BACKGROUND:Real-world data examining structured modality selection for mediastinal/hilar adenopathy in mixed malignant and benign cohorts is limited. We evaluated the performance of a multidisciplinary team (MDT)-guided strategy incorporating EBUS/EUS-B and EUS for both benign and malignant disease. METHODS:We conducted a retrospective study, including consecutive adults undergoing mediastinal/hilar lymph node sampling by endoscopy after MDT discussion. All cases were discussed at a dedicated thoracic MDT before the procedure, where the indication for sampling and the modality were predetermined based on anatomic accessibility on CT/PET-CT, clinical data, and anticipated tissue requirements. The primary outcome was diagnostic yield, defined as the proportion of procedures providing a definitive pathologic diagnosis consistent with the clinical and radiologic context, with concordance for benign diagnoses confirmed by a minimum of 3 months of clinical and radiologic follow-up. Secondary outcomes included yield by indication, modality, and adequacy of molecular testing. RESULTS:Among 213 patients (64.3% male; mean age 56±14.5 y), the overall diagnostic yield was 92%. Indications for biopsy comprised 134 suspected carcinomas and 79 suspected benign or lymphoproliferative cases. Diagnostic yield was 91.8% (n=123/134) in suspected carcinoma and 92.4% (n=73/79) in suspected benign or lymphoproliferative disease. Molecular testing was processed in 57 malignant cases, with 89.5% successful completion. CONCLUSION:A structured, MDT-driven endosonographic strategy was associated with high diagnostic and molecular adequacy in this cohort of malignant and benign mediastinal/hilar lymphadenopathy. Given the nonrandomized design and small sample size, findings should be interpreted cautiously. Prospective studies are warranted to further define the optimal role of each modality.
BACKGROUND:Interventional pulmonology (IP) is essential for managing thoracic diseases, yet its global distribution remains unequal. This study aimed to map IP across Africa by evaluating practice availability, training pathways, and barriers to development. METHODS:A cross-sectional electronic survey was conducted among interventional pulmonologists practicing in Africa between October and December 2025. Data were collected on institutional IP capacity, technique availability, training background, and perceived obstacles across the 5 African subregions. RESULTS:Fifty-one interventional pulmonologists from 16 countries participated, covering all 5 African subregions. Dedicated IP units were reported by 49.0% of respondents, with availability ranging from 75.0% in Northern Africa to 0.0% in Central Africa. Common techniques included medical thoracoscopy and rigid bronchoscopy (each 80.0%), while radial endobronchial ultrasound remained rare (24.0%). A significant training gap was identified: 49.0% of respondents had no structured IP training, and among those trained, 84.6% received training outside Africa. The primary barrier was equipment lack (34.0%), followed by high costs and training deficits. Despite these challenges, 98% of respondents rated local demand as medium to very high, and 92% of existing units performed procedures weekly, though 39.4% of patients faced wait times exceeding 1 week. CONCLUSION:Africa faces a significant IP capacity gap driven by regional disparities and structural barriers. Sustainable development will require indigenous training hubs and prioritization of cost-effective technologies to meet growing clinical demand.
BACKGROUND:Incidental detection is the most common pathway through which pulmonary nodules are identified. With the advancement of navigational and robotic-assisted bronchoscopy, existing risk stratification models often lack sufficient discrimination power, particularly for intermediate-risk nodules. Bronchosolve is a fully automated, imaging-only risk stratification tool that was previously validated in lung cancer screening cohorts. METHODS:We applied Bronchosolve to a cohort of adults with incidentally detected pulmonary nodules identified from registries at 2 large health care systems between 2006 and 2019. Nodules were classified as malignant or benign based on biopsy or extended clinical follow-up. Discrimination was assessed and compared with the VA Model. Sensitivity and specificity were reported at the Youden and high-sensitivity operating points. Additional analysis was performed in cases with nodule diameter 8 to 15 mm. RESULTS:Among 187 patients, malignancy prevalence was 70%. Bronchosolve achieved an AUC of 0.895 versus 0.870 for the VA model. Among nodules 8 to 15 mm, discrimination differences were larger (AUC 0.808 vs. 0.701). In nodules of 8 to 15 mm in diameter with an intermediate risk for malignancy by the VA model, Bronchosolve reclassified 51 patients to high risk and 23 to low risk; 33/37 (89%) malignancies were up-classified and 19/37 (51%) benign nodules were down-classified. CONCLUSION:In a nonscreening setting, Bronchosolve demonstrated robust discrimination for lung nodule malignancy risk using imaging alone compared with a widely used clinical risk model, with more pronounced separation in intermediate-sized nodules. In this subgroup, Bronchosolve also yielded clinically meaningful risk reclassification, with potential implications for downstream management.
