Search Results (738)

Advances in navigational bronchoscopy, robotic platforms, and intraprocedural imaging have transformed bronchoscopy from a diagnostic modality into a potential therapeutic platform for localized treatment of lung cancer. These developments are particularly relevant for patients who are medically inoperable, have limited pulmonary reserve, or require lung-sparing treatment strategies. This narrative review summarizes current evidence regarding bronchoscopic ablative technologies and intratumoral therapies for lung cancer. We discuss technological foundations including robotic bronchoscopy, electromagnetic and shape-sensing navigation, cone-beam computed tomography, augmented fluoroscopy, and radial endobronchial ultrasound. Available ablative modalities, including radiofrequency ablation, microwave ablation, cryoablation, photodynamic therapy, and pulsed electric field ablation, are reviewed alongside bronchoscopically delivered intratumoral chemotherapy, immunotherapy, and gene-based therapies. Early clinical studies demonstrate high technical success rates and favorable safety profiles for multiple bronchoscopic ablative approaches, with substantially lower rates of pleural complications compared with percutaneous techniques. Intratumoral therapies enable delivery of high local drug concentrations while minimizing systemic toxicity and may enhance antitumor immune responses through modulation of the tumor microenvironment. Emerging evidence suggests potential synergy between local ablation and immunotherapeutic strategies. However, available data remain limited by small sample sizes, heterogeneous treatment protocols, and a lack of randomized comparative studies. Bronchoscopic ablation and intratumoral therapies represent promising additions to the thoracic oncology armamentarium. Continued advances in navigation, imaging, and therapeutic delivery systems are enabling increasingly precise, minimally invasive interventions. Prospective clinical trials are needed to define optimal patient selection, procedural strategies, and integration with surgery, radiation, and systemic therapies within multidisciplinary lung cancer care. Full article

Background/Objectives: Pancreatic metastases are uncommon and may resemble primary pancreatic neoplasms on imaging, making tissue confirmation essential. This study aimed to characterize pancreatic metastases diagnosed by endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) and to describe tissue adequacy within the confirmed cohort and procedure-related adverse events. Methods: This retrospective, single-center study included 21 patients with histologically confirmed pancreatic metastases diagnosed by EUS-FNB between January 2021 and November 2025. Clinical data, EUS features, procedural parameters, histopathological findings, management, and outcomes were reviewed. Results: The mean age was 60.9 ± 12.9 years, and 57.1% of patients were male. Lung carcinoma was the most frequent primary tumor (33.3%), followed by renal cell carcinoma (19.0%). Most lesions were solitary (66.7%) and hypoechoic (85.7%). All 21 patients included in the final cohort had histologically adequate EUS-FNB specimens; this finding reflects the selected cohort of confirmed metastatic cases and should not be interpreted as an overall adequacy rate or measure of diagnostic performance. The mean number of needle passes was 1.14 ± 0.36. One small, asymptomatic intrapancreatic hematoma occurred and resolved conservatively. Three selected patients underwent surgical resection and were alive without evidence of disease at last follow-up; however, no inference regarding a survival benefit from surgery can be made from this small, selected subgroup. Conclusions: In this cohort of histologically confirmed pancreatic metastases, EUS-FNB provided tissue suitable for pathological characterization, with immunohistochemical analysis performed when required to determine tumor origin. The present study was not designed to estimate overall diagnostic accuracy or adequacy. Surgical resection may be considered in carefully selected patients with isolated disease, as supported by the published literature; however, the present cohort does not permit assessment of a survival benefit associated with surgery. Full article

Background: Endobronchial ultrasound (EBUS) is widely used for the diagnosis of pulmonary lesions. When combined with rapid on-site cytologic evaluation (ROSE), it can improve diagnostic accuracy and facilitate early identification of malignancy origin. However, differentiating primary lung cancer from metastatic tumors (e.g., breast or colorectal origin) during ROSE remains challenging due to limited cytopathology support and morphological similarities between tumor cells. This study aimed to develop a computer-aided diagnostic (CAD) system for classifying malignancy types from limited cytological samples to facilitate clinical decision-making. Methods: We utilized a retrospective dataset of cytological images obtained during EBUS procedures between November 2018 and June 2024. The study focused on classifying three malignancies: pulmonary adenocarcinoma, metastatic breast cancer, and metastatic colorectal cancer. A deep learning-based model (PLFCH) was developed, integrating few-shot learning, parameter-efficient fine-tuning, and a hybrid CNN–Transformer architecture to address limited annotated data. Results: A total of 41 patients with 346 cytological images were included. Under a 3-way 5-shot setting, the proposed model achieved an accuracy of 49.26%, outperforming existing few-shot learning methods, with precision, recall, and F1-score of 0.477, 0.493, and 0.480, respectively. Increasing the number of reference images to 20 per class further improved accuracy to 55.48%. Conclusions: The proposed framework demonstrated improved performance for cytological classification under limited data conditions. These findings provide an early proof of concept for applying few-shot learning to cytological assessment during EBUS procedures. Further improvements in model performance and validation in prospective, real-time clinical settings are required before its potential role in assisting diagnostic decision-making can be established. Full article

