by 1639
Abstract
The development of third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) targeting T790M-mutant non-small cell lung cancer (NSCLC) has raised the importance of re-biopsy after EGFR-TKI failure. This study aimed to investigate the feasibility of interventional pulmonology (IP) procedures as re-biopsy methods [...] Read more.
The development of third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) targeting T790M-mutant non-small cell lung cancer (NSCLC) has raised the importance of re-biopsy after EGFR-TKI failure. This study aimed to investigate the feasibility of interventional pulmonology (IP) procedures as re-biopsy methods for identifying the T790M mutation in EGFR-TKI-resistant patients. One hundred and thirty-nine NSCLC patients who underwent IP procedures for re-biopsy as their initial investigation after EGFR-TKI treatment failure were enrolled in this study between January 2020 and August 2022. All patients underwent a first re-biopsy with IP methods, with a diagnostic yield of 81.2% and T790M mutation detection rate of 36%. Thirty patients underwent a second re-biopsy; IP methods were used for 17 (56.6%) patients and non-IP methods for 13 (43.4%) patients; the T790M mutation detection rate was 36.4%. Only six patients underwent a third re-biopsy; no T790M mutation was noted. The T790M mutation detection rate did not differ between IP and non-IP methods (33.6 % vs. 37.5%, p = 0.762). In 11 cases (7.5%), a re-biopsy revealed histologic transformation from lung adenocarcinoma. IP procedures, as first-line re-biopsy methods for NSCLC, are feasible and provide sufficient tissue for identification of the resistance mechanism and target gene T790M mutation. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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11 pages, 5769 KiB  
Article
The Feasibility of Using the “Artery Sign” for Pre-Procedural Planning in Navigational Bronchoscopy for Parenchymal Pulmonary Lesion Sampling
by Elliot Ho, Roy Joseph Cho, Joseph C. Keenan and Septimiu Murgu
Diagnostics 2022, 12(12), 3059; https://doi.org/10.3390/diagnostics12123059 - 6 Dec 2022
Cited by 7 | Viewed by 3366
Abstract
Background: Electromagnetic navigation bronchoscopy (ENB) and robotic-assisted bronchoscopy (RAB) systems are used for pulmonary lesion sampling, and utilize a pre-procedural CT scan where an airway, or “bronchus sign”, is used to map a pathway to the target lesion. However, up to 40% of [...] Read more.
Background: Electromagnetic navigation bronchoscopy (ENB) and robotic-assisted bronchoscopy (RAB) systems are used for pulmonary lesion sampling, and utilize a pre-procedural CT scan where an airway, or “bronchus sign”, is used to map a pathway to the target lesion. However, up to 40% of pre-procedural CT’s lack a “bronchus sign” partially due to surrounding emphysema or limitation in CT resolution. Recognizing that the branches of the pulmonary artery, lymphatics, and airways are often present together as the bronchovascular bundle, we postulate that a branch of the pulmonary artery (“artery sign”) could be used for pathway mapping during navigation bronchoscopy when a “bronchus sign” is absent. Herein we describe the navigation success and safety of using the “artery sign” to create a pathway for pulmonary lesion sampling. Methods: We reviewed data on consecutive cases in which the “artery sign” was used for pre-procedural planning for conventional ENB (superDimension™, Medtronic) and RAB (Monarch™, Johnson & Johnson). Patients who underwent these procedures from July 2020 until July 2021 at the University of Minnesota Medical Center and from June 2018 until December 2019 at the University of Chicago Medical Center were included in this analysis (IRB #19-0011 for the University of Chicago and IRB #00013135 for the University of Minnesota). The primary outcome was navigation success, defined as successfully maneuvering the bronchoscope to the target lesion based on feedback from the navigation system. Secondary outcomes included navigation success based on radial EBUS imaging, pneumothorax, and bleeding rates. Results: A total of 30 patients were enrolled in this analysis. The median diameter of the lesions was 17 mm. The median distance of the lesion from the pleura was 5 mm. Eleven lesions were solid, 15 were pure ground glass, and 4 were mixed. All cases were planned successfully using the “artery sign” on either the superDimension™ ENB (n = 15) or the Monarch™ RAB (n = 15). Navigation to the target was successful for 29 lesions (96.7%) based on feedback from the navigation system (virtual target). Radial EBUS image was acquired in 27 cases (90%) [eccentric view in 13 (43.33%) and concentric view in 14 patients (46.66%)], while in 3 cases (10%) no r-EBUS view was obtained. Pneumothorax occurred in one case (3%). Significant airway bleeding was reported in one case (3%). Conclusions: We describe the concept of using the “artery sign” as an alternative for planning EMN and RAB procedures when “bronchus sign” is absent. The navigation success based on virtual target or r-EBUS imaging is high and safety of sampling of such lesions compares favorably with prior reports. Prospective studies are needed to assess the impact of the “artery sign” on diagnostic yield. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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10 pages, 1049 KiB  
Article
Feasibility and Safety of Transbronchial Lung Cryobiopsy for Diagnosis of Acute Respiratory Failure with Mechanical Ventilation in Intensive Care Unit
by Chih-Hao Chang, Jia-Shiuan Ju, Shih-Hong Li, Shao-Chung Wang, Chih-Wei Wang, Chung-Shu Lee, Fu-Tsai Chung, Han-Chung Hu, Shu-Min Lin and Chung-Chi Huang
Diagnostics 2022, 12(12), 2917; https://doi.org/10.3390/diagnostics12122917 - 23 Nov 2022
Viewed by 2352
Abstract
Background: Acute hypoxemic respiratory failure is common in intensive care units (ICUs). Lung biopsies may be required to make a definitive diagnosis in patients with unknown etiologies. The feasibility of transbronchial lung cryobiopsy is undetermined in patients with respiratory failure in the ICU. [...] Read more.
