Journal of Bronchology & Interventional Pulmonology最新文献

{"title":"American Association for Bronchology and Interventional Pulmonology (AABIP) Evidence-Based Guidelines on Bronchoscopic Diagnosis and Staging of Lung Cancer.","authors":"Russell J Miller, Ara A Chrissian, Fayez Kheir, Majid Shafiq, Abigail T Chua, Neal Navani, Francisco A Almeida, Abdul H Alraiyes, Paul A Bain, Christina R Bellinger, Cherng H Chao, George Z Cheng, Rebecca Cloyes, Javier Diaz-Mendoza, David M DiBardino, Erik Folch, Laura K Frye, Yaron B Gesthalter, Thomas R Gildea, Amit Goyal, Karen M Heskett, Van Kim Holden, Moishe Liberman, Christopher Manley, Nikhil K Meena, Catherine L Oberg, Jasleen K Pannu, Edward M Pickering, Michal Senitko, Jo-Anne O Shepard, Thomas Vandemoortele, Atul C Mehta, Kazuhiro Yasufuku","doi":"10.1097/LBR.0000000000001034","DOIUrl":"https://doi.org/10.1097/LBR.0000000000001034","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer remains a predominant cause of cancer-related deaths worldwide, and there are notable geographic and institutional differences in both diagnostic and staging approaches. To address this, the American Association for Bronchology and Interventional Pulmonology (AABIP) convened a multidisciplinary committee to craft evidence-based and evidence-informed recommendations for diagnosing peripheral pulmonary nodules and performing convex probe endobronchial ultrasound (CP-EBUS)-guided mediastinal staging.</p><p><strong>Methods: </strong>A modified Delphi method guided the creation and refinement of 9 Population, Intervention, Comparator, Outcome (PICO) questions. A systematic literature review, updated through March 2023, served as the basis for drafting recommendations. The panel used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence and relied on National Institute for Health and Care Excellence (NICE) language to express the strength of each recommendation. Where suitable, meta-analyses were completed; otherwise, systematic reviews and consensus among experts provided the evidence for guidance.</p><p><strong>Results: </strong>Nine recommendations were ultimately proposed: 6 were supported by meta-analyses and 3 by systematic reviews. The topics include comparing diagnostic yield and complication rates between peripheral bronchoscopy and transthoracic needle biopsy, the use of multiple biopsy instruments and the role of rapid on-site evaluation (ROSE) during peripheral bronchoscopy, and best practices for CP-EBUS-guided mediastinal staging. Several critical considerations emerged, such as lesion size, evolving technologies in bronchoscopy, and the importance of both available resources and local expertise.</p><p><strong>Conclusion: </strong>These guidelines aim to standardize and streamline recommendations for the bronchoscopic diagnosis and staging of lung cancer. Since rapid technological progress and observational data play significant roles in this field, ongoing research and evidence updates will be vital to refining best practices. Clinicians are advised to tailor these recommendations according to local circumstances, the unique needs of their patients, and any new findings as they develop.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid-On Site Evaluation and Safety of Pulmonologist- Performed Percutaneous Ultrasound-Guided Biopsy.","authors":"Christopher Lim","doi":"10.1097/LBR.0000000000001024","DOIUrl":"https://doi.org/10.1097/LBR.0000000000001024","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid-On Site Evaluation and Safety of Pulmonologist-Performed Percutaneous Ultrasound-Guided Biopsy.","authors":"Vanina Livi, Rocco Trisolini","doi":"10.1097/LBR.0000000000001020","DOIUrl":"https://doi.org/10.1097/LBR.0000000000001020","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Cadavers: A Critical Appraisal of Bronchoscopic Rotation Function Evaluation.","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1097/LBR.0000000000001021","DOIUrl":"https://doi.org/10.1097/LBR.0000000000001021","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Cadavers: A Critical Appraisal of Bronchoscopic Rotation Function Evaluation.","authors":"Naofumi Shinagawa","doi":"10.1097/LBR.0000000000001025","DOIUrl":"https://doi.org/10.1097/LBR.0000000000001025","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Atelectasis: Utilizing Transpulmonary Pressure to Enhance Robotic Bronchoscopy: A Single-Center, Prospective Study.","authors":"Sevak Keshishyan, Joseph Keenan, Erhan H Dincer, Jennifer Wong, Abbie Begnaud, Alireza Nathani, Heidi Gibson, Sudarshan Setty, Roy J Cho","doi":"10.1097/LBR.0000000000001017","DOIUrl":"https://doi.org/10.1097/LBR.0000000000001017","url":null,"abstract":"<p><strong>Background: </strong>Robotic navigation bronchoscopy (RNB) is effective for accessing peripheral lung lesions with precision and safety. However, the incidence of atelectasis during RNB can impede lesion identification. Higher positive end-expiratory pressure (PEEP) levels may mitigate atelectasis, but bedside assessment is challenging. Transpulmonary pressure (Ptp) assessment, proven useful in optimizing PEEP in ARDS, remains unexplored in RNB.