Journal of Bronchology & Interventional Pulmonology最新文献

{"title":"Shape-Sensing Robotic Bronchoscopy With Simultaneous Biopsy of Multiple Ipsilateral and Bilateral Pulmonary Nodules.","authors":"Carmold Murray, Robert Lee, Stephen Bruce, Merica Vorachitti, Selina Deanda, Paul Kang, Wali Zaidi, Deepika Razia, Ariba Moin, Devika Sindu, Abid I Khokar, Sumeet K Mittal, Ali I Saeed","doi":"10.1097/LBR.0000000000001060","DOIUrl":"10.1097/LBR.0000000000001060","url":null,"abstract":"<p><strong>Background: </strong>Robotic bronchoscopy with shape-sensing technology enables simultaneous biopsy of multiple pulmonary nodules, including both ipsilateral and bilateral nodules. While this technique holds promise, there is evolving data on its diagnostic yield and complication rates, especially in patients undergoing multiple ipsilateral and bilateral pulmonary nodules biopsies.</p><p><strong>Methods: </strong>The primary endpoint was to compare the diagnostic yield and complication rate of multiple pulmonary nodule biopsies (MPNBs) to that of a single pulmonary nodule biopsy. The secondary endpoint was to compare the diagnostic yield and complication rate of multiple ipsilateral biopsies to that of multiple bilateral biopsies. This single-center, IRB-approved retrospective study examined 526 patients who underwent robotic-assisted bronchoscopy with a shape-sensing platform at our center between June 2021 and December 2023.</p><p><strong>Results: </strong>Of the 526 included patients, 376 (71.5%) underwent single pulmonary nodule biopsy and 150 (28.5%) underwent MPNB. The only demographic difference was elevated Cocci serology or history (12.8%) in the single-nodule biopsy group. A similar diagnostic yield of 88% was seen in both groups. Within the MPNB group, 82 had multiple bilateral nodules, and 68 had biopsy of multiple ipsilateral nodules. A total of 339 pulmonary nodules were biopsied in the 150 MPNB patients. The size and location distribution of biopsied nodules were similar between ipsilateral and bilateral MPNB procedures. The radial ultrasound signal after robotic navigation was concentric, eccentric, or absent in 41.7%, 35.6%, and 22.7% of nodules, respectively. Intraoperative CT was used in 56% of MPNB procedures. The diagnostic yield of MPNB using Delphi criteria was 88% (58.7% malignant, 29.3% benign, and 12.0% nondiagnostic). Bleeding occurred in 3.3% of cases and pneumothorax in 6.0% (7 of 9 required chest tube placement). The hospitalization rate due to complications and comorbidities was 8.0%. Complication and hospitalization rates between multiple ipsilateral and multiple bilateral biopsies were similar.</p><p><strong>Conclusion: </strong>This study demonstrates a higher rate of pneumothorax requiring chest tube placement and hospitalization after multiple ipsilateral or bilateral pulmonary nodule biopsies compared with a single pulmonary nodule biopsy with a shape-sensing robotic bronchoscopy platform.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473998","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":"Sequential Bilateral Bronchoscopic Lung Volume Reduction for Residual Hyperinflation Following Successful Index Procedure in Pulmonary Emphysema: A Multicenter Study.","authors":"Aleezay Asghar, Mario Fonseca-Paricio, Nakul Ravikumar, Mark M Hammer, Victoria Forth, Ajay Wagh, D Kyle Hogarth, Majid Shafiq","doi":"10.1097/LBR.0000000000001067","DOIUrl":"10.1097/LBR.0000000000001067","url":null,"abstract":"<p><strong>Background: </strong>Bronchoscopic lung volume reduction (BLVR) improves pulmonary function and exercise capacity in select patients with emphysema, but some remain symptomatic with residual hyperinflation. We assessed the safety and effectiveness of bilateral BLVR in such cases.</p><p><strong>Methods: </strong>We retrospectively analyzed patients across 2 centers who underwent BLVR in the contralateral lung after successful BLVR in the index lung, with residual hyperinflation.</p><p><strong>Results: </strong>Thirteen patients [5 males; mean age 68; interquartile range (IQR)=64 to 73 y] underwent sequential bilateral BLVR. The median interval between index and contralateral BLVR was 16 (IQR=12-21) months, and the median length of overall follow-up following the index procedure was 22 (IQR=13-27) months. At baseline, the mean forced expiratory volume in 1 second (FEV1) was 33±9% of predicted, FEV1/forced vital capacity (FVC) ratio 39±6%, total lung capacity (TLC) 131±16%, residual volume (RV) 221±43%, RV/TLC ratio 67±10%, diffusion capacity for carbon monoxide (DLCO) 34±10%, and 6-minute walk test (6MWT) 297±72 m, with 7 (54%) patients requiring supplemental oxygen. Following bilateral BLVR, patients experienced significant improvements in RV (-52%, P=0.014), TLC (-13%, P=0.047), RV/TLC ratio (-13%, P=0.017), and DLCO (+6%, P=0.016). There were no significant long-term changes in FEV1, FEV1/FVC ratio, 6MWT, or oxygen requirement. Pneumothorax occurred in 1 (8%) and 2 (15%) patients after index and contralateral BLVR, respectively.