Background: Acute hypoxemic respiratory failure is common in intensive care units (ICUs). Lung biopsies may be required to make a definitive diagnosis in patients with unknown etiologies. The feasibility of transbronchial lung cryobiopsy is undetermined in patients with respiratory failure in the ICU. Methods: Patients who underwent bronchoscopy examinations with transbronchial lung cryobiopsy (TBLC) between July 2018 and December 2019 were retrospectively analyzed through medical chart review. The procedures were performed by well-experienced interventional pulmonologists. Results: Ten patients underwent bronchoscopy examinations with TBLC in the ICU at Chang Gung Memorial Hospital during the study period. In all patients, the diagnosis was made via pathological analysis. One patient developed pneumothorax and required chest tube placement after the procedure. None of the patients had bleeding requiring blood transfusion, and no deaths were directly related to the procedure. Conclusions: TBLC is a feasible technique to obtain lung pathology in patients with acute respiratory diseases of unknown etiologies. While the complication rate may be acceptable, the procedure should be performed by experienced interventional pulmonologists. However, airway blockers and fluoroscopy are highly recommended when used according to the current guideline. We do not encourage TBLC to be performed without having airway blockers available at the bedside. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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Review

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17 pages, 1265 KiB  
Review
Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review
by Blake Jacobs, Ghias Sheikh, Houssein A. Youness, Jean I. Keddissi and Tony Abdo
Diagnostics 2022, 12(4), 1016; https://doi.org/10.3390/diagnostics12041016 - 18 Apr 2022
Cited by 16 | Viewed by 10527
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a [...] Read more.
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Over the last decade, several randomized controlled studies shaped the current management of MPE in favor of an outpatient-based approach with a notable increase in IPC usage. Patient preferences remain essential in choosing optimal therapy, especially when the lung is expandable. In this article, we reviewed the last 10 to 15 years of MPE literature with a particular focus on the diagnosis and evolving management. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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14 pages, 1287 KiB  
Review
Single-Use and Reusable Flexible Bronchoscopes in Pulmonary and Critical Care Medicine
by Elliot Ho, Ajay Wagh, Kyle Hogarth and Septimiu Murgu
Diagnostics 2022, 12(1), 174; https://doi.org/10.3390/diagnostics12010174 - 12 Jan 2022
Cited by 17 | Viewed by 5260
Abstract
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as [...] Read more.
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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15 pages, 1318 KiB  
Review
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield
by Huzaifa A. Jaliawala, Samid M. Farooqui, Kassem Harris, Tony Abdo, Jean I. Keddissi and Houssein A. Youness
Diagnostics 2021, 11(12), 2331; https://doi.org/10.3390/diagnostics11122331 - 10 Dec 2021
Cited by 10 | Viewed by 5504
Abstract
Since the endobronchial ultrasound bronchoscope was introduced to clinical practice, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the procedure of choice to sample hilar and mediastinal adenopathy. Multiple studies have been conducted in the last two decades to look at the different [...] Read more.
Since the endobronchial ultrasound bronchoscope was introduced to clinical practice, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the procedure of choice to sample hilar and mediastinal adenopathy. Multiple studies have been conducted in the last two decades to look at the different technical aspects of the procedure and their effects on the final cytopathological yield. In addition, newer modes of ultrasound scanning and newer tools with the potential to optimize the selection and sampling of the target lymph node have been introduced. These have the potential to reduce the number of passes, reduce the procedure time, and increase the diagnostic yield, especially in rare tumors and benign diseases. Herein, we review the latest updates related to the technical aspects of EBUS-TBNA and their effects on the final cytopathological yield in malignant and benign diseases. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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12 pages, 695 KiB  
Review
Robotic Bronchoscopy for Peripheral Pulmonary Lesion Biopsy: Evidence-Based Review of the Two Platforms
by Abhishek Kumar, Jose D. Caceres, Siddharthan Vaithilingam, Gurshan Sandhu and Nikhil K. Meena
Diagnostics 2021, 11(8), 1479; https://doi.org/10.3390/diagnostics11081479 - 15 Aug 2021
Cited by 15 | Viewed by 5468
Abstract
Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. “CT-to-body divergence” has [...] Read more.
Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. “CT-to-body divergence” has been identified as a major limitation of this modality. In-tandem use of the ultrathin bronchoscope and radial endobronchial ultrasound probe has yielded only comparable results, attributable to the limited peripheral reach, device maneuverability, stability, and distractors like atelectasis. As such, experts have identified three key steps in peripheral nodule sampling—navigation (to the lesion), confirmation (of the correct location), and acquisition (tissue sampling by tools). Robotic bronchoscopy (RB) is a novel innovation that aspires to improve upon these aspects and consequently, achieve a better diagnostic yield. Through this publication, we aim to review the technical aspects, safety, feasibility, and early efficacy data for this new diagnostic modality. Full article
(This article belongs to the Special Issue Advances in Interventional Pulmonology)
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