Respiration最新文献

{"title":"Independent Validation of the LIONS PREY in Patients Undergoing Navigational Bronchoscopy.","authors":"Erik Büscher, Faustina Funke, Kaid Darwiche, Rüdiger Karpf-Wissel, Christian Taube, Servet Bölükbas, Maximilian Webendörfer, Martin Schuler, Nika Guberina, Sebastian Zensen, Johannes Haubold, Michael Forsting, Hubertus Hautzel, Uta Wülfing, Ardian Latifi, Yeon Wook Kim, Fabian Doerr, Marcel Opitz","doi":"10.1159/000550559","DOIUrl":"10.1159/000550559","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate malignancy risk prediction of pulmonary lesions is essential in the context of lung cancer screening and early diagnosis. Widely used risk prediction tools, such as the Brock and Herder models, have shown limited performance in high-risk cohorts referred for bronchoscopic evaluation. The LIONS PREY (lung lesion score predicts malignancy) was specifically developed to provide a simple and reliable estimate of malignancy risk in this clinical setting. This study aimed to externally validate the LIONS PREY model and to compare its predictive performance with the Brock and Herder models in patients undergoing index navigational bronchoscopy for pulmonary lesion evaluation.</p><p><strong>Methods: </strong>We retrospectively analysed patients who underwent index navigational bronchoscopy for peripheral pulmonary lesions between December 2019 and March 2024 at a tertiary academic centre. Malignancy risk was estimated using the LIONS PREY, Brock, and Herder models. Model performance was assessed via receiver operating characteristic (ROC) analysis and classification accuracy.</p><p><strong>Results: </strong>Among 193 evaluable lesions, 134 (69.4%) were histologically confirmed malignant. Malignant lesions were associated with increased growth dynamics (2.7 ± 4.1 mm vs. 1.0 ± 4.3 mm, p < 0.001) and spiculation (56.0% vs. 23.7%, p < 0.001). The LIONS PREY achieved an area under the ROC curve (AUC) of 0.94, outperforming Herder (AUC 0.72; p < 0.001) and Brock (AUC 0.62; p < 0.001) models. Correct classification rates were highest for LIONS PREY (85.0%) versus Herder (70.3%) and Brock (69.1%) (all p < 0.001).</p><p><strong>Conclusion: </strong>The LIONS PREY demonstrated superior predictive accuracy over Brock and Herder in high-risk patients undergoing navigational bronchoscopy, supporting its clinical utility for malignancy risk stratification.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric Long-Term Home Respiratory Support: Recommendations of the Swiss Society of Paediatric Pulmonology.","authors":"Regula Corbelli, Miriam Giarrana, Christian Bieli, Sylvain Blanchon, Sophie Guerin, Thomas Ferry, Carolyn Luhmann-Lunt, Daniel Trachsel, Nicolas Regamey, Isabelle Ruchonnet-Métrailler","doi":"10.1159/000550985","DOIUrl":"10.1159/000550985","url":null,"abstract":"<p><p>The number of paediatric patients evaluated for long-term home respiratory support has risen sharply in recent years, reflecting both improved survival of children with complex chronic conditions and expanded therapeutic indications. This population is characterized by substantial clinical heterogeneity, encompassing obstructive, restrictive, or central ventilatory disorders. Contributing comorbidities - such as severe obesity, chronic aspiration with secondary lung disease, neuromuscular weakness, impaired central respiratory drive, and dynamic upper airway obstruction - further complicate diagnostic assessment and long-term management. This consensus statement, developed by the Special Interest Group of the Swiss Society of Paediatric Pulmonology, provides comprehensive recommendations for Switzerland. It defines current indications for non-invasive and invasive home respiratory support, proposes criteria for patient selection, and outlines key competencies and composition of an optimal multidisciplinary care team. The document also specifies requirements for equipment provision, safety measures, and training of caregivers, while offering structured guidance for monitoring strategies, long-term follow-up, and management of acute exacerbations. Ethical considerations and best practices for transitioning adolescents to adult respiratory care are additionally addressed, with the aim of standardizing care pathways and improving clinical outcomes.