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Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution....
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Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting

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

Deadline for manuscript submissions: 20 July 2025 | Viewed by 4322

Special Issue Editors

Dr. Federico Raveglia

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Guest Editor
Department of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
Interests: thoracic surgery; lung cancer; hyperhidrosis; mediastinum; pleural disease; robotic surgery
Dr. Carmelina C. Zirafa

E-Mail Website
Guest Editor
Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy
Interests: thoracic surgery; lung cancer; hyperhidrosis; mediastinum; pleural disease; robotic surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Mohsen Ibrahim

E-Mail Website
Guest Editor
Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy
Interests: horacic surgery; RATS; thoracic oncology; airway surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Italian Society of Thoracic Endoscopy (SIET) was established in 1980 to support research and innovation in endoscopic thoracic surgery by promoting their development and application in the national and international context. Moreover, the SIET promotes the training of young people through courses in collaboration with universities and scientific societies. The SIET national meeting is a means of information and training exchange, with the aim of creating a cohesive and active scientific community. It is held every two years, welcoming specialists from different disciplines. This year, the multidisciplinary spirit of the SIET will be decisively demonstrated, with participants equally divided between surgical and pulmonological specialties , reflecting in the scientific sphere what happens every day in clinical practice.

The XXII SIET national meeting (17–19 October 2024, Florence, Italy, https://www.sietfirenze2024.it/) is mainly focused on the following topics: pathologies of the trachea and large airways, the mediastinum, and the pleura, resectable pulmonary tumor, management of primitive and/or metastatic peripheral pulmonary noduli , digitalization in clinical practice, and non-neoplastic thoracic pathologies.

These topics will be addressed by international experts presenting their personal experiences. The current Special Issue aims to promote the most interesting abstracts presented during the meeting by developing them into full articles.  In accordance with the purpose of this collection, manuscripts should address innovations in this specific field of interest. 

All contributions must have been accepted and presented during the XXI SIET annual meeting. 

Dr. Federico Raveglia
Dr. Carmelina C. Zirafa
Prof. Dr. Mohsen Ibrahim
Guest Editors

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. Journal of Clinical Medicine 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

  • lung cancer
  • interventional endoscopy
  • upper airway reconstruction
  • robotic diagnosis
  • robotic surgery

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Published Papers (6 papers)

