Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Aug 2022
ReviewTransbronchial Lung Cryobiopsy for Diffuse Parenchymal Lung Disease.
Transbronchial lung cryobiopsy (TBLC) offers a minimally invasive option for the diagnosis of diffuse parenchymal lung diseases, of which interstitial lung diseases comprise the most common diagnoses. It has a high diagnostic yield with prognostic and therapeutic implications. ⋯ However, TBLC techniques remain variable. Here we review the latest techniques described to maximize diagnostic yield and mitigate complications of TBLC as well as how this modality has been incorporated into guidelines.
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Semin Respir Crit Care Med · Aug 2022
ReviewBronchoscopic Lung Volume Reduction for Emphysema: Review and Update.
In carefully selected patients with severe chronic obstructive pulmonary disease, characterized by emphysema and hyperinflation, lung volume reduction is an option to reduce lung hyperinflation, improve lung function, quality of life, and exercise capacity. Currently, there are several bronchoscopic and surgical treatment options to achieve lung volume reduction. ⋯ Other bronchoscopic lung volume reduction options include treatment with coils, thermal vapor ablation, and sclerosant agents. In this review, we aim to summarize the current clinical evidence on the bronchoscopic lung volume reduction therapies and important aspects regarding optimal patient selection.
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Pleural malignancies are among the most common causes of pleural disease and form the basis of our daily pleural practice. There has been significant research and increase in both diagnostic and therapeutic management of malignant pleural diseases in the last decade. ⋯ Several trials compared different treatment modalities for pleural malignancies and continue to emphasize the need to reduce hospital length of stay and unnecessary pleural intervention, and the importance of patient choice in clinical decision making. This practical review aims to summarize the current knowledge for the management of pleural malignancies, and the understanding of the steps that we still have to climb to optimize management and reduce morbidity.
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Semin Respir Crit Care Med · Aug 2022
Interventional Pulmonology and Esophagus: Combined Endobronchial Ultrasound and Endoscopic Ultrasound for Mediastinal Staging.
Endoscopic ultrasound (EUS) techniques in addition to endobronchial ultrasound (EBUS) can lead to diagnosis and complete accurate staging of the mediastinum in a single session. This allows for decreased health care costs, less delay in diagnosis and treatment, reduced patient discomfort, and decreased morbidity compared with invasive surgical staging techniques. ⋯ Moreover, compared with EBUS alone, combined EUS and EBUS has significantly increased yield, as well as diagnostic sensitivity making a combined approach preferable as the emerging gold-standard technique for initial minimally invasive mediastinal staging. We discuss the advantage of using EUS in combination with EBUS and highlight techniques, lymph node landmarks, utility in staging and restaging of the mediastinum, roles in diagnosing mediastinal infections and granulomatous lesions, and future directions in endosonography.
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Lobar resection has been the established standard of care for peripheral early-stage non-small cell lung cancer (NSCLC). Over the last few years, surgical lung sparing approach (sublobar resection [SLR]) has been compared with lobar resection in T1N0 NSCLC. ⋯ Despite being in their infancy, the bronchoscopic ablative techniques are undergoing rapid research, as they extrapolate a significant knowledge-base from the percutaneous techniques that have been in the radiologist's armamentarium since 2000. Here, we discuss selected endoscopic and percutaneous thermal and non-thermal therapies with the focus on their efficacy and safety.