BACKGROUND:Bleeding is a well-recognized complication in flexible bronchoscopy, especially with advanced procedures. Oxymetazoline is a topical vasoconstrictor often used to reduce or treat bleeding in the nares and airways. METHODS:A retrospective cohort study was conducted on pediatric patients undergoing flexible bronchoscopy from 2015 to 2025. Language processing was used to analyze bronchoscopy-related procedures, and mixed-effects logistic regression models were used to compare blood pressure, heart rate, and rescue medication use in cohorts that were exposed to nasal, endobronchial, and no oxymetazoline. RESULTS:A total of 2874 patients (41% female, mean age: 5.8 y) underwent 3978 bronchoscopies, 66 (2%) of which were exposed to endobronchial oxymetazoline and 1039 (26%) to nasal oxymetazoline. Endobronchial oxymetazoline was associated with higher systolic blood pressure (β=5.73; 95% CI: 2.48-8.98; P=0.00067), diastolic blood pressure (β=3.68; 95% CI: 1.41-5.96; P=0.0016), and lower heart rate (β=-6.91; 95% CI: -10.84 to -3.00; P=0.00054). These effects were more pronounced when bleeding was reported. Endobronchial oxymetazoline was associated with increased bradycardia (OR: 1.92; 95% CI: 1.09-3.40; P=0.024), but not with increased rescue medication use (OR: 0.69; 95% CI: 0.38-1.24; P=0.21). CONCLUSION:Endobronchial and nasal oxymetazoline use during pediatric flexible bronchoscopy is associated with a mild increase in blood pressure and a decrease in heart rate, although it is well-tolerated and appears to be safe without an increased need for clinical intervention.
RATIONALE:Bronchoscopic lung volume reduction (BLVR) is an established treatment option for severe emphysema, improving lung function and quality of life. Despite its growing use, there are no standardized, validated tools to assess operator competency in performing BLVR, limiting training and credentialing. OBJECTIVE:To examine the validity of the VSTAT tools, which were designed to assess competency in cognitive and technical skills necessary for BLVR. METHODS:The Zephyr and Spiration VSTAT tools were used to assess 29 operators with varying levels of experience. Participants were categorized as Beginners, Intermediates, and Experts. Performance was evaluated through simulated scenarios. Scores were analyzed for reliability, validity, and correlation with clinical experience. RESULTS:The tools demonstrated strong internal consistency (Cronbach α=0.88 for Zephyr and 0.77 for Spiration). Significant differences in scores were observed across proficiency levels, with experts outperforming beginners. VSTAT scores correlated strongly with procedural experience (Spearman ρ=0.95 for Zephyr, ρ=0.70 for Spiration). CONCLUSION:The VSTAT tools provide a reliable and valid method for assessing BLVR competency. Their integration into training programs and certification processes could standardize the assessment of operator competency in BLVR.
BACKGROUND:The comparative sampling efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needles in mediastinal lymphadenopathy remains unclear. Would the fine needle biopsy (FNB), with its Franseen design, provide better results than the fine needle aspiration (FNA) during EBUS-TBNA? METHODS:We performed a single-center, investigator-initiated, single-blinded, randomized, parallel-group, superiority trial between August 2022 and July 2023. Consecutive patients were randomly assigned (1:1) to undergo EBUS-TBNA with either 19-gauge (G) FNA or 22-G FNB. The primary endpoint was the diagnostic yield, while the secondary endpoints were specimen adequacy and complication rates. RESULTS:The study included 150 patients with a mean age of 44.5±15.1 years (50.7% female patients). The diagnostic yield of FNB was not significantly different from FNA (94.7% vs. 89.3%; difference, 5.4%; 95% CI: -4.0% to 15.0%; P=0.23). Despite this, FNB had a higher rate of adequate tissue (98.6% vs. 86.7%; difference, 11.9%; 95% CI: 4.0%-22.0%; P<0.001) and larger core tissue (11.52 vs. 9.29 mm; mean difference, 2.23 mm; 95% CI: 1.4-3.1mm; P<0.001) than FNA. FNB showed a significantly higher diagnostic yield for histologic samples (90.7% vs. 76.0%; difference, 14.7%; 95% CI: 3.0-27.0; P=0.016) in post hoc analysis; however, this should be considered a hypothesis-generating finding. All procedures were well tolerated except for minor bleeding. CONCLUSION:Despite similar diagnostic yields, FNB was more effective than FNA in providing larger, adequate core tissue samples. This improvement in specimen quality may suggest a potential clinical benefit for comprehensive diagnosis and advanced pathologic work-up.
