Interventional pulmonology: Focus on pulmonary diagnostics

Authors


  • The Authors: Kazuhiro Yasufuku, MD, PhD, is a Thoracic Surgeon with specific expertise in minimally invasive thoracic surgery and diagnostic procedures. He is Assistant Professor of Surgery at the University of Toronto, Toronto General Hospital. He is also the Director of the Interventional Thoracic Surgery Program at the University Health Network. Kasia Czarnecka, MD, completed her Internal Medicine residency at the University of Toronto where she is currently training in Adult Respirology. She is also training in the Interventional Thoracic Surgery Program with Dr. Yasufuku and the Thoracic Surgery Team. Her research interests include interventional bronchology and pulmonology.

  • Conflict of Interest statement: K.Y. has received educational and research grants from Olympus Medical Systems Corp.

  • SERIES EDITORS: JOHN E HEFFNER AND DAVID CL LAM

Kazuhiro Yasufuku, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 9N-957, Toronto, ON M5G2C4, Canada. Email: kazuhiro.yasufuku@uhn.ca

ABSTRACT

Interventional pulmonology (IP) allows comprehensive assessment of patients with benign and malignant airway, lung parenchymal and pleural disease. This relatively new branch of pulmonary medicine utilizes advanced diagnostic and therapeutic techniques to treat patients with pulmonary diseases. Endobronchial ultrasound revolutionized assessment of pulmonary nodules, mediastinal lymphadenopathy and lung cancer staging allowing minimally invasive, highly accurate assessment of lung parenchymal and mediastinal disease, with both macro- and microscopic tissue characterization including molecular signature analysis. High-spatial resolution, new endobronchial imaging techniques including autofluorescence bronchoscopy, narrow-band imaging, optical coherence tomography and confocal microscopy enable detailed evaluation of airways with increasing role in detection and treatment of malignancies arising in central airways. Precision in peripheral lesion localization has been increased through innovative navigational techniques including navigational bronchoscopy and electromagnetic navigation. Pleural diseases can be assessed with the use of non-invasive pleural ultrasonography, with high sensitivity and specificity for malignant disease detection. Medical pleuroscopy is a minimally invasive technique improving diagnostic safety and precision of pleural disease and pleural effusion assessment. In this review, we discuss the newest advances in diagnostic modalities utilized in IP, indications for their use, their diagnostic accuracy, efficacy, safety and challenges in application of these technologies in assessment of thoracic diseases.

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