Background/Objectives: Fibrosing interstitial lung disease (F-ILD) is associated with progressive respiratory impairment and substantial symptom burden. Diaphragmatic ultrasound (DUS) is a non-invasive method for assessing diaphragmatic structure and function, but its clinical role in F-ILD remains uncertain. This systematic review evaluated the available evidence on DUS in adults with F-ILD. Methods: This systematic review was conducted and reported according to the PRISMA guidelines. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched and observational studies evaluating DUS in adults with F-ILD were included. Risk of bias was assessed using the QUADAS-2, and outcome-level certainty of evidence was evaluated by GRADE framework. Results: Six cross-sectional observational studies involving 232 participants were included. Diaphragmatic excursion (DE) was assessed in all six studies, while diaphragm thickness (DT) and thickening fraction (TF) were evaluated in four. Some studies reported abnormalities in DUS parameters during deep breathing and cross-sectional associations with pulmonary function, exercise capacity, dyspnoea, or radiological severity. Substantial heterogeneity in study populations, ultrasound protocols, and outcome reporting precluded meta-analysis. The certainty of evidence was very low. Conclusions: Current evidence suggests that DUS may detect diaphragmatic abnormalities in patients with F-ILD and may have future complementary value alongside established clinical assessments. However, the evidence is limited, heterogeneous, and of very low certainty and does not establish diagnostic accuracy, prognostic value, or usefulness for longitudinal monitoring. Accordingly, DUS cannot currently be recommended for routine clinical implementation in F-ILD, and prospective longitudinal validation is required. Full article

Background/Objectives: The early neonatal respiratory transition involves rapid changes in lung aeration and respiratory mechanics, but serial diaphragm-ultrasound trajectories in term neonates remain incompletely characterized. To describe bilateral diaphragmatic thickness, excursion, and diaphragmatic thickening fraction (DTF) during the first 48 h after birth. Methods: This prospective, single-center observational study analyzed 112 term neonates with complete ultrasound examinations at 1, 24, and 48 h of life. Bilateral thickness, excursion, DTF, and lung ultrasound score (LUS) were assessed during quiet spontaneous breathing. Serial comparisons used the Friedman test. No a priori sample-size calculation was reported. The analysis included all eligible neonates with complete serial data. Results: Right and left excursion increased from 5.65 ± 0.71 and 5.64 ± 0.69 mm at 1 h to 5.91 ± 0.58 and 5.91 ± 0.54 mm at 48 h, respectively (p = 0.024 and p = 0.033; Kendall’s W = 0.033 and 0.031). These effect sizes were small. DTF remained stable, whereas LUS decreased from 7.01 ± 2.64 at 1 h to 0.09 ± 0.35 at 48 h (p < 0.001; Kendall’s W = 0.885). Conclusions: In this single-center cohort, lung aeration changed substantially during the first 48 h, whereas diaphragm-ultrasound changes were small. These preliminary trajectories are descriptive and require standardized, multicenter validation before they can be used as reference values or guide clinical decisions. Full article

Severe pulmonary diseases, including atelectasis, pneumonia, and meconium aspiration syndrome, are major causes of neonatal respiratory distress, weaning difficulties, ventilator or oxygen dependence, prolonged oxygen requirements, extended hospitalization, and poor prognosis. The lack of simple and effective treatment strategies seriously endangers the survival and health of newborns, particularly premature infants. Recent advances in lung ultrasound (LUS) technology have made LUS-guided non-fiberobronchoscopic bronchoalveolar lavage (NFB-BAL) a promising solution. This approach addresses the limitations of conventional BAL in neonates by enabling accurate diagnosis, precise lesion localization, and dynamic procedural monitoring, hence reducing complications. Based on international expert consensus, these guidelines were developed to improve knowledge and promote the application of this technology and enhance operational standardization to ensure its effectiveness and safety. These guidelines contain 17 recommendations on 13 key clinical issues for reference and implementation in clinical practice. The wide application of these guidelines is expected to help significantly improve the prognosis of critically ill newborns with atelectatic pulmonary diseases. Full article