BACKGROUND:In the AQuIRE trial, most cases (83.6%) did not involve transbronchial needle aspiration (TBNA), often underutilized due to challenges in accessing peripheral pulmonary lesions (PPLs). Advances in robotic bronchoscopy with shape-sensing technology (ssRAB) have mitigated these challenges, but the optimal number of needle and cryoprobe passes for reliable diagnosis remains undefined. METHODS:This retrospective study compares the diagnostic yield (DY) of TBNA and transbronchial cryoprobe biopsy (TBCB) and their adequacy for molecular testing in PPLs. We performed a retrospective analysis of 166 patients who underwent ssRAB with both TBNA and TBCB from May to August 2024. Fisher exact tests and McNemar χ2 tests were used to compare prevalence differences in DY and molecular testing adequacy between discordant cases. Odds ratios (OR) and 95% CIs of associations between the number of passes and diagnostic yield and rates of obtaining adequate samples for molecular testing were obtained using generalized linear mixed models (GLMMs) with a logit link. RESULTS:TBCB demonstrated a higher diagnostic rate than TBNA (89% vs. 80%, OR=2.04, 95% CI=1.06-4.03; P=0.032), as well as better rates of obtaining samples adequate for molecular testing (60% vs. 20%, OR=5.94, 95% CI=2.31-16.38, P<0.001). TBCB provided diagnostic yields in 55% (χ2=9.33, P=0.002) of cases where TBNA failed to provide a diagnosis and was able to obtain adequate samples for molecular testing in 42% (χ2=15.06, P<0.001) of cases where TBNA was unable to. CONCLUSION:TBCB suggests a higher diagnostic yield and higher cellular adequacy for molecular testing compared with TBNA, underscoring its potential value as a reliable and versatile diagnostic tool in PPLs.
BACKGROUND:Interventional pulmonology (IP) has expanded rapidly due to procedural advancements and recent ACGME subspecialty recognition. However, significant heterogeneity persists in training curricula and procedural exposure. This study aims to delineate current trends in the United States IP fellowship education. METHODS:We conducted a cross-sectional, multisurvey study between June 2024 and August 2025 involving IP fellows (2024 and 2025 cohorts) and program directors (PDs) across 43 accredited US programs (44% of PDs and 34% to 45% of fellows per administration responded). Electronic surveys assessed demographics, training structure, procedural exposure, and perceived proficiency. RESULTS:Compared with 2013, procedural breadth has increased. Fellows reported the greatest self-rated proficiency gains in complex procedures such as rigid intubation, stent placement, ablative therapies, tracheostomy, and pleuroscopy. Procedural volume to proficiency correlations were nonsignificant for most procedures. Only 43% of programs reported using validated instruments to evaluate procedural competence. At the end of the fellowship, there was a strong fellow-PD concordance on fellow proficiency, where PD rated equal or higher than fellows' self-assessment for most procedures. CONCLUSION:Despite accreditation, variability remains across IP programs on volume, procedural type, and structure of clinical experience. The findings reveal substantial expansion in procedural scope and training infrastructure, accompanied by persistent heterogeneity in program design and assessment practices. Future efforts should prioritize the development of standardized, validated evaluation frameworks and the establishment of objective benchmarks for procedural competence.