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-23"},"PeriodicalIF":2.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends and Burden of Hospitalizations for Presumed Cardiac Sarcoidosis.","authors":"Carolin Hesse, Niklas F Ehl, Florent Baty, Martin H Brutsche","doi":"10.1159/000551706","DOIUrl":"10.1159/000551706","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac sarcoidosis is a potentially life-threatening manifestation of systemic sarcoidosis, yet its true prevalence remains uncertain. Improved imaging techniques and greater clinical awareness may have contributed to higher detection rates, but nationwide data on cardiac involvement and hospitalization burden in Switzerland are lacking. We aimed to characterize national trends, comorbidity patterns, and in-hospital outcomes of presumed cardiac sarcoidosis between 2010 and 2021.</p><p><strong>Methods: </strong>This nationwide retrospective nested case-control study used the Swiss Federal Statistical Office hospitalization database. Presumed cardiac sarcoidosis was defined by co-occurrence of International Classification of Diseases, 10th Revision, German Modification (ICD-10-GM) codes for sarcoidosis (D86.0-D86.8), and cardiac involvement (I41, I42, I44, I45, I46, I49, I50), excluding coronary artery disease (I25). Controls were age-, sex-, and admission month-matched sarcoidosis hospitalizations without cardiac involvement.</p><p><strong>Results: </strong>Among 5,636 hospitalized sarcoidosis patients, 813 (14%) met criteria for presumed cardiac sarcoidosis. Between 2010 and 2021, the number of hospitalizations for presumed cardiac sarcoidosis increased significantly, approximately doubling over the study period (rate ratio 2.09, 95% CI 1.87-2.35; p < 0.001). Over the same period, the proportion of patients carrying implantable cardiac devices doubled from 15% to 30% (+1.2% per year; 95% CI 0.3-2.1; p = 0.015). Compared with controls, patients with presumed cardiac sarcoidosis had a greater comorbidity burden (median 10 vs. 8), higher in-hospital mortality (5.5% vs. 2.3%; OR 2.45 [1.59-3.85]), and more frequent rehospitalizations (0.32 vs. 0.24 per year). In multivariable analyses, acute organ dysfunction was most strongly associated with in-hospital mortality, whereas heart failure and atrial fibrillation were the strongest predictors of rehospitalization.</p><p><strong>Conclusion: </strong>Hospitalizations for presumed cardiac sarcoidosis in Switzerland have nearly doubled between 2010 and 2021, likely reflecting increased diagnostic awareness and improved detection, although a true increase in disease incidence cannot be excluded. Despite rising case numbers and higher comorbidity burden, overall in-hospital mortality remained stable.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Based Comparison of Remission in Patients with Severe Type 2 Asthma Treated with Biologics: A Real-World Analysis from the \"Southern Italy Network on Severe Asthma Therapy\".","authors":"Giulia Scioscia, Carla Maria Irene Quarato, Alida Benfante, Maria Filomena Caiaffa, Raffaele Campisi, Giovanna Elisiana Carpagnano, Isabella Carrieri, Claudia Crimi, Mariella D Apos Amato, Danilo Di Bona, Chiara Lupia, Angelantonio Maglio, Vitaliano Nicola Quaranta, Corrado Pelaia, Girolamo Pelaia, Nicola Scichilone, Giuseppe Spadaro, Alessandra Tomasello, Alessandro Vatrella, Giuseppe Valenti, Nunzio Crimi, Maria Pia Foschino Barbaro","doi":"10.1159/000550911","DOIUrl":"10.1159/000550911","url":null,"abstract":"<p><strong>Introduction: </strong>Sex influences asthma phenotypes and treatment outcomes. However, real-world data on sex-related differences in severe asthma patients treated with biologics are limited. The objective of this study was to assess sex differences in baseline characteristics and treatment outcomes in a cohort of severe eosinophilic asthma (SEA) patients treated with biologics.