</p><p><strong>Methods: </strong>This single-center, prospective study enrolled 21 consecutive patients undergoing RNB. All patients were paralyzed and ventilated equally, including PEEP 10 cmH2O and Vt 6 to 8 cc/kg of ideal body weight, and had an esophageal balloon placed using established techniques. Once an adequate esophageal pressure (Pes) waveform was identified, the Pes was recorded. We used Pes as a surrogate for intrathoracic pressure to calculate Ptp.</p><p><strong>Results: </strong>A total of 21 patients were enrolled (male 11, 52%), BMI (27±4.1). The mean nodule size was 26.83±9.33 mm. The diagnostic yield was 87% for malignancy. The mean Vt was 7.15±1.16 cc/kg. Mean Pes and Ptp were 9.64±3.76 cmH2O and 0.36±1.2 cmH2O, respectively. Eight patients had negative Ptp, and compared with patients with positive Ptp, there were more eccentric or no signals (75% vs. 45%) by rEBUS.</p><p><strong>Conclusion: </strong>This study provides detailed instructions and feasibility of assessing Ptp in patients undergoing RNB and highlights a potential relationship between negative Ptp and the ability to obtain a concentric rEBUS signal. Our findings suggest that negative Ptp may be associated with a higher likelihood of encountering eccentric or absent rEBUS signals. Further research could enhance our understanding of pulmonary physiology during RNB.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Assessment of Effective Radiation Dose When Utilizing the Illumisite System for Evaluation of Peripheral Pulmonary Lesions.","authors":"Christopher Yurosko, Graham Stockdale, See-Wei Low, Bryan S Benn","doi":"10.1097/LBR.0000000000001011","DOIUrl":"10.1097/LBR.0000000000001011","url":null,"abstract":"<p><strong>Background: </strong>Electromagnetic navigation bronchoscopy (ENB) is an established modality for performing bronchoscopic biopsies of peripheral pulmonary lesions (PPLs). Although prior versions have been limited by computed tomography (CT) to body divergence (CTBD), the advent of digital fluoroscopic tomosynthesis with continuous real-time guidance with the Illumisite system may help to overcome CTBD. This enhanced visualization, however, will require additional radiation exposure to perform the 50-degree fluoroscopic sweep around the PPL, but data are lacking on the additional amount. The primary objective of our study is to evaluate the effective dose patients are exposed to during biopsy with this system.</p><p><strong>Methods: </strong>Single center retrospective analysis evaluating demographic data, nodule size, nodule location, diagnostic yield, incidence of complications, and radiation exposure.</p><p><strong>Results: </strong>Eighty-two patients underwent PPL biopsy from March 2021 to March 2023. The mean PPL size was 2.3±0.9 cm (0.9 to 4.9 cm) and 84% (n=69) were solid. The majority were in the peripheral lung third (53, 64.6%) and 71% (n=58) had an air bronchogram on CT chest. The mean fluoroscopy time was 5 minutes 10 seconds (± 3 min 39 s). The mean fluoroscopy cumulative air kerma (CAK) was 0.071 Gy (± 0.045 Gy) with a calculated mean effective dose of 0.997 mSv (± 0.63 mSv). The diagnostic yield was 73% (60/82). Pneumothorax occurred in 4 (5%) patients, all of which required chest tube drainage.</p><p><strong>Conclusion: </strong>Radiation exposure with the Illumisite system was less than historical reports for CT-guided biopsy or cone beam CT-guided bronchoscopic biopsies. Diagnostic yield and incidence of complications were comparable to prior reports.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Diagnostic Yield of Ultrasound-Guided Percutaneous Needle Biopsy of Peripheral Lung and Pleural Lesions, Lymph Nodes, and Other Sites Performed by Respiratory Physicians.","authors":"Christopher Lim, Sameer Karnam, Louis Irving, Gary Hammerschlag, John Taverner","doi":"10.1097/LBR.0000000000001010","DOIUrl":"10.1097/LBR.0000000000001010","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided percutaneous needle biopsy (US-PNB) represents an efficacious, safe, and cost-effective alternative to CT-guided biopsy for accessible thoracic lesions. Emerging evidence suggests that respiratory physicians experienced in thoracic ultrasound may achieve comparable diagnostic yield and safety outcomes to interventional radiologists. This study aimed to determine the diagnostic yield and safety of US-PNB of accessible thoracic lesions as performed by respiratory physicians, in an Australasian context.</p><p><strong>Methods: </strong>Demographic, clinical, and procedural information was prospectively collected at a single Australian tertiary centre for patients undergoing US-PNB of peripheral lung and pleural lesions, lymph nodes, and other accessible thoracic lesions in an outpatient setting between October 3, 2016 and December 20, 2019. The final diagnosis was determined following a discussion in a lung oncology multidisciplinary meeting. Twelve-month follow-up data was reviewed.