</p><p><strong>Conclusion: </strong>In patients with marked residual hyperinflation despite successful index BLVR, sequential bilateral BLVR appears relatively safe and moderately effective over an ∼2-year timespan.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473968","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":"Approaches for Lung Fiducial Markers Insertion in Stereotactic Body Radiotherapy: A Systematic Review and Meta-Analysis.","authors":"Christophe Abellan, Stéphane Mouraux, Simone Janett, Christophe von Garnier, Nicolas Villard, Cédric Bongard, Remy Kinj, Maurizio Bernasconi, Giorgio Treglia, Antonio Valenti, Stefano Cappio, Francesco Martucci, Alban Lovis, Alessio Casutt","doi":"10.1097/LBR.0000000000001061","DOIUrl":"10.1097/LBR.0000000000001061","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary fiducial markers (FMs) allow real-time tracking for stereotactic body radiotherapy (SBRT) by CyberKnife, which is an alternative to surgery in early-stage inoperable non-small-cell lung cancer (NSCLC) or intrathoracic oligometastatic disease. We conducted a systematic review and meta-analysis to compare the clinical performance and safety of 3 available approaches for FMs insertion for peripheral pulmonary lesions (PPL): transthoracic, endovascular, and endobronchial accesses.</p><p><strong>Methods: </strong>A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles on FM implantation before SBRT. Outcomes included clinical performance (inaccurate FM location and tracking rate) and per-procedural complications (pneumothorax and hemoptysis). We included 27 studies for a total of 2065 patients (627 with endobronchial access, 993 with transthoracic access, and 445 with endovascular access) and 4149 FMs insertions.</p><p><strong>Results: </strong>The lowest inaccurate FM location rate was found with nonlinear FM inserted by endobronchial access (0.030, 95% CI: 0.004-0.074). Tracking rate was high and similar with endobronchial (0.975, 95% CI: 0.949-0.994), endovascular (0.999, 95% CI: 0.941-1.000), and transthoracic approaches (0.985, 95% CI: 0.963-0.998). The highest rates of pneumothorax (0.342, 95% CI: 0.261-0.427) and hemoptysis (0.035, 95% CI: 0.015-0.060) occurred with the transthoracic access.</p><p><strong>Conclusion: </strong>While nonlinear FM insertion through endobronchial access achieved the lowest rate of inaccurate FM location, all 3 implantation approaches demonstrated high tracking feasibility for SBRT delivered using the CyberKnife system.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284001","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":"Underreporting of Malignant Central Airway Obstruction: A Retrospective Study of Radiology Reports in Patients Referred to a Comprehensive Cancer Center.","authors":"Nathaniel M Ivanick, William Mahoney, Ishaan Gupta, Jamal Suboh, Tyler Pauly, Maryam Ahmed, Basarat Baig, Saad Bin Jamil, Rajesh Kunadharaju, Sajeer Bhura, Hiwot Mengiste, Arjun Saradna, Harshwant Grover, Xiaoyi Ma, Mary F Croake, Mary Reid","doi":"10.1097/LBR.0000000000001065","DOIUrl":"10.1097/LBR.0000000000001065","url":null,"abstract":"<p><strong>Background: </strong>Malignant central airway obstruction (MCAO) is a common complication of lung cancer. Cross-sectional imaging is the best method of screening for this complication, but prior data indicate that such obstruction is frequently underreported on radiology reports.</p><p><strong>Methods: </strong>A cohort with known MCAO was selected and radiology reports were reviewed. Data on scan indication, airway obstruction severity intravenous contrast use were tracked, as were relevant dates. Data on diagnostic and therapeutic bronchoscopy were also tracked.</p><p><strong>Results: </strong>The frequency of missed MCAO across mild and severe obstruction was 54%. Mild obstruction was missed more frequently than severe obstruction 77% versus 46%. Symptom-based versus scheduled-based scans had no significant difference in identification rates (53% vs. 58%). Contrast enhancement versus noncontrast did not significantly impact identification rates (44% vs. 56%). Airway obstruction identification was associated with a significantly faster time to first clinic appointment (8 vs. 11 d), but not with a significant difference in patient survival.</p><p><strong>Conclusion: </strong>Radiology underreporting of MCAO occurs at rates higher than previously demonstrated, with better detection of severe over mild obstruction. Other clinical parameters do not appear to significantly impact rates of identification. Identification is significantly associated with shorter times to first visit evaluation.