</p><p><strong>Methods: </strong>We retrospectively analyzed 370 SEA patients (235 females, 135 males) treated with mepolizumab, benralizumab, or dupilumab. Clinical remission was defined as no OCS use plus at least two of: no exacerbations, ACT ≥20, or FEV1 >80%. Logistic regression was used to identify sex-specific predictors of remission at 24 months.</p><p><strong>Results: </strong>Severe type 2 asthma showed a prevalence in females (female-to-male ratio of 1.7:1). Baseline characteristics revealed higher prevalence of obesity (p = 0.015) and osteoporosis (p = 0.006) in females, and greater tobacco exposure (p = 0.05), FeNO (p = 0.03), and nasal polyposis (p = 0.0002) in males. Males had greater reduction in FeNO (p ≤ 0.05) and more male patients stopped exacerbations at 24 months (p < 0.0001), while females showed greater FEF_25-75% (p ≤ 0.05) improvement and larger IgE drops (p < 0.0001). Remission rates were similar across sexes at both 12 months (64.3% versus 74.1%; p = 0.06) and 24 months (71.5% versus 77.0%; p = 0.27). In females, remission was associated with eosinophils >300/μL (OR: 2.68; 95% CI: 1.41-5.07; p = 0.003), FeNO >50 ppb (OR: 21.05; 95% CI: 10.24-43.34; p < 0.0001), and nasal polyposis (OR: 2.74; 95% CI: 1.46-5.13; p = 0.001); obesity (OR: 0.20; 95% CI: 0.11-0.37; p < 0.0001), smoking (OR: 0.38; 95% CI: 0.21-0.70; p = 0.002), anxiety (OR: 0.47; 95% CI: 0.23-0.94; p = 0.04), and reflux (OR: 0.47; 95% CI: 0.27-0.84; p = 0.01) were negative predictors. In males, OCS dependency (OR: 0.35; 95% CI: 0.13-0.94; p = 0.03) and FEV1 <80% (OR: 0.18; 95% CI: 0.05-0.63; p = 0.004) were negative predictors.</p><p><strong>Conclusion: </strong>Biologics were equally effective in inducing clinical remission across sexes, but different predictors influenced outcomes. Sex-aware strategies may support personalized asthma care.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Impact of Pediatric Pulmonologist Involvement in Intensive Care Units: Bridging Expertise and Outcomes.","authors":"Satı Özkan Tabakçı, Murat Alperan Yavuz, Murat Yasin Gençoğlu, Salih Uytun, Şule Selin Akyan Soydaş, Işıl Bilgiç, Meltem Kürtül Çakar, Gamze Akça Dinç, Ayyüce Ünlü, Bahar Ece Tokdemir, Hande Yetişgin, Çelebi Yıldırım, Gökçen Dilşa Tuğcu, Sanem Eryılmaz Polat, Dilber Ademhan Tural, Güzin Cinel","doi":"10.1159/000551707","DOIUrl":"10.1159/000551707","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory illnesses are a major cause of mortality and morbidity in pediatric and neonatal intensive care units (ICUs). This study aimed to determine the impact of pediatric pulmonologist (PP) consultation on children in ICUs and assess differences in clinical outcomes.</p><p><strong>Methods: </strong>This single-center, retrospective, cross-sectional cohort study included children aged 0-18 years for whom PP consultations were requested between June 2022 and June 2023. Children were divided into two groups based on the median time from ICU admission to the consultation request. Group 1 (n = 221) received consultations within 14 days, defined as early consultation, while group 2 (n = 66) received consultations after 14 days, defined as late consultation. We compared demographic, clinical, and radiologic characteristics and the length of stay (LOS) in the hospital, ICU, and mechanical ventilator (MV).</p><p><strong>Results: </strong>Two hundred eighty-seven children were consulted by PPs. The most common reasons for the PP consultation were respiratory failure (39.4%), preoperative evaluation (14.6%), pneumonia (8.7%), atelectasis (5.9%), and suspicion of foreign body aspiration (5.6%). The median LOS in the hospital was 33 (IQR = 61) days, in the ICU was 13 (IQR = 33) days, and on the MV was 10.50 (IQR = 30.50) days. Group 1 had significantly lower LOS in the hospital, ICU, and MV than group 2 (p < 0.001 for all). We found that being monitored on an MV (p < 0.001), being consulted for prolonged intubation or respiratory failure (p < 0.001), and being consulted by a PP after a median of 14 days are the main contributors to prolonged ICU LOS.</p><p><strong>Conclusions: </strong>Early PP consultation for children treated in the PICU and NICU may be associated with better outcomes. Nevertheless, the retrospective nature of our study, the lack of risk scoring data for patients, and the numerous factors that can influence the LOS in the ICU and hospital for pediatric patients necessitate further comprehensive research to substantiate our findings.