The relatively new and growing field of interventional pulmonology is an area of pulmonary medicine that focuses on using minimally invasive endoscopic techniques to diagnose and treat lung, thoracic, tracheal and mediastinal conditions.
“The most immediate and important thing we do for patients is to help them breathe,” says Samjot Singh Dhillon, MD, Former Chief of Pulmonary Medicine at Roswell Park Comprehensive Cancer Center in Buffalo, NY. “With interventional procedures, we do that in a way that results in less trauma, faster recovery and reduced risk for complications.”
An obstructed or narrowed airway can result from a number of conditions, including a tumor, scarring from long-term intubation, or side effects of chemotherapy and radiation. The need for this critical care — maintaining the airway, restoring normal breathing and preventing lung collapse — is seen among patients with a ranges of illnesses and conditions.
For Dr. Dhillon, who cares primarily for patients with cancer, the minimally invasive approach — 90 percent of procedures are performed on an outpatient basis — helps ensure that patients are better able to continue their cancer treatment. These advanced treatments also offer a more rapid result, opening the airway immediately, without the delays of waiting for chemotherapy or radiation to shrink tumors. These treatments also offer an approach for patients who cannot undergo surgery because they are frail, have multiple comorbidities, or are at the end of life.
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
- Endobronchial valve placement to correct persistent air leak in patients with pneumothorax
- Percutaneous dilatational tracheostomy
- Indwelling pleural catheter to manage pleural effusion
- Photodynamic therapy
At Roswell Park, Dr. Dhillon’s team, which includes two of the nation's few fellowship-trained interventional pulmonologists, uses interventional procedures to visualize, diagnose, biopsy and stage lung and thoracic tumors. Endobronchial ultrasound (EBUS) makes critical biopsy procedures easier and more accurate. “EBUS provides an outstanding view of the sample area and precise navigation around critical structures,” explains Dr. Dhillon. “We use both linear and radial EBUS, reaching lung areas that would otherwise be inaccessible without surgery.” EBUS also makes it possible to biopsy lymph nodes in the mediastinum via bronchoscope.
Interventional pulmonology diagnostic capabilities include:
- Endobronchial ultrasound (EBUS): Roswell Park is a high-volume provider for EBUS, performing 400 procedures a year.
- Flexible bronchoscopy allows visualization of individual lobes or segment bronchi. Roswell Park uses a variety of broncoscopes, including ultrathin models for peripheral navigation.
- Rigid bronchoscopy better controls the airway and larger lumen during complex endobronchial interventions; also used for mechanical tumor debulking.
- Autofluorescence bronchoscopy uses autofluorescent light to detect premalignant lesions not usually seen with white light bronchoscopy. Roswell Park combines this test with low-dose CT scan in the Lung Cancer Screening Program to detect precancerous lesions or early-stage lung cancer in people at high risk for lung cancer.
- Electromagnetic navigation bronchoscopy uses a GPS-like system to “drive” to the precise location of otherwise-inaccessible lung lesions for diagnosis and treatment planning.
- Pleuroscopy uses an endoscope inserted into the chest cavity for diagnosis and management of pleural disease.
This fall, Roswell Park Comprehensive Cancer Center opened a state-of-the-art Endoscopy Center to meet demand for these procedures. The new center, designed for optimal patient safety and comfort, efficient physician collaboration and onsite pathology review, is the only center in the region with many of these advanced capabilities.