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Purpose The increasing use of computed tomography (CT) imaging has led to the detection of more ground-glass nodules (GGNs) and subsolid nodules (SSNs), which may be malignant and require a biopsy for proper diagnosis. Approximately 75% of persistent GGNs can be attributed to adenocarcinoma in situ or minimally invasive adenocarcinoma. A CT-guided biopsy has been proven to be a reliable procedure with high diagnostic performance. However, the diagnostic accuracy and safety of a CT-guided biopsy for GGNs and SSNs with solid components ≤6 mm are still uncertain. The aim of this study is to assess the diagnostic accuracy of a CT-guided core needle biopsy (CNB) for GGN and SSNs with solid components ≤6 mm. Methods This is a retrospective study of patients who underwent CT-guided CNB for the evaluation of GGNs and SSNs with solid components ≤6 mm between February 2020 and January 2023. Biopsy findings were compared to the final diagnosis determined by definite histopathologic examination and clinical course. Results A total of 22 patients were enrolled, with a median age of 74 years (IQR: 68-81). A total of 22 nodules were assessed, comprising 15 (68.2%) SSNs with a solid component measuring ≤6 mm and seven (31.8%) pure GGNs. The histopathological examination revealed that 12 (54.5%) were diagnosed as malignant, nine (40.9%) as benign, and one (4.5%) as non-diagnostic. The overall diagnostic accuracy and sensitivity for malignancy were 86.36% and 85.7%, respectively. Conclusion A CT-guided CNB for GGNs and SSNs with solid components measuring ≤6 mm appears to have a high diagnostic accuracy.
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Expiratory central airway collapse (ECAC) comprising excessive central airway collapse (EDAC) and tracheobronchomalacia. Treatment is challenging for severe cases that are not candidates for surgical management. We report a case of severe ECAC successfully managed with continuous positive airway pressure (CPAP) therapy. A 75-year-old female patient status post right pneumonectomy, presented with chronic cough. Dynamic bronchoscopy evaluation showed severe EDAC which improved with intraprocedural noninvasive positive pressure (NIPPV) therapy. Due to patients' comorbidities, she was not a candidate to surgical tracheobronchoplasty. Therefore, we attempted pneumatic stenting with long-term CPAP therapy resulting in improvement of symptoms and functional capacity. The long-term efficacy of pneumatic stenting has not been clearly established yet. Literature review of management of ECAC with NIPPV consist primarily of case reports and there is only one clinical trial being conducted to assess the efficacy of CPAP therapy in ECAC. While NIPPV arises as a sufficient alternative for management of severe ECAC, larger scale studies are needed to prove the real efficacy of NIPPV in this setting.
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INTRODUCTION: The widespread use of computed tomography as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. METHODS: This is a single-center, retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic, FL, USA. RESULTS: A total of 46 PPNs were biopsied in 22 patients. All lesions were ≤2 cm with a median minimum and maximum cross-sectional lesion size of 1.40 cm and 1.05 cm, respectively. Diagnostic yield was 86.9% (n = 40), and target reach was 91.3% (n = 42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n = 36), bronchus sign was present in 82.6% of cases (n = 38), 54.4% (n = 25) were malignant nodules, and 32.6% (n = 15) were benign. Fourteen patients had at least one malignant lesion out of two or more nodules sampled, and 10 patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n = 2) with one case of bleeding and one of pneumothorax. CONCLUSION: This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment.