BACKGROUND:Balloon tracheobronchial dilation is a key technique for managing central airway stenosis. Conventional occlusive balloons interrupt ventilation and oxygenation, limiting the duration and safety of dilation. The objective of this study was to evaluate the clinical outcomes of tracheobronchial stenosis dilation using a nonocclusive balloon and to describe relevant technical aspects of its application. METHODS:A retrospective cross‑sectional study was conducted, including all patients with central airway stenosis who underwent dilation with a nonocclusive balloon at a tertiary center. In all cases, stenosis severity was ≥50%, confirmed by endoscopic or tomographic assessment, and associated with compatible symptoms. Demographic characteristics, stenosis features, procedural details, oxygenation parameters, and complications were collected. RESULTS:Sixteen procedures were performed in 11 patients; 6 stenoses (54.5%) were malignant. The trachea was the most frequent location (n=8; 72.7%). The median stenosis severity was 83%. The mean minimum oxygen saturation during the procedure was 96.1%±3.6%, increasing to 98.6%±0.8% at the end of the procedure (P=0.009). Most procedures (n=14; 87.5%) included 3 consecutive dilation cycles. In 2 cases (12.5%), a single prolonged cycle was performed, lasting 300 and 600 seconds, respectively. Airway stents were placed in 6 procedures (38%), all in malignant stenosis. Mild complications occurred in 2 patients (13%), consisting of minor or moderate bleeding, not related to balloon dilation. CONCLUSION:Nonocclusive balloon dilation provides effective treatment of tracheobronchial stenosis while maintaining ventilation and oxygenation. This technique enables longer, safer dilation cycles by eliminating the need for apnea.
BACKGROUND:The demand for minimally invasive diagnostic techniques for peripheral pulmonary lesions (PPL) is rising. Augmented fluoroscopy (AF) provides real-time guidance by overlaying CT-derived virtual targets onto fluoroscopic images, yet its diagnostic value remains poorly defined. METHODS:We retrospectively analyzed 226 PPLs targeting procedures performed with navigational bronchoscopy supplemented by AF and R-EBUS between December 2019 and March 2024. TIVL was assessed across 5 standard planes (posteroanterior, 30 degrees toward, 30 degrees away, 30 degrees clockwise, and 30 degrees counterclockwise). Diagnostic yield was defined according to the ATS/ACCP strict criteria. Multivariable logistic regression identified predictors of diagnostic success. RESULTS:Of the 226 analyzed PPLs, 101 (44.7%) showed no R-EBUS signal. In lesions without an R-EBUS signal, diagnostic yield increased from 0% with ≤1 plane to 42% with ≥4 planes. In multivariable analysis, TIVL in 3 planes was associated with a >5-fold higher likelihood of diagnostic success (OR: 5.57; P<0.05), and in ≥4 planes with an almost 14-fold increase (OR: 13.6; P=0.01). Lesions within 16 mm of the point of entry demonstrated stepwise yield improvements up to 89% with ≥4 confirmed planes, while more distant lesions showed no significant benefit. In the ≥3-TIVL-plane subgroup, BMI showed a negative trend toward lower diagnostic yield (OR: 0.92; P=0.059). CONCLUSION:The number of fluoroscopic planes with confirmed TIVL is a significant determinant of diagnostic yield in AF-guided navigational bronchoscopy, particularly in lesions lacking R-EBUS signals. Multiplane TIVL assessment may enhance diagnostic performance in centers without cone-beam CT or digital tomosynthesis availability.
Background: Persistent air leaks (PALs), nonhealing fistulas between the bronchoalveolar and pleural space existing for at least 5 to 7 days, are challenging to manage. With the humanitarian use device exemption from the United States Food and Drug Administration beginning in 2008, intrabronchial valves (IBVs) for use in PALs research exist as a burgeoning knowledge base. Methods: We completed a single-center retrospective cohort review of IBV placement for PAL from 2015 to 2025. Descriptive statistics were used to analyze demographic and outcomes data. Fine-Gray analysis was used to determine the impact of the duration of PAL before IBV placement on the probability of ever resolving air leaks. Results: A total of 66 cases were reviewed. Patient comorbidities included COPD (43.9%), acute respiratory distress syndrome (28.8%), ILD (16.7%), lung cancer (16.7%), and prior lung transplant (3.0%). Overall, PAL resolution was 63.6% with an average time to air leak resolution after IBV placement of 10.8 days (95% CI: 4.8-16.8; n=42). One-year all-cause mortality was 36.4% (24/66). Each additional 10 days with a chest tube in place before IBV placement corresponded to a 10% lower probability of PAL resolution over time (sHR: 0.901; 95% CI: 0.815-0.996; P =0.042). The cumulative incidence of PAL resolution at 30 days was 39.4% (95% CI: 6.2-72.6) in patients with ILD versus 66.3% (95% CI: 52.6-79.9) in patients without ILD. Conclusion: The use of IBVs for the treatment of PALs remains an effective treatment option. The effectiveness of air leak resolution may be influenced by the timing of IBV placement.