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Procedural Efficiency in Endobronchial Ultrasound with Dual versus Single NEEDLEs: Evaluating the Value of a Second Needle in Endobronchial Ultrasound as It Pertains to Economic and Environmental Impact.","authors":"Christopher M Kapp, Jeremy J Kim, Coral Giovacchini, Jamie H Rowell, Chinh Phan, Donald Scott Slusarenko, Cristina Salmon, Kamran Mahmood, Rebecca P Kirby, Momen M Wahidi","doi":"10.1159/000551855","DOIUrl":"10.1159/000551855","url":null,"abstract":"<p><strong>Introduction: </strong>Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the standard for mediastinal and hilar lymph node sampling. Traditionally, a single needle is used, which can lead to procedural downtime while specimens are processed, potentially prolonging anesthesia duration. This study aimed to determine whether using a second needle could expedite the procedure enough to offset its cost.</p><p><strong>Methods: </strong>In a prospective, single-blind, multi-center, randomized controlled trial, 126 adult patients undergoing EBUS-TBNA were randomized to either 1 or 2 needles. The primary outcome was time per needle pass. Secondary outcomes included cost-benefit analysis, diagnostic yield, next-generation sequencing (NGS) sufficiency, and carbon impact.</p><p><strong>Results: </strong>The two-needle group had significantly faster needle passes (56.2 ± 14.3 vs. 82.1 ± 21.9 s; p < 0.001), though total procedure time was not significantly different (22.2 ± 9.1 vs. 24.7 ± 12.5 min; p = 0.101). More needle passes were performed in the two-needle group (16.9 ± 6.5 vs. 13.9 ± 6.1; p = 0.004), with no difference in the number of lymph nodes sampled. Diagnostic yield was 96.0% overall, and NGS sufficiency in cancer cases was 93.6%, with no differences between groups.</p><p><strong>Conclusion: </strong>Using a second needle decreases time per needle pass without changing overall procedure time or compromising diagnostic performance. Although it increases immediate cost and environmental impact, a customizable model was developed to help centers determine when the time savings justify the added expense, based on anesthesia cost, needle price, and planned passes per node.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Nodal Upstaging following Systematic Endobronchial Ultrasound Lymph Node Staging in Non-Metastatic Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis.","authors":"John Zhu, Matthew Bricknell, Jack M Watson, Tracy L Leong, Daniel P Steinfort","doi":"10.1159/000551141","DOIUrl":"10.1159/000551141","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate hilar and mediastinal staging is critical for prognosis and treatment selection in non-metastatic non-small cell lung cancer (NSCLC). While current guidelines recommend systematic mediastinal lymph node staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for early-stage disease, its utility in wider populations is increasingly recognized. We aimed to determine the rate of nodal upstaging following systematic endoscopic mediastinal staging in non-metastatic NSCLC.</p><p><strong>Methods: </strong>MEDLINE, Embase, and Cochrane databases were searched from inception to February 2025. We included prospective and retrospective studies of adults with curative-intent NSCLC undergoing systematic EBUS-TBNA staging that reported per-patient nodal upstaging. Two reviewers independently extracted data. A random-effects meta-analysis assessed the pooled proportion of PET-occult lymph node metastases. Upstaging rates were quantified across clinical N stages. Subgroup analyses and meta-regression assessed methodological variables (PROSPERO: CRD42024547873).</p><p><strong>Results: </strong>Twenty-six studies comprising 5,161 participants were included. The pooled rate of PET-occult nodal metastases was 8.6% (95% CI: 6.7-11.0%), corresponding to a number needed to test of 12. Nodal upstaging rates varied by clinical stage: 7.2% for cN0, 10.6% for cN1, 5.0% for cN2, and 0.3% for cN3. Statistical heterogeneity was substantial (I2 = 82.0%); however, subgroup analyses and meta-regression did not identify significant sources of variance.