Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is a relatively new and growing field within pulmonary medicine that focuses on using minimally invasive, advanced diagnostic and therapeutic procedures for lung, thoracic, tracheal and, mediastinal disease conditions, including lung cancer.

Critical biopsy procedures using interventional techniques are easier and more accurate and can treat areas in the lungs that otherwise would be inaccessible without surgery.

Interventional pulmonologists work closely with lung surgeons, cancer specialists, and pathologists to ensure that the right procedure is performed for all major lung problems, including comprehensive evaluations of: Abnormal chest X-rays; cancer in the lungs and chest; chronic cough; coughing up blood (hemoptysis); fluid around the lungs (pleural effusion); persistent respiratory failure requiring tracheostomy placement and management, and; shortness of breath.

IP for lung cancer

IP techniques are nonsurgical procedures used to visualize, diagnose, biopsy, stage, and treat lung and thoracic tumors.

An airway can get narrowed or obstructed due to a number of conditions, including a tumor, scarring from long-term intubation, or side effects of chemotherapy and radiation. About 20 percent of lung cancer patients will end up having a tumor invade their windpipe, which may result in coughing up blood and cause significant shortness of breath and chest pain.

Interventional therapeutic procedures aim to restore breathing, keep the airways open, and prevent lung collapse to ensure less trauma, faster recovery, and reduced risk for complications.

These advanced treatments offer a more rapid result, opening the airway immediately, without the delays of waiting for chemotherapy or radiation to shrink the tumors.

These nonsurgical lung cancer treatments help ensure that cancer patients are able to continue their subsequent treatment.

These treatments also offer an approach for patients who cannot undergo surgery due to their frailty, multiple comorbidities, or very old age.

Interventional diagnostic procedures

There are several interventional pulmonology diagnostic techniques:

  • Endobronchial ultrasound (EBUS), uses an ultrasound probe attached to a bronchoscope (a flexible tube inserted into the lungs through the mouth or nose) to biopsy the lung, helping with early detection and diagnosis of lung cancer. It provides a clear view of the sample area and an accurate navigation around critical structures.
  • Flexible bronchoscopy uses a bronchoscope that is inserted through the mouth or nose into the windpipe to check for lung problems. It allows visualization of individual lobes or segment bronchi of the lungs.
  • Rigid bronchoscopy controls the airway and larger lumen better during complex endobronchial interventions. It also is used for mechanical tumor debulking.
  • Autofluorescence bronchoscopy uses autofluorescent light to detect pre-malignant lesions not usually seen with white light bronchoscopy. It can be combined with low-dose computed tomography CT (LDCT) scan for the screening of lung cancer to detect pre-cancerous lesions or early-stage lung cancer in people who are high risk.
  • Electromagnetic navigation (EMN) bronchoscopy is an advanced bronchoscopy procedure with a GPS-like system that allows visualization of hard-to-access lung areas and “guides” the bronchoscope to the precise location of otherwise-inaccessible lung lesions for diagnosis and treatment.
  • Pleuroscopy uses an endoscope inserted into the chest cavity (pleural space) for the diagnosis and management of pleural disease.
  • Bronchoalveolar lavage is a procedure where a fluid is passed through a bronchoscope into a small part of the lung and then collected back for examination to diagnose lung cancer.

Interventional therapeutic procedures

Interventional pulmonology treatments include:

  • Airway ablation, achieved via excision, laser, or argon plasma coagulation (APC).
  • Balloon bronchoscopy, which dilates narrowed airways via a balloon passed through a bronchoscope
  • Airway stent placement, including silicone, metal, or hybrid (silicone-covered metal) stents. It uses a bronchoscope to insert a stent (small mesh tube) into a narrowed airway, to help relieve advanced cancer symptoms, such as difficulty breathing, coughing, and pneumonia.
  • Indwelling pleural catheter, is a small tube specially designed to drain fluid from around the lungs to manage fluid accumulation in the chest cavity (pleural effusion).
  • Pleurodesis, a procedure in which the pleural space is irritated either mechanically or chemically to close off the space and prevents further accumulation of fluid.
  • Photodynamic therapy, which uses a cancer drug, called a photosensitizer, injected into the bloodstream along with a laser or other light to target and destroy cancer cells.
  • Endobronchial brachytherapy, a targeted high-dose radiation therapy that delivers radiation via an endoscope to destroy tumors in the lungs or throat, minimizing damage to the surrounding healthy tissue.

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