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258283","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":"Accuracy of Rapid On-Site Evaluation in Robotic-Assisted Bronchoscopy Fine Needle Aspirations of Lung Nodules.","authors":"Heather I Chen-Yost, Judy Pang, Wei Hao, Yuhan Geng, Spencer Keil, Angela Sherman, Jose De Cardenas","doi":"10.1097/LBR.0000000000001058","DOIUrl":"10.1097/LBR.0000000000001058","url":null,"abstract":"<p><strong>Background: </strong>Shape-sensing robotic-assisted bronchoscopy (ssRAB) is an emerging technique for sampling lung nodules. When evaluating the value of pairing ssRAB with rapid on-site evaluation (ROSE), other studies have only looked at diagnostic yield. This study aims to assess the diagnostic concordance of ROSE and histopathologic biopsies in ssRAB sampling.</p><p><strong>Methods: </strong>We analyzed lung nodules sampled by ssRAB fine needle aspiration (FNA) and had ROSE. The following parameters were recorded: preliminary and final cytology diagnoses, concurrent histopathology biopsy diagnosis, tool type, number of passes for ROSE, lesion size, and location. A χ2 test was performed for categorical variables, and one-way analysis of variance was used to compare means for continuous variables. A P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 249 FNA cytology specimens from 234 patients were obtained, with 202 concurrent histopathologic biopsies. The lesion size, location, and proceduralist experience did not affect cytology diagnosis; however, the diagnostic yield improved with increasing lesion size. Diagnostic yield plateaued after 3 passes (P=0.01). Forceps biopsies had a lower diagnostic yield (74%) than cryoprobe biopsies (87%), and forceps were more likely to yield a nondiagnostic sample than cryobiopsies (P=0.04). A positive ROSE preliminary diagnosis for malignancy correlated highly with a positive histopathology biopsy (86% correlation).</p><p><strong>Conclusion: </strong>A positive result for malignancy on ROSE correlated highly with a positive histopathology biopsy. Three fine needle passes were sufficient for diagnostic results, with a plateau in subsequent biopsies. Histopathologic tissue diagnosis was superior with the cryoprobe than with tissue obtained using conventional forceps.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258305","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":"Real-world Comparative Analysis of Transbronchial Versus Transthoracic Biopsy for Middle Lung Zone Pulmonary Lesions in the Preadvanced Bronchoscopy Era.","authors":"Tsukasa Ishiwata, Alexander Gregor, Thomas K Waddell, Kazuhiro Yasufuku, Kasia Czarnecka-Kujawa","doi":"10.1097/LBR.0000000000001057","DOIUrl":"10.1097/LBR.0000000000001057","url":null,"abstract":"<p><strong>Background: </strong>The optimal diagnostic approach for indeterminate pulmonary lesions in the middle lung zone remains unclear, particularly in settings without advanced bronchoscopic technologies. This study explores factors influencing diagnostic approach selection and differences in diagnostic flow in facilities operating without such advanced technologies, aiming to clarify practice patterns that may help bridge the technological gap in current clinical guidance.</p><p><strong>Methods: </strong>We retrospectively analyzed patients referred to a tertiary thoracic oncology program for middle lung zone lesion diagnosis between January 2015 and June 2016. Patients were grouped by the initial diagnostic approach: transbronchial-first (TBF) or transthoracic-first (TTF). We compared diagnostic yield, complications, diagnostic workup duration, and costs.</p><p><strong>Results: </strong>The study included 108 TBF and 99 TTF patients. TBF had larger lesions (P = 0.0087) and more pulmonary lesions with a positive bronchus sign (P < 0.0001). TBF had a lower initial diagnostic yield (77.8% vs 89.9%, P = 0.0238), but a lower pneumothorax rate (P < 0.0001) and shorter workup duration (P = 0.0001). Overall costs were similar (P = 0.6773), but TBF was more cost-effective for cases requiring pathologic nodal staging (P = 0.0002).</p><p><strong>Conclusion: </strong>Experienced clinician-driven triage of middle lung zone lesions, based on lesion characteristics, effectively guided initial diagnostic approaches. When appropriately triaged, an initial transbronchial approach resulted in fewer complications, shorter workup duration, and lower costs for pathologic nodal staging, even in an era predating advanced bronchoscopy. Although limited by its retrospective and historical design, these findings provide descriptive insights and underscore the continued value of established diagnostic practices in settings without universal access to newer technologies.