</p><p><strong>Conclusion: </strong>This is the first published systematic review to evaluate the rate of PET-occult nodal disease in non-metastatic NSCLC using systematic staging EBUS-TBNA. Approximately 1 in 12 patients were identified to have PET-occult nodal metastases. These findings support the routine implementation of systematic endoscopic staging to guide curative-intent treatment decisions across non-metastatic disease stages.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-14"},"PeriodicalIF":2.6,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologic Therapy Timing and Severe Asthma Progression: Insights from the Italian Registry on Severe Asthma.","authors":"Matteo Martini, Lorenzo Cecchi, Maria Aliani, Leonardo Antonicelli, Francesco Bini, Fausto De Michele, Nicola Cosimo Facciolongo, Rosa Fasano, Francesco Menzella, Antonino Musarra, Adriano Vaghi, Giuseppe Valenti, Claudio Micheletto, Maria Beatrice Bilò","doi":"10.1159/000551651","DOIUrl":"10.1159/000551651","url":null,"abstract":"<p><strong>Introduction: </strong>Timely initiation of biologic therapies is crucial in the management of severe asthma. However, delays in diagnosis and access to advanced treatments are common in real-life settings. We investigated disease progression and trajectories, with a focus on the impact of treatment latency among patients with severe asthma.</p><p><strong>Methods: </strong>This longitudinal observational analysis included adult patients with severe asthma enrolled in the Italian Registry on Severe Asthma (IRSA). Data were stratified by use and timing of biologic therapy. Two core analyses were conducted: (1) characterization of patients not receiving biologics; (2) evaluation of disease progression and the relationship with the timing of biologic initiation.</p><p><strong>Results: </strong>At baseline, 43.7% of the 2,114 patients were not receiving biologics, despite having severe disease and a T2-high phenotype. The average time of progression from initial diagnosis to severe asthma was 17 years. The median time from severe asthma diagnosis to biologic initiation was 2 years (IQR: 0.9-4.2). At the 1-year follow-up, patients who initiated biologics after enrollment showed the most significant clinical improvements compared with patients without biologic treatment or already on biologics at baseline, including a 64.8% reduction in the number of exacerbations (p = 0.019), a mean reduction in annual exacerbation rate of 4.1 events (p < 0.001), and an increase of 6.3 points in ACT score (p < 0.001).</p><p><strong>Conclusion: </strong>Severe asthma often develops after a prolonged progression from initial symptom onset. Structured referral and earlier biologic initiation may be associated with better outcomes and potentially influence the clinical trajectory of severe asthma.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-7"},"PeriodicalIF":3.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shape-Sensing Robotic-Assisted Bronchoscopic Cryoablation for Primary and Metastatic Pulmonary Nodules: Feasibility, Safety, and Early Outcomes.","authors":"Liqin Xu, Wenduo Gu, Mitchell Zhao, Grace Lin, Keriann Van Nostrand, Niral M Patel, Bryce Duchman, Brian Daniel Tran, Jorge A Munoz Pineda, Russell Jason Miller, Felix J F Herth, George Cheng","doi":"10.1159/000551795","DOIUrl":"10.1159/000551795","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive bronchoscopic interventions are increasingly explored as alternatives to surgery for pulmonary nodules. Clinical evidence on transbronchial cryoablation guided by robotic-assisted bronchoscopy (RAB) and cone-beam computed tomography (CBCT) remains limited. This study evaluated the feasibility, safety, and long-term effectiveness of shape-sensing RAB (ssRAB)-guided transbronchial cryoablation for lung nodules, including metastatic lesions.