Background: Foreign body aspiration of dental objects is an uncommon but potentially serious complication of dental procedures. This study comprehensively reviewed published cases of dental object aspiration in adults, summarized clinical presentations and complications, and evaluated the success of bronchoscopic retrieval approaches and tools used. Methods: A search of PubMed from 1984 through 2023 was performed using the terms “dental” and “aspiration” and “bronchoscopy.” Case reports and case series of adult patients requiring health care intervention were included. Results: A total of 100 patients from 74 publications were included. Mean age was 63.5 years and 18% were female. The most common comorbidities were cognitive impairment (6%), hypertension (6%), and coronary artery disease (5%). The most frequently aspirated objects were dental prostheses (29%), crowns (22%), and implant drivers (17%). Blunt shapes predominated (61%). Objects were most commonly lodged in the right lower lobe (26%) and right mainstem bronchus (21%). Chest X-ray was the initial imaging modality for 92%. Flexible bronchoscopy was the preferred initial retrieval approach (59%), with bronchial forceps the most commonly used tool (34%). Initial retrieval was successful for 75%. Backup approaches were successful for 94.7%. Conclusion: In conclusion, the elderly and/or cognitively impaired patients are most at risk for dental object aspiration. Chest X-ray was favored for treatment planning. Flexible bronchoscopy with the use of a bronchial forceps was the most successful combination for management of dental object aspiration. Clinicians may find these approaches useful when treating dental object aspiration.
Background: Hypoxemia is a frequent complication during bronchoscopy, and optimal oxygenation strategies remain clinically important. Previous evidence suggests that high-flow nasal cannula (HFNC) may outperform conventional oxygen therapy (COT). Methods: A meta-analysis of randomized controlled trials (RCTs) was conducted by searching PubMed, Embase, and Cochrane databases for studies comparing HFNC with COT in adult patients undergoing flexible bronchoscopy. Outcomes included the incidence of hypoxemia, lowest SpO 2 , procedure duration, patient comfort, and sedation dose. Pooled data were analyzed using a random-effects model, with results reported as risk ratios (RR), mean differences (MD), or standardized mean differences (SMD), as appropriate. Heterogeneity was assessed using the Cochran Q test and I 2 statistic. Results: Fourteen RCTs (n=2480) were included: 1263 patients (50.9%) received HFNC. HFNC significantly reduced the risk of hypoxemia (RR, 0.41; 95% CI: 0.29-0.59; P <0.0001) and increased minimum SpO 2 (MD, +5.10 percentage points; 95% CI: 3.30-6.91; P <0.0001). There was no significant difference in patient comfort (SMD, –0.07; 95% CI: –0.25 to 0.11; P =0.46) and procedure time (MD, –0.73 min; 95% CI: –1.73 to 0.27; P =0.154). Sedation requirements were slightly higher in the HFNC group (SMD, 0.17; 95% CI: 0.04-0.29; P =0.008). Conclusion: HFNC significantly reduces hypoxemic events and improves oxygenation compared with COT during bronchoscopy. Although anesthetic use slightly increased, there was no difference in procedure time or patient comfort.
