Lower airway bacterial microbiome may influence recurrence after resection of early-stage non-small cell lung cancer.

Objective: The lower airway bacterial microbiome influences carcinogenesis and response to immunotherapy in non-small cell lung cancer (NSCLC). We investigated the association of this microbiome with recurrence in early NSCLC.

Methods: Microbiomes of presurgery bronchoalveolar lavage (BAL) and saliva, and resected stage I NSCLC tumor and adjacent lung tissues of 48 patients were examined by 16S gene sequencing.

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT.

: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed.

Placement of markers to assist minimally invasive resection of peripheral lung lesions.

With development of lung cancer screening programs and increased utilization of radiographic imaging there is significantly higher detection of smaller lung nodules and subsolid lesions. These nodules could be malignant and pose a diagnostic challenge. Video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery (RATS) represent minimally invasive methods for tissue sampling.

Role of bronchoscopy in management of central squamous cell lung carcinoma .

Squamous cell carcinoma in situ (SCIS) is the pre-invasive stage of squamous cell carcinoma. Early detection and management of SCIS can prevent further progression. Although surgery and external beam radiation therapy are treatment options for SCIS, smaller lesions can be easily managed by bronchoscopic modalities like photodynamic therapy (PDT), cryotherapy, mechanical debulking with biopsy forceps, electrocautery and argon plasma coagulation (APC).

Molecular subtyping reveals immune alterations associated with progression of bronchial premalignant lesions.

Bronchial premalignant lesions (PMLs) are precursors of lung squamous cell carcinoma, but have variable outcome, and we lack tools to identify and treat PMLs at risk for progression to cancer. Here we report the identification of four molecular subtypes of PMLs with distinct differences in epithelial and immune processes based on RNA-Seq profiling of endobronchial biopsies from high-risk smokers. The Proliferative subtype is enriched with bronchial dysplasia and exhibits up-regulation of metabolic and cell cycle pathways.

The value of using radial endobronchial ultrasound to guide transbronchial lung cryobiopsy.

Conventional transbronchial biopsies have a low diagnostic yield for interstitial lung disease (ILD) and peripheral lung nodules due to crush artifact and smaller tissue samples. Transbronchial lung cryobiopsies (TBLC) circumvent these drawbacks but are associated with higher incidence of complications including life threatening airway bleeding and pneumothoraces. Radial probe endobronchial ultrasound (RP-EBUS) can be used during the TBLC for assessing the biopsy site prior to the cryobiopsy to avoid vasculature and to decrease the risk of complications.

Effect of the number of lymph nodes examined on the survival of patients with stage I non-small cell lung cancer who undergo sublobar resection.

Objectives: Early stage lung cancer is being detected at a higher frequency with the implementation of screening programs. At the same time, medically complex patients with multiple comorbidities are presenting for surgery, with a concomitant rise in rates of sublobar resection. We sought to examine the effect of sampling lymph nodes on the outcomes of patients who undergo sublobar resection for small (<2 cm) stage I non-small cell lung cancer (NSCLC).

Sarcopenia is a predictor of outcomes after lobectomy.

Background: As screening for lung cancer rises, an increase in the diagnosis of early stage lung cancers is expected. Lobectomy remains the standard treatment, but there are alternatives, consideration of which requires an estimation of the risk of surgery. Sarcopenia, irrespective of body mass index, confers a worse prognosis in many groups of patients including those undergoing surgery.

Airway Obstruction Caused by Iron Pill Aspiration: An Interventional Pulmonology Approach to Prevent Surgery.

Iron Pill Aspiration (IPA) is a challenging medical condition that requires prompt management to prevent detrimental outcomes. One of the most serious complications of IPA is airway inflammation which commonly leads to severe obstruction. Airway complications may require surgical intervention including the resection of the affected lung.

Concomitant Mediastinoscopy Increases the Risk of Postoperative Pneumonia After Pulmonary Lobectomy.

Background: Mediastinoscopy is considered the gold standard for preresectional staging of lung cancer. We sought to examine the effect of concomitant mediastinoscopy on postoperative pneumonia (POP) in patients undergoing lobectomy.

Methods: All patients in our institutional database (2008-2015) undergoing lobectomy who did not receive neoadjuvant therapy were included in our study.

Initial experience of medical pleuroscopy via the peel-away introducer of the indwelling pleural catheter using a thin bronchoscope.

We present a case series describing a modified technique of combining medical Pleuroscopy (MP) and indwelling pleural catheter (IPC) placement for obtaining pleural biopsies and managing recurrent pleural effusions. The unique feature of this technique is the introduction of a thin bronchoscope through the peel-away introducer of IPC to obtain pleural biopsies thus avoiding a bigger incision followed by placement of IPC. This procedure was performed on nine patients in an outpatient setting.

Management of cardiac implantable electronic devices during interventional pulmonology procedures.

An increasing number of patients are receiving cardiac implantable electronic devices (CIED) now. Many of them need pulmonary procedures for various indications including, but not limited to, lung cancer and benign endobronchial lesions. Over the last two decades, interventional pulmonology (IP) has expanded its scope to include various modalities that use heat and electrical energy and in the process, create electromagnetic field in the vicinity.

Bronchoscopy for the diagnosis of peripheral lung lesions.

Peripheral pulmonary lesions (PPLs) are generally considered as lesions in the peripheral one-third of the lung although a precise definition and radiographic anatomical landmarks separating central and peripheral lesion does not yet exist. The radiographic detection of such lesions has increased significantly with the adoption of lung cancer screening programs. These lesions are not directly visible by regular flexible bronchoscopes as they are usually distal to the lobar and segmental bronchi.

Esophago-pulmonary fistula manifesting as recurrent pneumonias and migrating mediastinal calcifications.

A 43-year old man presented with recurrent pneumonias, episodes of hemoptysis and an enlarging right lower lobe mass. A clear diagnosis was not previously established in spite of multiple radiological evaluations and biopsies. Meticulous review of his CT imaging showed that he had subcarinal calcification on his prior CT scans, which had decreased in size and now multiple new small areas of calcifications were seen in the right lower lobe lesion.

Detecting the Presence and Progression of Premalignant Lung Lesions via Airway Gene Expression.

Lung cancer is the leading cause of cancer-related death in the United States. The molecular events preceding the onset of disease are poorly understood, and no effective tools exist to identify smokers with premalignant lesions (PMLs) that will progress to invasive cancer. Prior work identified molecular alterations in the smoke-exposed airway field of injury associated with lung cancer.

Complex multimodality central airway management of aspergillus pseudomembranous tracheobronchitis.

A 69-year-old woman developed central airway obstruction due to invasive infection resulting in pseudomembranous tracheobronchitis (PTB). Several challenges were encountered in the airway management of this patient including her having relatively smaller airways which were more prone to obstruction by pseudomembranes and made airway interventions difficult. The patient had clinical deterioration in spite of antifungal therapy and bronchoscopic debridement.

Management of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis.

Background: The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions.

Methods: We conducted a systematic review and meta-analysis on the published literature.

Endobronchial ultrasound for the detection of chronic pulmonary artery thrombus.

Endobronchial ultrasound (EBUS) has been shown to be able to successfully identify acute/subacute pulmonary thromboembolism (PE). Most reported cases have required confirmation by computerized tomography (CT) angiography. This report demonstrates a case where CT angiography was not conclusive and the EBUS was useful in clarifying the chronic process inside the pulmonary artery compatible with clinical diagnosis of chronic pulmonary artery thrombosis.