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258301","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":"Role of Thoracic Ultrasound in Predicting Prognosis in Patients With Parapneumonic Effusions.","authors":"Hannah Bozell, Christian Wong, Sophie Silverstein, Sunny Dharia, Ibrahim Khatim, Isam Albaba, Hay Alexander, Paul J Feustel, Thomas Glozman, Laiba Masood, Nagendra Madisi, Boris Shkolnik, Munish Luthra, Terrill Huggins, Jonathan Kurman, Kurt Hu, Amit Chopra","doi":"10.1097/LBR.0000000000001062","DOIUrl":"10.1097/LBR.0000000000001062","url":null,"abstract":"<p><strong>Background: </strong>The presence of pleural effusion in pneumonia is associated with a high risk of thoracic surgery and death. Current prediction scores do not incorporate sonographic findings. There are no studies to date examining the prognostic significance of thoracic ultrasound (TUS) in the current era of intrapleural enzyme treatment for parapneumonic effusions.</p><p><strong>Methods: </strong>This was a retrospective analysis of prospectively collected data of hospitalized adult patients with parapneumonic effusions. Patient demographics, pleural fluid analysis (PFA), and TUS data were obtained. The primary objective is to determine whether TUS can predict unfavorable outcomes of in-hospital death or thoracic surgery in patients with parapneumonic effusions.</p><p><strong>Results: </strong>A total of 186 parapneumonic effusions were identified. The majority of effusions were echogenic (124/186, 67%), and most had septations (105/124, 85%). An unfavorable outcome occurred in 35% (65/186), including 14% (26/186) who had in-hospital death and 21% (39/186) who had thoracic surgery. The presence of echogenicity (HR: 2.03, 95% CI: 1.10-3.73, P=0.02) and empyema (HR: 2.41, 95% CI: 1.46-3.97, P<0.01) was associated with the unfavorable outcomes. However, sonographic findings were not independent predictors of in-hospital death or thoracic surgery in multivariate analysis.</p><p><strong>Conclusion: </strong>Sonographic evidence of echogenic effusion was associated with higher in-hospital death and thoracic surgery. Nevertheless, TUS findings were not independent predictors of in-hospital death or thoracic surgery in patients with parapneumonic effusions.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258226","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":"Comparing CO2 Laser Wedge Resection to Radial Incision With Dilation in the Endoscopic Treatment of Benign Tracheal Stenosis: A Systematic Review.","authors":"Naixin Kang, An Ho, Paul A Bain, Chenchen Zhang","doi":"10.1097/LBR.0000000000001064","DOIUrl":"10.1097/LBR.0000000000001064","url":null,"abstract":"<p><strong>Background: </strong>Carbon dioxide (CO2) laser therapy is widely used in the endoscopic treatment of benign tracheal stenosis (BTS). However, the comparative effectiveness of its 2 principal techniques-CO2 laser wedge resection and radial incision with dilation-remains uncertain. This study aims to compare the recurrence rates of BTS following CO2 laser wedge resection versus radial incision with dilation.</p><p><strong>Methods: </strong>We conducted a systematic review using MEDLINE (Ovid), Embase, Web of Science, and Cochrane Central through March 28, 2025. Three independent reviewers (C.Z., N.K., and A.H.) performed study screening, risk of bias assessment, and data extraction. A random-effect model was applied for meta-analysis. The primary outcome was to compare recurrence rates between wedge resection and radial incision.</p><p><strong>Results: </strong>Twelve trials, including 685 patients met inclusion criteria. CO2 laser wedge resection was associated with a lower recurrence rate (43.2%) compared with those treated with radial incision with dilation (66.1%), approaching statistical significance (χ²=3.75, P=0.053). At follow-up beyond 3 years, this difference became significant (55.8% vs. 81.0%, χ²=9.46, P=0.002). Wedge resection also showed longer time to first recurrence. Reported complication rates were low across both techniques.</p><p><strong>Conclusion: </strong>CO2 laser wedge resection may be superior to radial incision with dilation in reducing recurrence of BTS, particularly over long-term follow-up. Personalized treatment strategies considering procedural variables and patient-specific factors are warranted to optimize outcomes.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258249","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":"Reduction in Time-to-Diagnosis for Lung Cancer Resulting From Implementation of a Formal Incidental Pulmonary Nodule (IPN) Program Compared With Traditional Referral Pathways.","authors":"Amit K Mahajan, Mayra Antoanet Ochoa Cuba, Nancy Collar, Kimberly Pullen, Frances Muldowney, Nihar Shah, Priya P Patel, Duy K Duong, Kei Suzuki, Melanie Subramanian, Abe Nader, Manjula Parne, Michael J Weyant, John Deeken","doi":"10.1097/LBR.0000000000001056","DOIUrl":"10.1097/LBR.0000000000001056","url":null,"abstract":"<p><strong>Background: </strong>Incidental pulmonary nodules (IPN) are nodules identified on imaging performed for a reason unrelated to the diagnosis of cancer. This study analyzes improvement in time-to-diagnosis for patients first presenting with an IPN that was later diagnosed as lung cancer through a formal IPN program.