</p><p><strong>Methods: </strong>We performed a retrospective review of patients who underwent ssRAB-guided transbronchial cryoablation using ERBECRYO-2 cryotherapy system between July 2023 and May 2025 at the University of California, San Diego. Feasibility was defined as successful probe positioning and completion of cryoablation; safety was assessed by procedure-related adverse events within 14 days, and efficacy was defined as radiographic local control during serial follow-up. Histopathologic findings from nodules subsequently resected were recorded.</p><p><strong>Results: </strong>Fourteen patients with 15 nodules (mean age, 70.3 ± 8.6 years; mean nodule size, 11.1 ± 4.9 mm) were included. ssRAB-guided cryoablation was successfully performed in all cases (feasibility 100%). No procedure-related serious adverse events occurred; minor adverse events included throat irritation (21.4%), dyspnea (14.3%), and isolated hemoptysis, pleuritic pain, or pulmonary infection (7.1% each). The median follow-up time after the transbronchial cryoablation is 110 days, with a range, 13-487 days. Local control was achieved in 86.7% of nodules. Eight nodules were resected after a median of 79 days, showing fibrosis and inflammation on pathology. Seven nodules were followed radiographically for a median of 358 days, with 85.7% (6/7) remaining stable. Patients receiving immunotherapy demonstrated a trend toward longer local progression-free survival.</p><p><strong>Conclusion: </strong>ssRAB transbronchial cryoablation using a CO₂-based Erbe system is feasible and demonstrates a favorable safety profile with encouraging early local control across primary and metastatic nodules. The approach enables precise, intraprocedural confirmation of probe placement and may serve as an adjunct to systemic therapies. Prospective multicenter studies are needed to validate these findings, refine cryoablation protocols, establish radiographic and pathologic markers of complete ablation, and clarify the role of transbronchial cryoablation within multidisciplinary lung cancer care.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-13"},"PeriodicalIF":2.6,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Mycobacterial Culture Yield from Pleural Tissue Using Pleuroscopic Cryobiopsy versus Forceps Biopsy in Patients with Tuberculous Pleurisy.","authors":"Che-Chia Chang, Li-Chung Chiu, Wei-Chun Lee, Shu-Yi Huang, Chih-Hao Chang, Fu-Tsai Chung, Shih-Hong Li, Meng-Heng Hsieh, Meng-Jer Hsieh, Shu-Min Lin, Horng-Chyuan Lin, Chih-Wei Wang, Chung-Shu Lee","doi":"10.1159/000551717","DOIUrl":"10.1159/000551717","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic yield of mycobacterial culture from pleural tissue in tuberculous pleurisy is high and practical. However, the yield rates of mycobacterial culture from pleural tissue obtained through different pleural biopsy techniques via medical pleuroscopy remain unclear. This study aimed to compare the efficiency of mycobacterial culture from pleural tissue obtained by cryobiopsy and forceps biopsy during medical pleuroscopy for diagnosing tuberculous pleurisy.</p><p><strong>Methods: </strong>This retrospective study included 84 patients with tuberculous pleurisy who underwent mycobacterial culture testing using pleural tissue samples. Of these, 33 patients underwent pleuroscopic cryobiopsy and 51 underwent pleuroscopic forceps biopsy from April 2016 to December 2023 at two tertiary hospitals. Mycobacterial cultures from pleural tissue obtained by cryobiopsy and forceps biopsy were analyzed.</p><p><strong>Results: </strong>The average age of the participants was 67.1 years, with 67.9% being men. The sensitivity of Mycobacterium tuberculosis (MTB) cultures from pleural tissue was 54.5% (18/33) for cryobiopsy and 62.7% (32/51) for forceps biopsy (p = 0.455). The sensitivity of MTB culture was higher, up to 64.4% and 74.2%, in cases with pleural adhesion lesions and a combination of adhesion lesions and micronodules, respectively.</p><p><strong>Conclusion: </strong>There was no significant difference in the yield rate of MTB culture obtained by cryobiopsy or forceps biopsy in cases of undiagnosed pleural effusion during pleuroscopy. When tuberculous pleurisy is suspected, forceps biopsy may be the optimal method for obtaining mycobacterial cultures from pleural tissue.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}