The rapidly evolving specialty of interventional pulmonology (IP) is playing an increasingly significant role in the diagnosis, staging and management of lung cancer — the third most common cancer in the United States.

IP is also becoming an integral component of multidisciplinary lung cancer care, connecting pulmonary medicine, thoracic surgery, oncology, radiology and critical care to improve outcomes for patients with thoracic disease.

Since IP offers several advantages over traditional surgery — including procedural efficiency and reduced procedural invasiveness — patients typically experience shorter recovery times, less post-operative pain, fewer complications and shorter hospital stays.

In turn, this has led to a growing demand for IP strategies.

Dr. Tarek Dammad, Director of the Pulmonary Division and Academic Interventional Pulmonology, specializes in advanced IP technologies. In the following Q&A, Dr. Dammad shares his insights into the innovative field of IP and how its applications are pushing the envelope for lung cancer care.

Q: What is interventional pulmonology, and what does an interventional pulmonologist do?

A: IP is an emerging, evolving and innovative field of medicine and a sub-specialty of pulmonary and critical care medicine. It focuses on the diagnosis and management of complex airway, pleural and thoracic diseases. It is particularly relevant in modern clinical practice because thoracic diseases are increasingly common and diagnostically complex. The field of IP has the potential to significantly improve patient outcomes and reduce recovery times since it utilizes advanced techniques and technologies to reach and treat areas previously inaccessible. An interventional pulmonologist is a pulmonologist with additional fellowship training in advanced diagnostic and therapeutic procedures involving the lung and central airways. They commonly perform procedures such as flexible bronchoscopy, endobronchial ultrasound and navigational robotic bronchoscopy, coupled with advanced imaging techniques to reach peripheral nodules, diagnose them and potentially treat them. Interventional pulmonologists can also use rigid bronchoscopy for tumor resection, LASER bronchoscopy, electrocautery and cryotherapy bronchoscopy to treat endoluminal disease and place airway stents. Furthermore, they can manage benign or malignant central airway obstructions and pleural diseases with medical thoracoscopy. Interventional pulmonologists work collaboratively in multidisciplinary programs that include thoracic surgeons, oncologists, radiation oncologists and radiologists in addition to other specialties like ENT.

Q: Can lung cancer be treated in a non-surgical way and without using chemotherapy or radiation?

A: One of the major roles of IP is in the evaluation and staging of lung cancer. Lung cancer can be treated without surgery, conventional chemotherapy or radiation therapy in a few selected patients, owing to advances in precision oncology. Minimally invasive bronchoscopic techniques, including endobronchial tumor resection, thermal ablation, cryotherapy and airway stenting, are options for localized disease and palliation. However, lung cancer management depends on several factors such as tumor stage, histology, molecular profile, comorbidities and treatment goals. This approach may not be suitable for every patient with lung cancer.

Q: Can we diagnose lung cancer using interventional pulmonology?

A: One of the primary functions of IP is the diagnosis of lung cancer. There are several types and subtypes of lung cancer: All of these can be diagnosed using IP. Using minimally invasive bronchoscopic and pleural procedures, interventional pulmonologists can obtain tissue samples from lung masses, pleural lesions, pulmonary nodules, endobronchial tumors and mediastinal lymph nodes. Techniques such as endobronchial ultrasound, bronchoscopy and robotic-assisted bronchoscopy, coupled with advanced imaging and medical thoracoscopic procedures, can be used as well.

Q: Are all interventional pulmonology techniques minimally invasive?

A: Most procedures within IP are considered minimally invasive. These are performed through the mouth in case of bronchoscopy, and through a small needle puncture or one small incision in the setting of the diagnosis of pleural diseases and management. However, some procedures are more invasive than others. These include techniques such as rigid bronchoscopy, airway stent placement and endoluminal tumor resection. The patient’s condition also determines the degree of invasiveness required.

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