Interventional pulmonology (IP) is a relatively new, diverse and rapidly evolving specialty. It is driven by technological advancements and new bronchoscopic ablative therapies. These innovations are revolutionizing lung cancer treatment by enabling minimally invasive access to lesions that were once difficult or impossible to sample without surgery. Additionally, advances in imaging technology are improving the precision of procedures.

However, practice patterns vary widely across academic centers, private practice and hybrid models. As a result, there is no single practice pattern for interventional pulmonologists. IP fellows are continuously adapting their skills to different clinical environments and a deeper understanding of procedural practice is becoming valuable.

Dr. Tarek Dammad, Director of the Pulmonary Division and Academic Interventional Pulmonology shared his insights on emerging technologies that could be relevant for IP practices in the future.

Q: How does robotic-assisted bronchoscopy (RAB) compare with conventional navigational bronchoscopy for peripheral lung nodules?

A: Every year, millions of pulmonary nodules are identified. Protocols are then followed to identify if these nodules are benign or malignant. The sub-type of peripheral lung nodules located in the outer portion of the lung parenchyma presents bigger diagnostic challenges. Both robotic-assisted bronchoscopy and conventional navigational bronchoscopy perform well for larger, central nodules and reduce the need for surgical biopsy. However, for smaller and deeper nodules, RAB has superior diagnostic success. RAB has enhanced maneuverability and catheter stability and when coupled with advanced imaging like cone-beam CT or augmented fluoroscopy/tomosynthesis, the small target lesion is reached with confidence about 90% of the time. This is important for both diagnostic and therapeutic purposes

Q: How can AI improve the future of advanced bronchoscopy?

A: Artificial intelligence (AI) has the potential to improve nearly every aspect of bronchoscopic intervention. Diagnostic bronchoscopy, interventional pulmonology and endobronchial imaging are all currently applying AI. Peripheral lung nodules are becoming increasingly common to identify via lung screening programs, and bronchoscopic procedures are leaning towards more technological sophistication. AI has the potential to improve computer-aided diagnosis and detection. However, any advancements using AI need to be carefully integrated into standard workflows.

Q: Are bronchoscopic ablative therapies effective alternatives for medically inoperable lung cancer?

A: A substantial subset of patients with early-stage lung cancer are considered medically inoperable for surgery for various reasons such as advanced age, comorbidities, poor pulmonary function or severe cumulative obstructive pulmonary disease. Within IP, bronchoscopic ablative therapies are evolving adjunctive therapeutic modalities for treatment of lung cancer. These therapies, which include radiofrequency ablation, microwave ablation, cryoablation, LASER and photodynamic therapy are relevant for patients who cannot tolerate surgical resection. Ablative therapies such as localized targeted bronchoscopic drug delivery are likely to become the standard of care in the future as more clinical trials are conducted. Compared to radiation therapy or radiosurgery, the potential advantages of bronchoscopic ablative therapies may include minimally invasive procedures, preservation of lung tissue and lesser collateral tissue injury.

For further information on bronchoscopy, lung cancer and Dr. Dammad’s work on this topic, please see the following references: