Abstract
The field of interventional pulmonology (IP) has grown from a fringe subspecialty utilized in only a few centers worldwide to a standard component in advanced medical centers. IP is increasingly recognized for its value in patient care and its ability to deliver minimally invasive and cost-effective diagnostics and treatments. This article will provide an in-depth review of advanced bronchoscopic technologies used by IP physicians focusing on pulmonary nodules. While most pulmonary nodules are benign, malignant nodules represent the earliest detectable manifestation of lung cancer. Lung cancer is the second most common and the deadliest cancer worldwide. Differentiating benign from malignant nodules is clinically challenging as these entities are often indistinguishable radiographically. Tissue biopsy is often required to discriminate benign from malignant nodule etiologies. A safe and accurate means of definitively differentiating benign from malignant nodules would be highly valuable for patients, and the medical system at large. This would translate into a greater number of early-stage cancer detections while reducing the burden of surgical resections for benign disease. There is little high-grade evidence to guide clinicians on optimal lung nodule tissue sampling modalities. The number of novel technologies available for this purpose has rapidly expanded over the last decade, making it difficult for clinicians to assess their efficacy. Unfortunately, there is a wide variety of methods used to determine the accuracy of these technologies, making comparisons across studies impossible. This paper will provide an in-depth review of available data regarding advanced bronchoscopic technologies.
Highlights
Interventional pulmonology (IP) has come a long way since its introduction by Gustav Killian when he removed a pork bone from a farmer’s lung in 1876 [1]
We present below the most up-to-date review of the literature; no ”best” technology can be determined without additional study and consensus agreement on how diagnostic yield is determined
A standard method for determining diagnostic yield in biopsy literature would be valuable in guiding future practices to ensure we provide the best possible care for our patients
Summary
Interventional pulmonology (IP) has come a long way since its introduction by Gustav Killian when he removed a pork bone from a farmer’s lung in 1876 [1] It was not until nearly 100 years later, in 1972, that Howard Anderson attempted the first tissue sampling of lung parenchyma through a rigid bronchoscope [1]. The accelerating rate of technological advancement is challenging to keep up with for clinicians both in and outside of the field of IP. This review aims to synthesize the literature around these technologies so that clinicians can gain insight into what these technologies could offer them, their patients, and their practices. We quickly uncovered that reporting of diagnostic yield, benign nodule follow-up and benign histology was highly variable. We present below the most up-to-date review of the literature; no ”best” technology can be determined without additional study and consensus agreement on how diagnostic yield is determined. Given the very high incidence of pulmonary nodules and the significant consequences of missed or delayed diagnoses, research in this field is of great importance and consequence to our patients
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