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9 pages, 647 KiB  
Article
Diagnostic Yield of CE-EBUS in Mediastinal and Hilar Lymphadenopathy: A Preliminary Study
by Ilaria Suriano, Luca Frasca, Filippo Longo, Antonio Sarubbi, Giovanni Tacchi and Pierfilippo Crucitti
J. Clin. Med. 2025, 14(8), 2800; https://doi.org/10.3390/jcm14082800 - 18 Apr 2025
Viewed by 212
Abstract
Background/Objectives: Contrast-enhanced endobronchial ultrasound (CE-EBUS) is a minimally invasive technique that combines traditional endobronchial ultrasound (EBUS) with a contrast agent (sulfur hexafluoride), enhancing the visualization of blood flow in mediastinal and hilar lymph nodes. This study aimed to assess the use of [...] Read more.
Background/Objectives: Contrast-enhanced endobronchial ultrasound (CE-EBUS) is a minimally invasive technique that combines traditional endobronchial ultrasound (EBUS) with a contrast agent (sulfur hexafluoride), enhancing the visualization of blood flow in mediastinal and hilar lymph nodes. This study aimed to assess the use of CE-EBUS in patients with advanced neoplasms and hilar or mediastinal lymphadenopathy, particularly to improve diagnostic accuracy and expedite sample collection. Methods: A retrospective observational study was conducted from April 2021 to December 2023, involving 49 patients divided into two groups: EBUS (n = 26) and CE-EBUS (n = 23). Patients had advanced neoplasms with hilar and mediastinal lymphadenopathy, including bulky masses and nodal metastases with central necrosis. In the CE-EBUS group, 4.8 mL of sulfur hexafluoride was administered intravenously. Morphological, echogenic, and vascular characteristics, diagnostic accuracy, sample collection adequacy and molecular testing were compared between the groups. Results: The diagnostic accuracy in CE-EBUS was similar to EBUS (21 vs. 19 patients), with no significant difference (p = 0.100). However, for patients with bulky masses and necrosis, the molecular assessment rate was significantly higher in the CE-EBUS group (81.8%) compared to the EBUS group (33.3%) (p = 0.014). Conclusions: CE-EBUS-TBNA could improve the accuracy of molecular assessments in patients with bulky, necrotic lymphadenopathy and could help collect vital neoplastic tissue for molecular testing. Full article
(This article belongs to the Special Issue Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting)
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17 pages, 2774 KiB  
Article
Long-Term Outcomes of Interventional Bronchoscopy for Central Airway Obstruction in a Single-Center Retrospective Study: A Subgroup Analysis of Malignant and Benign Lesions
by Paolo Scanagatta, Francesco Inzirillo, Giuseppe Naldi, Casimiro Eugenio Giorgetta, Eugenio Ravalli, Gianluca Ancona and Sara Cagnetti
J. Clin. Med. 2025, 14(7), 2155; https://doi.org/10.3390/jcm14072155 - 21 Mar 2025
Viewed by 289
Abstract
Background: Central airway obstruction (CAO) remains a major challenge in thoracic oncology, particularly in patients with advanced lung cancer. Despite advances in systemic therapies, interventional bronchoscopy, especially rigid bronchoscopy (RB), plays a critical role in managing CAO. Methods: Between June 2005 and December [...] Read more.
Background: Central airway obstruction (CAO) remains a major challenge in thoracic oncology, particularly in patients with advanced lung cancer. Despite advances in systemic therapies, interventional bronchoscopy, especially rigid bronchoscopy (RB), plays a critical role in managing CAO. Methods: Between June 2005 and December 2023, 416 patients with central airway obstructions were treated. The cohort included 213 males (51%) and 203 females (49%), with a mean age of 64.8 years. A retrospective review of patient data was conducted, and descriptive statistics were used to summarize demographics and procedural outcomes. Survival rates and complication data were analyzed using Kaplan–Meier survival curves. Multivariate analysis was performed to identify significant predictors of survival and complications, considering factors such as tumor stage, prior treatments, and comorbidities. The study also analyzed the impact of adjuvant therapies and stenting on patient outcomes. Results: Of the 416 patients, 86 (20.7%) had benign lesions, including 61 cases of post-tracheostomy stenosis or prolonged intubation, while the remaining 330 (79.3%) had malignant CAO. Patients receiving adjuvant therapies showed a significant survival advantage, with a median survival of 24 months compared to 15 months for those not receiving adjuvant therapies (p = 0.015). Stenting was performed in 141 cases, but no significant survival difference was found between patients with and without stents (p = 0.52). Complications were rare, with airway rupture observed in 1.9% and perioperative mortality in 0.25%. Symptom relief was achieved in the majority of patients, with significant improvements in quality of life, particularly in those with malignant obstructions. Conclusions: RB remains a cornerstone in the management of CAO, providing effective and durable symptom relief. It is particularly beneficial for advanced malignancies, offering a palliative approach that improves both survival and quality of life. Our study supports the guidelines endorsing RB for CAO management and highlights its role in providing significant symptom relief and stabilization in patients with severe airway obstruction. Full article