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Broncoscopía , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Procedimientos Quirúrgicos Robotizados , Humanos , Broncoscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Procedimientos Quirúrgicos Robotizados/métodos , Nódulos Pulmonares Múltiples/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Tomografía Computarizada por Rayos X , AdultoRESUMEN
INTRODUCTION: The use of cryobiopsy in conjunction with robotic assisted bronchoscopy is on the rise due to the safety and increased diagnostic yield of cryobiopsy. The incorporation of 3D fluoroscopy in the procedure improves the workflow and helps confirm the accuracy of sampling of peripheral pulmonary nodules. METHODS: We describe an observational series of 12 patients comprising 14 nodules where cryobiopsy was performed during shape-sensing robot-assisted bronchoscopy cryobiopsy under general anesthesia. 3D fluoroscopy was used to confirm accurate placement of the cryoprobe. All these patients underwent a second spin with the 3D fluoroscopy either to sample a second lesion intraoperatively or to investigate suspected pneumothorax. RESULTS: The development of a pneumatocele was noted after cryobiopsy in each of the cases. The majority of these were in the upper lobe with the median size of a sampled nodule being 14 mm. The majority of patients were asymptomatic with 1 patient developing mild hemoptysis and 4 patients developing chest tightness or dyspnea. None of the patients required an intervention for the pneumatocele. CONCLUSION: The development of pneumatoceles appears to be a fairly frequent and benign occurrence following cryobiopsy, likely due to increased tissue destruction. The increased use of intraoperative 3D fluoroscopy is likely to highlight changes to the pulmonary parenchyma that were previously not known. The occurrence of pneumatoceles does not appear to adversely impact the safety or tolerability profile of cryobiopsy.
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Broncoscopía , Criocirugía , Procedimientos Quirúrgicos Robotizados , Humanos , Broncoscopía/métodos , Broncoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Femenino , Anciano , Fluoroscopía , Procedimientos Quirúrgicos Robotizados/métodos , Criocirugía/métodos , Criocirugía/efectos adversos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico , Biopsia/métodos , Biopsia/efectos adversos , Biopsia/instrumentación , Quistes/patología , Quistes/diagnóstico , AdultoRESUMEN
INTRODUCTION: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. METHODS: A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. RESULTS: A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). CONCLUSION: Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure.
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Broncoscopía , Biopsia Guiada por Imagen , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Procedimientos Quirúrgicos Robotizados , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Broncoscopía/métodos , Anciano , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagen , Biopsia Guiada por Imagen/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Nódulos Pulmonares Múltiples/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico , Nódulo Pulmonar Solitario/patología , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnósticoRESUMEN
Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.
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Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Infecciones por Coronavirus/prevención & control , Pandemias , Control de InfeccionesRESUMEN
Systematic reviews evaluating multiple interventions can be useful in different clinical situations. However, some concerns arise when more than two interventions are compared and there is a paucity of good quality randomized clinical trials. A novel statistical method based on indirect comparisons, called network meta-analysis (NMA), can be a useful approach to find a clinical answer when multiple interventions are evaluated for the same outcome or comparator. The aim of this review is to describe the main characteristics and provide a user guide for a critical analysis of NMA focusing on its three main domains, namely homogeneity, transitivity and consistency.
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Metaanálisis en RedRESUMEN
ABSTRACT Objective: To evaluate current practices in sedation for bronchoscopy in Latin America. Methods: This was an anonymous survey of select members of the Latin American Thoracic Association. The questionnaire, made available online from November of 2015 through February of 2016, was designed to collect data on demographic characteristics; type of facility (public or private); type/volume of bronchoscopies; type of sedation; and type of professional administering the sedation. Results: We received 338 completed questionnaires from 19 countries; 250 respondents (74.0%) were male. The mean respondent age was 36.0 ± 10.5 years. Of the 338 respondents, 304 (89.9%) were pulmonologists; 169 (50.0%) worked at public facilities; and 152 (45.0%) worked at teaching facilities. All of the respondents performed diagnostic fiberoptic bronchoscopy, 206 (60.9%) performed therapeutic fiberoptic bronchoscopy, 125 (37.0%) performed rigid bronchoscopy, 37 (10.9%) performed endobronchial ultrasound, and 3 (0.9%) performed laser therapy/thermoplasty/cryotherapy. Sedation for bronchoscopy was employed by 324 respondents (95.6%). Of the 338 respondents, 103 (30.5%) and 96 (28.4%) stated, respectively, that such sedation should "usually" and "never" be administered by a bronchoscopist; 324 (95.9%) supported training bronchoscopists in sedation. Sedation administered by a bronchoscopist was reported by 113 respondents, conscious sedation being employed by 109 (96.2%). The use of benzodiazepines, propofol, and opiates was reported, respectively, by 252 (74.6%), 179 (52.9%), and 132 (39.0%) of the 338 respondents. Deep sedation and general anesthesia were more common at private facilities. Conclusions: The consensus seems to be that a well-trained bronchoscopist can safely administer sedation for bronchoscopy. However, approximately 40% of bronchoscopists do not do so regularly.
