Advances in interventional pulmonology

Abstract

Interventional pulmonology (IP) remains a rapidly expanding and evolving subspecialty focused on the diagnosis and treatment of complex diseases of the thorax. As the field continues to push the leading edge of medical technology, new procedures allow for novel minimally invasive approaches to old diseases including asthma, chronic obstructive pulmonary disease and metastatic or primary lung malignancy. In addition to technologic advances, IP has matured into a defined subspecialty, requiring formal training necessary to perform the advanced procedures. This need for advanced training has led to the need for standardization of training and the institution of a subspecialty board examination. In this review, we will discuss the dynamic field of IP as well as novel technologies being investigated or employed in the treatment of thoracic disease.

Keywords::

• asthma
• cryoprobe
• EBUS
• emphysema
• interventional pulmonology
• lung cancer
• lung nodule
• navigational bronchoscopy
• pleural effusion
• rigid bronchoscopy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Endobronchial ultrasound-transbronchial needle aspiration has been shown to allow for a safe and effective minimally invasive approach to lung cancer staging and tissue acquisition of molecular analysis. New endobronchial ultrasound bronchoscopes are being introduced which more closely mimic conventional bronchoscopes in their performance profiles.

• New navigation bronchoscopy modalities are allowing for improved peripheral lung lesion sampling and may pave the way for bronchoscopically deployed ablative technologies.

• Advanced bronchoscopic imaging modalities such as optical coherence tomography and confocal laser fluorescence microendoscopy hold the potential to revolutionize lesion identification and visualization of lung parenchymal disease.

• Cryoprobe biopsy is being studied as a means to improve transbronchial biopsy yield.

• Novel bioabsorbable and drug-eluting airway stents may provide new ways of drug delivery and decrease stent complications.

• Multiple modalities of bronchoscopic lung volume reduction are being studied and appear to show potential efficacy in the treatment of heterogeneous emphysema.

• Bronchial thermoplasty has been shown to have durable demonstrable effect in difficult-to-control asthma. Its primary obstacles to overcome remain recognition in the medical community and reimbursement from insurance companies.

• Tunneled pleural catheter placement continues to encroach upon more invasive surgical techniques in the palliative management of malignant pleural effusion.

• Interventional pulmonology continues to evolve and mature prompting recognition of the need for standardized training and creation of a board certification.

Notes