(This article belongs to the Special Issue Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting)
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22 pages, 891 KiB  
Article
An Assessment of ChatGPT’s Responses to Common Patient Questions About Lung Cancer Surgery: A Preliminary Clinical Evaluation of Accuracy and Relevance
by Marina Troian, Stefano Lovadina, Alice Ravasin, Alessia Arbore, Aneta Aleksova, Elisa Baratella and Maurizio Cortale
J. Clin. Med. 2025, 14(5), 1676; https://doi.org/10.3390/jcm14051676 - 1 Mar 2025
Viewed by 692
Abstract
Background: Chatbots based on artificial intelligence (AI) and machine learning are rapidly growing in popularity. Patients may use these technologies to ask questions regarding surgical interventions, preoperative assessments, and postoperative outcomes. The aim of this study was to determine whether ChatGPT could [...] Read more.
Background: Chatbots based on artificial intelligence (AI) and machine learning are rapidly growing in popularity. Patients may use these technologies to ask questions regarding surgical interventions, preoperative assessments, and postoperative outcomes. The aim of this study was to determine whether ChatGPT could appropriately answer some of the most frequently asked questions posed by patients about lung cancer surgery. Methods: Sixteen frequently asked questions about lung cancer surgery were asked to the chatbot in one conversation, without follow-up questions or repetition of the same questions. Each answer was evaluated for appropriateness and accuracy using an evidence-based approach by a panel of specialists with relevant clinical experience. The responses were assessed using a four-point Likert scale (i.e., “strongly agree, satisfactory”, “agree, requires minimal clarification”, “disagree, requires moderate clarification”, and “strongly disagree, requires substantial clarification”). Results: All answers provided by the chatbot were judged to be satisfactory, evidence-based, and generally unbiased overall, seldomly requiring minimal clarification. Moreover, information was delivered in a language deemed easy-to-read and comprehensible to most patients. Conclusions: ChatGPT could effectively provide evidence-based answers to the most commonly asked questions about lung cancer surgery. The chatbot presented information in a language considered understandable by most patients. Therefore, this resource may be a valuable adjunctive tool for preoperative patient education. Full article
(This article belongs to the Special Issue Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting)
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13 pages, 719 KiB  
Article
Real-Life Comparison of Diagnostic Yield and Sample Adequacy of 22 G and 25 G EBUS-TBNB Needles: A Retrospective Study
by Filippo Lanfranchi, George Kalak, Gioele Castelli, Laura Mancino, Gabriele Foltran, Alberto Pavan, Lorenzo Ciarrocchi, Licia Laurino and Lucio Michieletto
J. Clin. Med. 2025, 14(5), 1637; https://doi.org/10.3390/jcm14051637 - 28 Feb 2025
Viewed by 595
Abstract
Background/Objectives: EBUS-TBNA is a safe and minimally invasive procedure to evaluate hilar and mediastinal lymph nodes (LNs). The Franseen needle provides a transbronchial needle biopsy (TBNB). Various needle sizes are available. In the literature, diagnostic yield (DY) and sample adequacy (SA) between [...] Read more.
Background/Objectives: EBUS-TBNA is a safe and minimally invasive procedure to evaluate hilar and mediastinal lymph nodes (LNs). The Franseen needle provides a transbronchial needle biopsy (TBNB). Various needle sizes are available. In the literature, diagnostic yield (DY) and sample adequacy (SA) between needle sizes are still being debated. Methods: In total, 88 patients with lymphadenopathy were consecutively enrolled from June to December 2021. Chest CT and PET/CT scans were performed. Dimension at imaging and EBUS and the standardized uptake value (SUV) were recorded. EBUS-TBNB was performed with 22 G or 25 G needle sizes. DY for cancer and SA for predictive markers were evaluated. Overall DY (ODY) was also evaluated. Results: A 22 G needle was used in 51 patients and a 25 G needle was used in 37 patients with no differences in sex and age. The 22 G population presented a larger median dimension of LN both at imaging and EBUS compared to the 25 G population. Median LN SUV was higher in the 22 G population. Notably, 70 out of 88 patients had LNs suspicious for malignancy, which was higher in the 22 G group compared to the 25 G group (n = 46, 90% vs. n = 24, 65%; p = 0.004). DY for cancer was similar in both groups (84% for 22 G; 91% for 25 G). Also, SA for predictive markers was similar. ODY values were 78% and 92%, respectively, for the 22 G and 25 G needles. Conclusions: The 25 G needle has a higher DY (even if not statistically significant) and SA for predictive markers similar to the 22 G needle; further studies are necessary to evaluate if 25 G is comparable to the 22 G needle. Full article