RESUMO Objetivo: Avaliar as práticas atuais de sedação na broncoscopia na América Latina. Métodos: Trata-se de um inquérito realizado de forma anônima com membros selecionados da Associação Latino-Americana de Tórax. O questionário, disponibilizado on-line entre novembro de 2015 e fevereiro de 2016, foi desenvolvido para coletar dados sobre características demográficas, tipo de serviço (público ou privado), tipo/volume de broncoscopias, tipo de sedação e tipo de profissional que administra a sedação. Resultados: Recebemos 338 questionários preenchidos de 19 países; 250 entrevistados (74,0%) eram do sexo masculino. A média de idade dos entrevistados foi de 36,0 ± 10,5 anos. Dos 338 entrevistados, 304 (89,9%) eram pneumologistas; 169 (50,0%) trabalhavam em estabelecimentos públicos; e 152 (45,0%) trabalhavam em instituições educacionais. Todos os entrevistados realizavam fibrobroncoscopia diagnóstica, 206 (60,9%) realizavam fibrobroncoscopia terapêutica, 125 (37,0%) realizavam broncoscopia rígida, 37 (10,9%) realizavam ultrassom endobrônquico, e 3 (0,9%) realizavam terapia a laser/termoplastia/crioterapia. A sedação na broncoscopia foi empregada por 324 entrevistados (95,6%). Dos 338 entrevistados, 103 (30,5%) e 96 (28,4%) afirmaram, respectivamente, que a sedação "geralmente" e "nunca" deveria ser administrada por um broncoscopista; 324 (95,9%) apoiavam o treinamento de broncoscopistas em sedação. A sedação era administrada por um broncoscopista segundo 113 entrevistados, sendo a sedação consciente empregada por 109 (96,2%). O uso de benzodiazepínicos, propofol e opiáceos foi relatado, respectivamente, por 252 (74,6%), 179 (52,9%) e 132 (39,0%) dos 338 entrevistados. Sedação profunda e anestesia geral eram mais comuns em serviços privados. Conclusões: O consenso foi de que um broncoscopista bem treinado poderia administrar com segurança a sedação na broncoscopia. No entanto, aproximadamente 40% dos broncoscopistas não o fazem regularmente.
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Tridimensional printing is becoming relevant in medicine, specially in surgical and interventional specialties. We review the technical aspects and clinical application of airway tridimensional printing. Using this technique, simulation models for bronchoscopy and models for diagnostic and therapeutic procedures such as stent design, tracheal reconstruction and airway models can be created.
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Humanos , Sistema Respiratorio , Impresión Tridimensional , Modelos Anatómicos , Prótesis e Implantes , Diseño de Prótesis , Tráquea , Stents , Entrenamiento SimuladoRESUMEN
No disponible
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Humanos , Masculino , Adulto , Accidentes de Trabajo , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/terapia , Broncoscopía/métodosRESUMEN
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Humanos , Traqueobroncomalacia/epidemiología , Atelectasia Pulmonar/complicaciones , Traqueobroncomalacia/complicaciones , Bronquios/patología , Obstrucción de las Vías AéreasRESUMEN
No disponible
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Humanos , Masculino , Anciano , Enfermedades Profesionales , Exposición Profesional , Antracosis/diagnóstico , Antracosis/etiología , Cobre/efectos adversos , Minería , Tomografía Computarizada por Rayos X , Broncoscopía , BiopsiaRESUMEN
No disponible
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Humanos , Nódulo Pulmonar Solitario/epidemiología , Nódulo Pulmonar Solitario/prevención & control , Neoplasias Pulmonares/diagnóstico , Diagnóstico Precoz , Neumotórax/diagnóstico , Nódulo Pulmonar Solitario/diagnóstico , Broncoscopía/métodos , Tejido Parenquimatoso/patología , Técnicas de AblaciónRESUMEN
Bronchoscopy cryoprobes are used for palliative treatment of endobronchial obstructions caused by tumors and removal of granulation tissue or foreign bodies. Currently this technology is also used for diagnosis of diffuse interstitial lung disease (ILD). The multidisciplinary team that establishes the clinical, radiological and histopathological correlation in ILD, decides about performing a surgical lung biopsy when the characteristics of the interstitial disease are not similar to Idiopathic Pulmonary Fibrosis (IPF). Although surgical lung biopsy is the gold standard for diagnosis, treatment, and prognosis, transbronchial cryo-biopsy has a high diagnostic yield, low morbidity and mortality rate, low rate of complications and lower cost. It is the diagnostic method of choice in ILD when it is available. Technological improvements with greater freezing power and tensile strength of the cryo probes, allow their use in cryotherapy and cryo-recanalization for occlusive airway tumors.