</p><p><strong>Methods: </strong>This is a 5-year retrospective, single-center analysis of outcomes for IPN patients diagnosed with lung cancer who presented through a formal IPN program (FIP) pathway compared with a matched group of patients diagnosed with lung cancer presenting through traditional IPN referral (TIR) pathway. The primary endpoint was time-to-diagnosis of lung cancer. A chart review was performed to determine the date of the initial CT scan identifying the IPN to the date of the procedure to diagnose lung cancer in the FIP group and the TIR group. The number of days from identification of the IPN to diagnosis was compared between the 2 groups.</p><p><strong>Results: </strong>Between May 2019 and May 2024, a total of 9303 patients were identified with IPNs through the formal IPN program. Ninety-six of these patients (1%) were diagnosed with cancer following nodule biopsy. Eighty-one of the patients (84%), making up the FIP group, were diagnosed with primary lung cancer. Twenty-one of the 81 primary lung cancer patients in the FIP group (27%) were diagnosed with early-stage disease and underwent curative resection. The average time from identification of an IPN to diagnosis of lung cancer in the FIP cohort was 43 days. The average time from identification of the IPN to diagnosis of lung cancer in the TIR cohort was 177 days. There was a 134-day difference between the 2 groups from identification of an IPN to diagnosis of lung cancer.</p><p><strong>Conclusion: </strong>Implementation of a formal IPN program can reduce time-to-diagnosis of lung cancer in patients presenting with an IPN by 134 days compared with traditional referral patterns. Formal IPN programs can result in a shift towards an earlier stage of diagnosis for lung cancer.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998206","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":"Routine Pathology Testing Prior to Bronchoscopy has Limited Clinical Impact With Significant Economic and Environmental Costs.","authors":"Christine Lu, Alistair Miller, Ben Dunne, Daniel P Steinfort, Ashleigh Witt","doi":"10.1097/LBR.0000000000001045","DOIUrl":"10.1097/LBR.0000000000001045","url":null,"abstract":"<p><strong>Background: </strong>Routine preprocedural pathology testing is no longer recommended for minor and intermediate-risk elective procedures. British Thoracic Society guidelines advise hemoglobin, platelet count, and coagulation studies only in patients with risk factors for bleeding. Despite this, such tests are commonly ordered without a clear clinical indication before bronchoscopic procedures, incurring unnecessary financial and environmental costs.</p><p><strong>Methods: </strong>We conducted a retrospective review of outpatient bronchoscopic procedures over a 12-month period at an Australian tertiary hospital. Preprocedural pathology testing was defined as any test ordered at bronchoscopy referral or repeated within 6 weeks before the procedure. We evaluated the impact on clinical management and complication rate. Financial cost was estimated using Australian Medical Benefits Schedule (MBS) prices, and environmental impact via carbon dioxide equivalent (CO2e) emissions.</p><p><strong>Results: </strong>A total of 436 bronchoscopic procedures were performed, with all with preprocedural pathology testing. Abnormal results occurred in 8.3% of cases, but only 4.0% led to clinical intervention-all in patients with established risk factors. No interventions were required for patients without risk factors, and no procedures were delayed or cancelled. There was no correlation between abnormal blood test results and adverse outcomes. Routine testing cost AUD 30,441.20 (19,548.12 USD) and produced an estimated carbon footprint of 103.2 kg CO2e.</p><p><strong>Conclusion: </strong>Routine pathology testing before bronchoscopic procedures offers limited value, with most results not influencing management. Clinically significant abnormalities occurred only in patients with established risk factors, supporting a targeted approach. Given the significant financial and environmental costs, transitioning to selective, evidence-based testing is essential to optimize resource use and improve sustainability.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998235","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}