(This article belongs to the Special Issue Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting)
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9 pages, 2802 KiB  
Case Report
Multilocular Thymic Cyst with High F18 Fluorodeoxyglucose Uptake and Rheumatoid Arthritis: A Case Report
by Francesco Ferrante, Camilla Poggi, Anastasia Centofanti, Rita Vaz Sousa, Valerio Sebastianelli, Antonio Pio Evangelista, Francesco Mattoccia, Beatrice Zacchini, Tiziano De Giacomo, Marco Anile, Federico Venuta and Massimiliano Bassi
J. Clin. Med. 2025, 14(2), 620; https://doi.org/10.3390/jcm14020620 - 18 Jan 2025
Viewed by 814
Abstract
Background: multilocular thymic cysts are uncommon acquired cysts in the anterior mediastinum caused by incomplete thymic involution. They may be associated with autoimmune diseases, such as rheumatoid arthritis and systemic sclerosis. Methods: a 61-year-old man with a history of rheumatoid arthritis for 8 [...] Read more.
Background: multilocular thymic cysts are uncommon acquired cysts in the anterior mediastinum caused by incomplete thymic involution. They may be associated with autoimmune diseases, such as rheumatoid arthritis and systemic sclerosis. Methods: a 61-year-old man with a history of rheumatoid arthritis for 8 years was referred to our unit because of a multiloculated mass in the anterior mediastinum with a high F18 fluorodeoxyglucose uptake at PET-CT scan. Histology showed a multilocular thymic cyst with lymphoid tissue, organized in germinal centers and internodal areas. Results: rheumatoid arthritis-related symptoms progressively disappeared after the excision of the mass. Conclusions: to our knowledge, this is the first report in the English language of rheumatoid arthritis symptoms improvement after multilocular thymic cyst surgical removal. Full article
(This article belongs to the Special Issue Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting)
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9 pages, 2111 KiB  
Case Report
Remifentanil-Propofol-Ketamine- Based Total Intravenous Anesthesia with Spontaneous Breathing for Adult Rigid Bronchoscopy
by Luca Frasca, Antonio Sarubbi, Filippo Longo, Fabio Costa, Domenico Sarubbi, Alessandro Strumia, Valentina Marziali and Pierfilippo Crucitti
J. Clin. Med. 2025, 14(2), 377; https://doi.org/10.3390/jcm14020377 - 9 Jan 2025
Cited by 1 | Viewed by 1048
Abstract
Background: Rigid bronchoscopy (RB) is the gold standard for managing central airway obstruction (CAO), a life-threatening condition caused by both malignant and benign etiologies. Anesthetic management is challenging as it requires balancing deep sedation with maintaining spontaneous breathing to avoid airway collapse. There [...] Read more.
Background: Rigid bronchoscopy (RB) is the gold standard for managing central airway obstruction (CAO), a life-threatening condition caused by both malignant and benign etiologies. Anesthetic management is challenging as it requires balancing deep sedation with maintaining spontaneous breathing to avoid airway collapse. There is no consensus on the optimal anesthetic approach, with options including general anesthesia with neuromuscular blockers or spontaneous assisted ventilation (SAV). Methods: This case series presents our anesthetic protocol using remifentanil–propofol–ketamine total intravenous anesthesia (TIVA) with SAV in four patients with airway obstructions. Muscle relaxants were avoided in all cases. Results: Ketamine’s ability to preserve respiratory drive and airway reflexes, along with its bronchodilating properties, made it ideal for managing CAO. All procedures successfully restored airway patency without complications or drug-related side effects. Conclusions: Our findings suggest that remifentanil–propofol–ketamine TIVA combined with SAV is a viable anesthetic approach for therapeutic RB, offering effective sedation, maintaining airway patency, and minimizing perioperative complications. Full article
(This article belongs to the Special Issue Multidisciplinarity in Thoraco-Pulmonary Diseases: Every Generation Needs a New Revolution. Insights from the XXII SIET National Meeting)
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