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Humanos , Broncoscopía/métodos , Enfermedades Pulmonares Intersticiales/diagnóstico , Crioterapia/métodos , Biopsia/métodos , Tomografía Computarizada por Rayos X , Enfermedades Pulmonares Intersticiales/clasificación , Enfermedades Pulmonares Intersticiales/fisiopatologíaRESUMEN
No disponible
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Inmunoterapia , Anticuerpos Monoclonales/administración & dosificación , Ultrasonografía , Procedimientos Quirúrgicos Mínimamente Invasivos , Carcinoma de Pulmón de Células no Pequeñas/patología , InmunohistoquímicaRESUMEN
In the last years, several techniques have been developed to obtain a prompt diagnosis or rule out lung cancer. Endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield for mediastinal and central pulmonary lesions. This procedure is especially useful for lung cancer diagnosis and mediastinal staging. Two different types of EBUS are currently available: Radial EBUS and lineal EBUS. Each one has technical differences together with a range of clinical indications. The aim of this review is to discuss about EBUS-TBNA and its current clinical indications, evidence about the accuracy of the procedure for lung cancer diagnosis and staging, and evaluation of the pathological and molecular studies (EGFR, ALK, and ROS1) obtained through EBUS-TBNA and rapid on-site evaluation (ROSE).
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Humanos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Pulmón/patología , Neoplasias Pulmonares/patología , Reproducibilidad de los Resultados , Endosonografía/instrumentación , Endosonografía/métodos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/diagnóstico por imagen , Ilustración Médica , Estadificación de NeoplasiasRESUMEN
Chronic obstructive pulmonary disease (COPD) has no curative treatment, and in moderate to advanced stages, functional parameters and quality of life are affected. Lung volume reduction improves respiratory parameters and quality of life of these patients. Endoscopic lung volume reduction is a minimally invasive procedure that uses endobronchial valves or coils. Valves are unidirectional, blocking the air from entering the target lobe during inspiration, allowing the exit of air and secretions during expiration. Complete fissure and absence of collateral ventilation are needed for an adequate functioning of endobronchial valves. Endobronchial coils cause mechanical retraction of the lung parenchyma. We report two patients who underwent endoscopic lung volume reduction by endobronchial valves. One patient was on continuous positive pressure non-invasive ventilation due to his severe emphysema.
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Humanos , Masculino , Persona de Mediana Edad , Anciano , Enfisema Pulmonar/cirugía , Tamaño de los Órganos , Neumonectomía/métodos , Índice de Severidad de la Enfermedad , Broncoscopía/métodos , Resultado del TratamientoRESUMEN
No disponible
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Humanos , Masculino , Femenino , Receptores ErbB/análisis , Receptores ErbB/genética , Linfoma Anaplásico de Células Grandes/diagnóstico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Biopsia con Aguja Fina/métodos , Técnicas y Procedimientos Diagnósticos , Inmunohistoquímica/métodosRESUMEN
The use of thoracic ultrasound as a diagnostic tool in the emergency department, intensive care unit or in patients with pulmonary diseases is increasing steadily. It is used to guide percutaneous tracheostomies, to assess pleural effusions, to rule out pneumothorax, and to guide the placement of endovascular and pleural catheters. It is also useful in the assessment of patients with dyspnea. The aim of this review is to provide the practical and technical basics for the use of this diagnostic tool among internists and specialists in pulmonary diseases.