Background: The ninth TNM edition distinguishes single-station (N2a) from multistation (N2b) disease, increasing concern for cross-contamination between N2 lymph nodes during EBUS staging when ROSE is unavailable. The absolute probability and clinical impact of this phenomenon are uncertain. We estimated a theoretical upper bound on false upstaging and the number of needle changes required to prevent one false upstage. Methods: A Monte Carlo decision model simulated mediastinal staging in 100,000 virtual patients across published estimates of occult N2 prevalence, probability of a single-station involvement, and contamination rates. Outcomes were the probability of false N2b upstaging and the number of additional needle changes needed to prevent one false upstage (NNC). Sensitivity analyses varied the contamination rate, single-station probability, and sampling order. Results: False upstaging in central cN0 disease was ∼0.5% to 0.8% in the base case, increasing to 1.4% in higher-risk scenarios. cN1 disease showed slightly higher probabilities. Needle-change efficiency was low; preventing one false upstage required roughly 250 to 350 extra needle changes in central cN0 and >1000 in peripheral cN0. Sensitivity analysis showed comparable influence of contamination rate, single-station probability, and sampling order. Conclusion: The risk of spurious upstaging during EBUS staging without ROSE is small but not negligible, concentrated in central cN0 and cN1 tumors. When ROSE is not available, routine needle change between N2 stations provides minimal benefit for most patients. In cases where ROSE is not available and resources are limited, a selective strategy targeting high-risk contexts may offer the best balance between accuracy and procedural efficiency.
Background: Operating room noise can result in provider- and patient-related adverse outcomes. The recommended sound pressure threshold in medical settings is 35-45 dB(A). This study aimed to quantify sound pressure across different types of bronchoscopy procedures. Methods: Sound meters were placed in the bronchoscopy suite. Ambient sound pressure levels were measured continuously during flexible, rigid, and robotic bronchoscopy procedures. Procedures were classified as “quiet” or “loud” using the median equivalent continuous sound pressure level (Leq). A logistic regression model was used to identify associations between the type of bronchoscopy and “loud” or “quiet” procedures. Results: A total of 186 procedures were analyzed, of which 64% were flexible, 11% were rigid, and 25% were robotic. Across all procedures, the median Leq was 56.8 (55.1 to 58.1) dB(A). Leq was 58.2 (57.5 to 58.9), 59.4 (58.6 to 60.5), and 57.9 (57.5 to 58.4) dB(A) for flexible, rigid, and robotic bronchoscopy, respectively ( P <0.0001). In comparison to flexible bronchoscopy, rigid bronchoscopy was more likely to be loud, while robotic bronchoscopy was less likely to be loud. Conclusion: This is the first study to quantify sound pressure levels during bronchoscopy procedures. Across all types of bronchoscopy procedures, sound pressure levels exceeded those recommended by guidelines for the medical setting and were considered a moderate degree of noise. Rigid bronchoscopy was associated with higher sound pressure levels, whereas robotic-assisted bronchoscopy was associated with lower sound pressure levels when compared with flexible bronchoscopy. Future studies are needed to explore the potential deleterious effects of bronchoscopy noise on operators and patients to inform preventive measures.
Background: Outcomes of robotic-assisted bronchoscopy (RAB) in patients of small stature remain uncertain due to concerns about their potentially smaller lung volumes. We assess the effectiveness and safety of RAB across height variations. Methods: This is a subset analysis of TARGET, a multicenter, prospective, observational study using the MONARCH Robotic Bronchoscopy Platform, which enrolled patients with lung lesions undergoing RAB across 21 sites. RAB safety and effectiveness were compared across height quartiles by assessing reach, measured through radial endobronchial ultrasound (r-EBUS) confirmation and the distance from the bronchoscope tip to the lesion, and access, evaluated by the diagnostic yield (DY). Comparisons across groups were performed via ANOVA, the Kruskal-Wallis test, or Fisher exact test as appropriate. Results: A total of 679 patients were analyzed, categorized into height quartiles: <160.02 cm (N=182), 160.03 to 167.64 cm (N=189), 167.65 to 175.26 cm (N=140), and >175.27 cm (N=168). Mean nodule size was 20.9 mm, with a distance from the pleura of 15.7 mm; 47.2% were in the outer third of the lung, with no significant differences across quartiles. r-EBUS localization succeeded in 91.7% of cases, with no quartile differences ( P =0.95). The mean distance from the bronchoscope tip to the lesion was 22.6 mm, consistent across groups ( P =0.84). Intermediate DY was higher in the third quartile of height, but no significant differences were observed for strict or liberal DY. Pneumothorax and bleeding rates were 4.1% and 2.4%, respectively, with no significant differences across quartiles ( P =0.33 and 0.93, respectively). Conclusion: Our findings demonstrate a comparable effectiveness and safety profile of RAB across varying heights.
Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that allows for the evaluation of mediastinal and hilar lymph nodes. It has also been described in limited studies for the evaluation of central pulmonary lesions. Objectives: Our study aimed to describe the diagnostic performance of linear EBUS in pulmonary lesions, the sensitivity for malignancy, and its suitability as an adjunctive test for lung cancer. Methods: We analyzed procedures from the Stather Canadian Outcomes Registry for Chest Procedures (SCOPE) database that included sampling of at least 1 intrapulmonary lesion with linear EBUS. Diagnostic yield (DY) and sensitivity were calculated using the standard definitions. Suitability for molecular testing was evaluated in the lung cancer cohort, in which lung lesion sampling was the only diagnostic site. Results: Four hundred and 10 records were identified, one of which was excluded for lack of follow-up data. The most frequent final diagnosis was lung cancer in 346/409 cases (84.6%). DY for the lung EBUS-TBNA was 370/409 (90.5%), and sensitivity for malignancy was 358/372 (96.2%). The sensitivity of linear EBUS lung TBNA for lung cancer was 331/346 (95.7%). The data set did not record failed attempts at lung lesion localization with linear EBUS, during which no sample was collected. Conclusion: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective and safe diagnostic tool for lung lesions visible on ultrasound. Lesion size is associated with improved DY. Lung cancer ancillary testing is feasible in almost all cases.
Interventional pulmonology is a young and growing field; this necessitates an understanding of billing, coding, and documentation rules. Interventional pulmonologists may not appreciate these intricacies. Advocating for resources to benefit patients with administrators, insurance companies, and others requires understanding these principles. This series of 4 articles will review the fundamental and advanced aspects of billing, coding, documentation, and programmatic building of an interventional pulmonology program. Part 1 will review the fundamentals of billing, coding, and reimbursement. Part 2 will review bronchoscopy/endoscopy codes and procedural modifiers. Part 3 will review pleural codes and unlisted codes. Part 4 will combine the previous parts and describe approaches to build, expand, and capture the work involved in a robust interventional pulmonary program. Each part will compliment and support the others with the end goal being to create a broad framework for any IP program to use as a foundation to balance patient care, revenue capture, growth, and a clinical work-life balance. This first part of the series will review some of the foundational principles of billing and coding, which will be built on in the subsequent parts of the series. This includes: health care common procedure coding system, current procedural terminology, ambulatory payment categories, and relative value units, among others. This includes how new codes are created, valued, compensated, and how this effects interventional pulmonologists. Without a thorough understanding of optimal medical billing and coding, interventional pulmonologists are often at a disadvantage. This 4-part series seeks to address and rectify this issue.
Background: Malignant pleural effusions (MPE) are associated with poor prognosis. Guidelines prioritize palliation of symptoms, recommending thoracentesis, pleurodesis or indwelling pleural catheters (IPC) based on predicted survival and patient preference. However, prognosis estimation in MPE is often inaccurate, and recent studies suggest MPE is not a bystander in the broader context of oncologic disease. Methods: Retrospective cohort study including patients with confirmed MPE who underwent definitive pleural interventions [talc poudrage by medical thoracoscopy (MT), talc slurry following chest tube drainage (CTD), or IPC placement] at a tertiary hospital between 2012 and 2022. Results: Two hundred fifty-four out of 783 MPE patients (32.4%) received definitive pleural treatment modalities—MT in 106 (41.7%), CTD in 98 (38.6%), and IPC in 50 (19.7%) patients. The overall relapse rate was 52.8%, with a median time from definitive treatment to effusion relapse of 29 days, significantly different between modalities ( P <0.001). Overall mortality was high (89.8%), with a median overall survival (OS) of 172 days, significantly different between interventions ( P <0.001). Median survival varied significantly according to the result of pleurodesis ( P <0.001). In a multivariate regression model adjusting for time from MPE diagnosis to treatment, systemic therapy, radiologic presentation and ECOG-PS, successful pleurodesis remained an independent predictor of improved OS ( P <0.001). Postpleurodesis survival was more than 3-times higher in the successful pleurodesis subgroup ( P <0.001). Conclusion: This study suggests the impact of definitive pleural interventions goes beyond the palliation of symptoms, with successful pleurodesis remaining a significant predictor of improved survival regardless of performance status and systemic cancer treatments.