</p><p><strong>Results: </strong>One hundred and fifty-one patients underwent 162 US-PNB procedures. This included 3 patients who underwent US-PNB of separate sites, and 8 patients who underwent repeat US-PNB procedures of the same site. Overall, the diagnostic yield of US-PNB was 83% (95% CI: 76-88). Diagnostic yield varied by procedural site, with yields highest in lymph node biopsy (91%, 95% CI: 79-97) and lowest in pleural biopsy (66%, 95% CI: 50-79). Complications occurred during 23 procedures (14%) and were largely minor. Pneumothorax occurred in 4 patients (2.5%), with 1 patient requiring intercostal catheter insertion.</p><p><strong>Conclusion: </strong>US-PNB of peripheral lung and pleural lesions, lymph nodes, and other accessible thoracic lesions performed by respiratory physicians is safe with high diagnostic yield.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits of Using Peripheral Nerve Blocks for Medical Thoracoscopy: A Retrospective Analysis.","authors":"Elizabeth Luebbert, Bertin D Salguero, Greta Joy, Sidra Salman, Christian M Lo Cascio, Ghislaine Echevarria, Udit Chaddha, Poonam Pai B H","doi":"10.1097/LBR.0000000000001006","DOIUrl":"10.1097/LBR.0000000000001006","url":null,"abstract":"<p><strong>Background: </strong>Medical thoracoscopy (MT) is a minimally invasive procedure performed to diagnose and treat pleural disorders. MT is usually accomplished with the use of monitored anesthesia care (MAC) and local anesthetic (LA) infiltration. There is little data regarding the analgesic benefits and use of peripheral nerve blocks (PNB) for MT.</p><p><strong>Methods: </strong>A retrospective review was done looking at patients who underwent MT at a single center in New York City from January 2021 to September 2023, comparing the procedural times, intraoperative opioid consumption, and postoperative opioid consumption in the post-anesthesia care unit (PACU) of patients who received a PNB with MAC versus MAC alone.</p><p><strong>Results: </strong>Ninety records were queried, 23 (25.6%) had a PNB, of which 14 (60.8%) received an erector spinae plane block (ESPB) and 9 (39.1%) received a serratus anterior plane block (SAPB). 67 (74.4%) received MAC alone. When comparing those who received a PNB with MAC versus MAC alone, there was a reduction in procedure time (34 vs. 40 min, P=0.007), in-room time (53 vs. 68 min, P=<0.001), median use of intraoperative opioids (milligram morphine equivalent, 3.0 vs. 6.0, P=<0.001), and overall need for dexmedetomidine (0 vs. 20.9%, P=0.04). There was no difference in the intraoperative opioid use or postoperative opioid consumption recorded in PACU.</p><p><strong>Conclusion: </strong>The addition of a PNB, either SAPB or ESPB, to MAC for MT is safe and might reduce procedural time and overall intraoperative opioid use. However, larger randomized clinical trials are necessary to confirm these findings.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Video-assisted Thoracoscopic Versus Percutaneous Tunneled Pleural Catheter Techniques on Pleurodesis Outcomes: A Retrospective, Single-center Study.","authors":"Julie Lin, Udit Chaddha, Blanca Urrutia-Royo, Nakul Ravikumar, Sivasubramanium V Bhavani, James Katsis, Mark K Ferguson, Septimiu Murgu","doi":"10.1097/LBR.0000000000001007","DOIUrl":"10.1097/LBR.0000000000001007","url":null,"abstract":"<p><strong>Background: </strong>Tunneled pleural catheters (TPCs) generate an inflammatory reaction, which, along with frequent drainage, aids in achieving pleurodesis enabling removal in 30% to 50% of patients. However, it is unknown whether the technique of TPC placement influences pleurodesis outcomes.</p><p><strong>Methods: </strong>This is a retrospective, single-center study of patients who underwent TPC placement from 2010 through 2018. Pleurodesis success was defined as TPC removal within 90 days of placement in the setting of no further drainage and in the absence of catheter malfunction, infection, patient's choice for another treatment modality, or other catheter-related complications. Pleurodesis failure was defined as patients who did not have TPC removal within 90 days of insertion.</p><p><strong>Results: </strong>A total of 326 patients underwent TPC insertion by thoracic surgery, interventional pulmonology, or interventional radiology. Fourteen patients were excluded due to insufficient follow-up. Of the 312 patients included in the final analysis, 32.7% achieved pleurodesis. Patients who had their TPC inserted thoracoscopically achieved higher pleurodesis success compared with a percutaneous technique (61.2% vs 24.9%, P < 0.001). Thoracoscopically placed catheters had two times greater chance of removal than those inserted percutaneously (hazard ratio: 2.04, 95% CI: 1.14-3.64, P = 0.02) after controlling for pleural biopsies and sclerosing agents used during thoracoscopy.</p><p><strong>Conclusion: </strong>Thoracoscopic TPC placements may be associated with higher pleurodesis rates compared with a percutaneous technique. Our results are only hypothesis-generating, and these findings warrant confirmation in prospective studies.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}