Seminars in respiratory and critical care medicine
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Transbronchial lung cryobiopsy (TBLCB) is a relatively new and promising technique for the acquisition of larger amounts of higher quality lung tissue for the diagnosis of lung diseases. There is a growing body of literature describing a diagnostic yield comparable to surgical lung biopsy with a favorable safety profile. ⋯ However, several questions remain including its role in the diagnostic algorithm, indications, and technique. Herein we provide a review of the available literature describing diagnostic yield, complications, and differing techniques as well as a perspective from pathology.
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Semin Respir Crit Care Med · Dec 2018
ReviewThoracoscopy: Advances and Increasing Role for Interventional Pulmonologists.
Thoracoscopy is an increasingly common procedure that provides significant clinical information and therapeutic applications. The procedure allows the physician to biopsy the parietal pleura under direct visualization with high accuracy. In addition, one can drain pleural fluid, place a chest tube in a precise location, and perform poudrage pleurodesis. ⋯ MT is less invasive, has a comparable diagnostic yield, and may be better tolerated in high-risk patients. The indications, complications, and advances in thoracoscopy will be discussed in this article. In the era of rapidly evolving therapeutics for lung cancer, immune-modulation and ever-increasing risks of immunosuppression, MT will evolve and continue to play a pivotal role in the evaluation and research of pleuropulmonary diseases.
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Since its advent more than a decade ago, real-time linear endobronchial ultrasound (EBUS) guided transbronchial needle aspiration has revolutionized the diagnosis and staging of nonsmall cell lung cancer (NSCLC), and has become the standard of care with widespread acceptance. It is also extensively used to diagnose other disease entities such as malignancy besides NSCLC, benign diseases, or infectious processes. ⋯ Meanwhile, with several ground-breaking discoveries in lung cancer treatment over the past few years, linear EBUS has found its way to fit into this scheme as a safe and effective diagnostic tool. This review summarizes the most recent evidence on evaluating the performance of linear EBUS-guided biopsy in various clinical situations.
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AbstractThieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Semin Respir Crit Care Med · Dec 2018
ReviewBronchoscopic Lung Volume Reduction in Patients with Severe Emphysema.
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure for patients with symptomatic severe emphysema who may not be candidates for surgical lung volume reduction. BLVR has been shown to improve both functional and clinical outcomes with a relatively low risk of severe complications. Any potential candidate to BLVR should be on optimal pharmacological and nonpharmacological treatment. ⋯ A variety of BLVR techniques have been published with different associated benefits and risks. Current strategies include either blocking procedures such as endobronchial valves and intrabronchial valves or nonblocking procedures such as endobronchial coils and bronchoscopic thermal vapor ablation. The aim of this review is to describe current options of BLVR including their efficacy and safety based on available data.