Background: Point-of-care ultrasound (POCUS) use continues to expand across specialties caring for pediatric patients in the perioperative period, offering noninvasive, diagnostic information that complements clinical assessment in real time. Although many POCUS applications were developed and validated in adults, pediatric POCUS requires unique considerations. This review examines the current evidence of diagnostic POCUS within pediatric perioperative care. Methods: A structured search of PubMed was performed for literature published through December 2025, using terms related to point-of-care ultrasound, perioperative care, cardiac, lung, gastric, and airway ultrasound, as well as focused assessment with sonography in trauma (FAST). Priority was given to systematic reviews, meta-analyses, randomized controlled trials, clinical practice guidelines, and landmark observational studies, while supplemented by recent high-quality publications. Findings: POCUS in each of the following areas is discussed: cardiac, pulmonary, airway, gastric, and FAST. Topics for each of the areas include a general overview, considerations for devices and probe selection to optimize imaging, specific uses and applications of the imaging, and potential limitations. Conclusions: POCUS is a valuable tool to complement comprehensive clinical evaluation of children in the perioperative period. Widespread adoption will require additional pediatric normative data, standardized protocols, and structured training for providers. Future research should continue to validate POCUS algorithms and clarify the role of artificial intelligence in enhancing image interpretation and accessibility. Full article

Background: Maintenance hemodialysis is characterized by repetitive changes in fluid distribution, blood pressure, and organ perfusion. Conventional clinical examination, empirical dry-weight adjustment, and biomarkers do not fully resolve the compartment-specific nature of congestion in this population. This narrative review reframes ultrasound-based volume assessment as a multimodal diagnostic problem involving pulmonary congestion, intravascular filling, systemic venous congestion, cardiac reserve, tissue response, and perfusion vulnerability. Methods: We synthesized clinically relevant evidence indexed in PubMed and Google Scholar for studies published between January 2016 and April 2026, prioritizing dialysis-specific randomized trials, prospective cohorts, systematic reviews, consensus statements, and methodological studies related to diagnostic ultrasound, Doppler-based congestion assessment, contrast-enhanced ultrasound, elastography, artificial intelligence, point-of-care ultrasound, and remote ultrasound monitoring. Results: Lung ultrasound currently has the strongest dialysis-specific evidence for detecting and tracking pulmonary congestion. Inferior vena cava ultrasound provides adjunctive information on intravascular filling and right-sided pressure but is not a surrogate for total body water. Echocardiographic parameters help characterize filling pressure and cardiac tolerance to fluid removal, whereas venous Doppler and the Venous Excess Ultrasound Score provide an emerging approach to systemic venous congestion. Elastography and contrast-enhanced ultrasound remain investigational tools for tissue characterization and perfusion vulnerability, while AI-assisted analysis, handheld point-of-care ultrasound, and tele-ultrasound may improve standardization, automated B-line quantification, and scalability. Conclusions: Different ultrasound modalities answer different diagnostic questions in maintenance hemodialysis. A compartment-specific framework integrating congestion, perfusion, and cardiac-reserve domains may better support individualized ultrafiltration planning, hemodynamic risk assessment, and future outcome-oriented research. Full article

A 12-year-old neutered male domestic shorthair cat presented with recurrent pleural effusion following repeated thoracentesis. Initial analysis of the pleural effusion did not reveal neoplastic cells. Thoracic imaging demonstrated pleural effusion without identifiable nodular lesions. However, abdominal computed tomography and histopathological examination of an ultrasound-guided percutaneous core liver biopsy identified a large hepatic mass, confirmed to be cholangiocarcinoma, with suspected metastases to the spleen. After exclusion of other potential causes, the effusion was suspected to be a paramalignant pleural effusion. Despite palliative management, the disease progressed, and the cat was euthanized 98 days after definitive diagnosis. Postmortem examination revealed widespread metastatic cholangiocarcinoma involving the lungs, spleen, and intercostal muscles. No gross mass lesions were identified in the pulmonary parenchyma. Histological results demonstrated neoplastic cell infiltration within both the pulmonary lymphatic and blood vessels, a finding consistent with lymphovascular spread, which can contribute to the development of pleural effusion. This case show that while the characteristics of neoplasia-associated pleural fluid may vary according to disease stage, cholangiocarcinoma-associated pleural effusion may occur in the absence of cytologic evidence of malignancy, pulmonary nodules on thoracic imaging, or typical hepatobiliary signs. Full article

Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article

Background/Objectives: Tissue-level markers of treatment response are lacking in severe asthma. Transthoracic ultrasound (TUS) non-invasively detects pleural-line and subpleural abnormalities that have been linked to small-airway disease, but it has not been evaluated as a marker of response to biologic therapy. The primary objective was to determine whether mean pleural-line thickness in the right and left hemithoraces changed between baseline and week 16 of biologic therapy. The secondary objectives were to describe the accompanying changes in pleural-line regularity, lung function, symptom control, and quality of life, and to examine whether the ultrasound changes are related to the clinical and functional response. Methods: In this prospective, single-center study, 41 adults with severe asthma who were starting omalizumab (n = 18), mepolizumab (n = 12), or benralizumab (n = 11) underwent standardized 14-zone TUS, spirometry, the Asthma Control Test (ACT), and the Asthma Quality of Life Questionnaire (AQLQ) at baseline and after 16 weeks. Pleural-line thickness and pleural-line regularity score were the primary TUS measures. Paired and between-group tests and Spearman rank correlations were used. Results: At week 16, 20 patients (48.8%) were complete responders. The mean ACT score increased from 13.2 ± 4.1 to 22.6 ± 2.9, the mean AQLQ total score from 3.6 ± 1.2 to 4.9 ± 1.2, FEV1 from 86.0 ± 24.8% to 99.0 ± 20.9% predicted, and FEF25–75 from 61.4 ± 35.0% to 81.2 ± 33.4% predicted (all p ≤ 0.001), whereas the blood eosinophil count fell from a median of 400 (0–1990) to 80 (0–330) cells/µL (p < 0.001). Median pleural-line thickness decreased from 1.27 to 0.94 mm in the right hemithorax and from 1.31 to 0.97 mm in the left hemithorax (both p < 0.001), and the pleural-line regularity score increased on both sides (both p < 0.001). Pleural-line thickness decreased significantly in all three biologic groups (all p ≤ 0.001), with no evidence of a differential treatment effect. Changes in pleural-line thickness did not correlate with ΔACT, ΔAQLQ, ΔFEV1, or ΔFEF25–75 (all p > 0.05). Conclusions: After 16 weeks of biologic therapy, pleural-line thickness was reduced and the pleural-line regularity score had improved on TUS. Because these pleural changes did not correlate with the symptomatic or spirometric response, TUS may capture a complementary, tissue-level dimension of the treatment effect. As the study was an uncontrolled single-arm design, the changes cannot be attributed to the biologic agent itself, and prospective controlled validation is required before TUS can be proposed as a marker of response. Full article

Cystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato, most commonly involves the liver and lungs, whereas the spleen is an uncommon site, accounting for less than 2% of cases; isolated primary splenic involvement is rarer still and is only sporadically reported in children. Total splenectomy has traditionally been the standard treatment for splenic CE, yet it carries a lifelong risk of overwhelming post-splenectomy infection, a particularly relevant concern in a child. We describe a 13-year-old boy from a rural, sheep-rearing area of eastern Sicily in whom a splenic cyst was incidentally detected on ultrasonography performed after minor blunt abdominal trauma. Ultrasound and contrast-enhanced computed tomography showed a 3.7 cm cyst with a partly calcified wall and a thin enhancing rim compatible with a pericyst, reported as stage CE3a (WHO-IWGE), and Echinococcus IgG serology was positive. In the absence of histological confirmation, a presumptive diagnosis of splenic CE was made after considering the relevant differential diagnoses. Given the small, uncomplicated cyst and the wish to preserve splenic function, the patient was managed with continuous albendazole monotherapy (400 mg twice daily) for six months, without any invasive procedure. Treatment was well tolerated, and serial imaging showed a modest reduction in size together with evolution of the cyst content toward a solid, calcified, inactive-appearing pattern that remained stable for six months after treatment discontinuation. This case suggests that, in exceptionally selected patients, albendazole monotherapy with close imaging surveillance may allow spleen preservation; it should not be regarded as a standard alternative to surgery. Full article

