Update in interventional pulmonology: A prologue to a new review series

Abstract

The past decade has witnessed an unprecedented explosion of technological innovations in the field of Interventional Pulmonology (IP), with broad clinical applications crossing specialty lines including such various disease processes as lung cancer, asthma, chronic obstructive pulmonary diseases and pleural infections, among others. Bronchoscopists now routinely use advanced navigation techniques to reach once inaccessible lesions, can obtain large biopsy specimens safely by cryobiopsies and process these specimens optimally to identify molecular alterations allowing for individualized cancer management. Pleural disease experts have accrued a large body of evidence supporting minimally invasive management of pleural infections or malignant pleural effusions that were, until recently, primarily addressed surgically. Such a paradigm shift has led to an increased awareness among IP specialists of the growing need for a standardization of practice, clinical research efforts to validate the clinical relevance of proposed new technologies and, perhaps more importantly, the needed transition from apprenticeship education models to standardized specialized training programmes leading to demonstrable and measurable clinical expertise. To that effect, IP fellowship programmes are being developed in the United States with ongoing efforts to incorporate standardized curriculum and competency-based evaluation tools. Similar efforts are also underway in Europe and the rest of the world, under the auspices of the European Association of Bronchology and Interventional Pulmonology and the World Association of Bronchology and Interventional Pulmonology. An important challenge facing the IP community consists of defining minimum education standards and training requirements to promote clinical expertise while maintaining the dissemination of knowledge and access to those IP-related technologies that occupy an increasingly central role in patient management, such as endobronchial ultrasound for the diagnosis of mediastinal lymphadenopathy, or pleuroscopy for the diagnosis of unexplained exudative pleural effusions. These numerous changes in clinical education, research and practice position this special thematic review as a particularly relevant and timely addition to the body of literature pertaining to the subspecialty. We invited worldwide experts in various fields of IP to contribute comprehensive narrative reviews, which we believe best illustrate the upcoming opportunities and challenges for IP specialists, and pulmonologists at large, worldwide. We are honoured and grateful for the opportunity to introduce their work and sincerely hope that the selected articles will capture the spirit of innovation sweeping through the field and continue to advance the specialty forward.