Locally advanced non-small cell lung cancer (NSCLC) is a biologically and clinically heterogeneous disease in which mediastinal lymph node involvement remains the principal prognostic and therapeutic discriminator. Accurate nodal staging guides selection among surgical resection, definitive chemoradiotherapy, immunotherapy, and targeted therapy. This narrative review synthesizes contemporary evidence on mediastinal staging modalities, nodal disease burden, and treatment selection in stage II-III NSCLC. Contemporary staging integrates CT and FDG-PET/CT with systematic tissue confirmation using EBUS-TBNA and EUS, with surgical mediastinal staging reserved for selected high-risk or discordant cases. The ninth edition TNM N2a/N2b distinction, increasing use of neoadjuvant and perioperative immunotherapy, and molecularly guided therapy have further amplified the clinical consequences of under- or over-staging. Nodal assessment should therefore be interpreted through a multidisciplinary framework that integrates anatomy, biology, treatment response, and patient operability. Full article

Objective: The aim of this study was to explore the diagnostic value of lung ultrasound (LUS) for bronchopulmonary dysplasia (BPD) in extremely premature infants. Methods: This was a prospective observational cohort study in which infants with gestational age (GA) ≤ 28⁺⁶ weeks were included. LUS was performed at least once a week until 36 weeks of postmenstrual age. The LUS characteristics of infants with moderate–severe BPD were compared with those of infants with non–mild BPD. Results: A total of 114 infants were included, of which 69 (60.5%) had non–mild BPD, and 45 (39.5%) had moderate–severe BPD. The mean GA and birth weight of infants with non–mild BPD and moderate–severe BPD were 27.0 ± 1.4 and 26.3 ± 1.6 weeks and 969 ± 184 and 802 ± 228 g, respectively. The proportions of rough pleural lines, fused B-lines, patch-like anechoic appearance on the pleural surface, subpleural speckled hyperechoic appearance, lung consolidation (≥0.5 cm), fuzzy or invisible A-lines, and pleural insect erosion (PIE)-like changes in the moderate–severe BPD group were significantly greater than those in the non–mild BPD group (100% vs. 37.7%, 88.9% vs. 13.0%, 84.4% vs. 7.2%, 73.3% vs. 8.7%, 80.0% vs. 11.6%, 86.7% vs. 10.1%, and 75.6% vs. 5.8%, respectively; p < 0.001). In evaluating moderate–severe BPD, rough pleura had 100.0% (95% CI: 0.921–1.000) in sensitivity, 63.4% (95% CI: 0.518–0.736) in PPV, and 62.3% (95% CI: 0.505–0.728) in specificity. PIE-like changes had 75.6% (95% CI: 0.613–0.858) in sensitivity, 89.5% (95% CI: 0.759–0.958) in PPV, and 94.2% (95% CI: 0.860–0.977) in specificity. Pleura surface irregular patch-like anechoic had 84.4% (95% CI: 0.712–0.923) in sensitivity, 88.4% (95% CI: 0.755–0.949) in PPV, and 92.8% (95% CI: 0.841–0.969) in specificity. Subpleural speckled hyperechogenicity had 73.3% (95% CI: 0.592–0.840) in sensitivity, 84.6% (95% CI: 0.704–0.930) in PPV, and 91.3% (95% CI: 0.824–0.960) in specificity. Conclusions: LUS is a valuable tool for evaluating and diagnosing BPD. Full article

Lung cancer remains the leading cause of cancer-related mortality worldwide, and durable benefit from immune checkpoint inhibitors is limited by immune exclusion, microenvironmental immunosuppression, and toxicity. This narrative translational review evaluates whether endobronchial intratumoral delivery of immuno- and gene-based therapies can transform bronchoscopic access into a therapeutic platform linking local tumour intervention with systemic antitumour immunity. We synthesise evidence on endobronchial ultrasound, electromagnetic navigation bronchoscopy, and robotic-assisted bronchoscopy, together with local checkpoint blockade, cytokine and mRNA-lipid nanoparticle constructs, oncolytic virotherapy, dendritic-cell approaches, viral and non-viral gene transfer, and enzyme- or metabolite-based strategies. Current clinical evidence remains preliminary, consisting mainly of Phase I trials, small prospective cohorts, and case-based signals, with feasibility and safety observations but no completed randomised trial demonstrating efficacy against standard-of-care systemic therapy. The most plausible candidates are patients with advanced or recurrent NSCLC, bronchoscopically accessible lesions, inadequate response to systemic immunotherapy, and immune-excluded or locally immunosuppressed tumours. Biomarkers such as PD-L1, tumour mutational burden, CD8+ infiltration, tertiary lymphoid structures, radiomics, and circulating tumour DNA require validation. This review integrates delivery technology, immune mechanisms, statistical evidence appraisal, biomarker limitations, AI-guided planning, and global feasibility. Full article