Symposium 17 - APRC 2024

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Symposium 17：Advances in Diagnostic Bronchoscopy

The increase of incidental discovery for peripheral pulmonary lesions (PPLs) and lung cancer has led more urgent and requirement in tissue diagnosis. The PPLs and mediastinal lymphadenopathy are the most challenging for clinicians. There are various modalities for diagnosis and tissue sampling of pulmonary lesions. For PPLs, techniques include thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (RP-EBUS), navigation bronchoscopy including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB). In recently, the progress of newer technologies including robotic assisted bronchoscopy (RAB), cone beam CT (CBCT), and augmented fluoroscopy (AF) are introduced to navigate to peripheral pulmonary nodules. EBUS-TBNA is a good method for mediastinal lymph node. The section will introduce new techniques for PPLs and update EBUS-TBNA application.

Date: Sunday, April 28, 2024 | Time: 08:30-10:00 (GMT+8)

Moderator: Prof. Chih-Yen Tu (Taiwan) | Dr. Bin Hwangbo (South Korea) | Dr. Ming-Shyan Huang (Taiwan)

Time (GMT+8)	Topic	Speaker	Country / Region
08:30-09:00	EBUS-TBNA for Lung cancer Staging: Current Status and Future Directions	Dr Bin Hwangbo	South Korea
09:00-09:30	The diagnosis of lung nodule in the era of interventional pulmonology	Dr. Chia-Hung Chen	Taiwan
09:30-10:00	Application of hybrid operating room in the field of interventional pulmonology	Dr. Shun-Mao Yang	Taiwan

EBUS-TBNA for Lung cancer Staging: Current Status and Future Directions

Abstract:
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the primary procedure for invasive mediastinal staging of lung cancer. Adding endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) following EBUS-TBNA can improve the sensitivity of endoscopic staging in mediastinal staging. Confirmatory mediastinoscopy is still recommended by guidelines after negative EBUS-TBNA results. However, according to our study, false-negative EBUS-TBNA cases who underwent upfront surgery have favorable survival, which was similar to that of pN1 patients, which may provide a rationale for omitting mediastinoscopy after negative EBUS-TBNA results. Moreover, a recent randomized controlled trial by Bousema et al. showed that the rate of unforeseen N2 disease after endoscopic staging without mediastinoscopy is in acceptable range. The role of EBUS-TBNA in lung cancer staging became more important.

Recommendations for invasive mediastinal staging with EBUS-TBNA are slightly different in several international guidelines. To find proper indications for staging with EBUS-TBNA, prediction models for mediastinal metastasis and its detection by EBUS-TBNA were developed by our group using age, histology, tumor centrality, tumor size and cN stage by CT or PET-CT as predictors. To guide lymph node selection process during EBUS-TBNA, studies on echo-features of lymph nodes and deep learning methodology have been published. Prediction models for nodal metastasis and other methodologies can assist decision making during EBUS-TBNA staging. Proposals for the 9th edition of the TNM classification for lung cancer added new sub-descriptors to N2 for single station (N2a) and multiple station (N2b) involvement. N1 staging is getting more important with the adoption of neoadjuvant chemo-immunotherapy. As N staging became more complex, the role of EBUS-TBNA is essential in guiding treatment decisions. More studies on the role of EBUS-TBNA are needed to meet clinical needs to tailor the treatment.

Dr. Bin Hwangbo

Head, Department Of Internal Medicine | National Cancer Center
South Korea

Professional Experience:

Dr. Hwangbo is a pulmonologist and a bronchoscopist working at National Cancer Center of South Korea. She is the president of South Korea Bronchology Group. She is an expert in endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). In 2009, Dr. Hwangbo first introduced a transesophageal sampling technique using an EBUS bronchoscope (EUS-B-FNA) for the diagnosis and staging of lung cancer.

The diagnosis of lung nodule in the era of interventional pulmonology

Abstract:
Since its introduction in the 1966 by Professor Shigeto Ikeda, flexible bronchoscopy has become the most commonly used invasive technique for diagnosing and treating diseases of the lungs and bronchi. Basic bronchoscopic techniques such as bronchoalveolar lavage, endobronchial and transbronchial biopsy, and cytology brushing, continue to be cornerstone in the management of our patients with lung ailments. However, it is the multiple advances in the last decade that have taken the role of bronchoscopy to a much higher level both in the diagnostic and therapeutic arena.

The increase in incidental discovery of pulmonary nodules has led to more urgent requirement of tissue diagnosis. The peripheral pulmonary nodules are especially challenging for clinicians. There are various modalities for diagnosis and tissue sampling of pulmonary lesions, but most of these modalities have their own limitations. This has led to the development of many advanced technical modalities, which have empowered pulmonologists to reach the periphery of the lung safely and effectively. These techniques include thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (RP-EBUS), and navigation bronchoscopy-including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB). Recently, newer technologies-including robotic-assisted bronchoscopy (RAB), cone-beam CT (CBCT), and augmented fluoroscopy (AF)-have been introduced to aid in the navigation to peripheral pulmonary nodules. Technological advances will also enable more precise tissue sampling of smaller peripheral lung nodules for local ablative and other therapies of peripheral lung cancers in the future. On this speech, we will summarize on recent advances in diagnostic bronchoscopy technology.

Dr. Chia-Hung Chen

Physician| China Medical University Hospital
Taiwan

Professional Experience:

Chia-Hung, Chen received his M.D. in 2008 and PhD degree in Graduate Institute of clinical medicine science in 2017 from the China Medical University. After training residency in Department of Internal Medicine and fellowship in Division of Pulmonary and Critical Care Medicine of the China Medical University Hospital from 2002 to 2007, he became attending physician since 2007. He was an Assistant Professor since 20177 and Associate Professor in China Medical University since 2019 and actively had worked research focused on the interventional pulmonology. He is a member of Taiwan Society of Pulmonary and Critical Care Medicine and the World Association for Bronchology and Interventional Pulmonology. He received the APSR Young Investigator’s award 2006 and Taiwan Society of Pulmonary and Critical Care Medicine, Excellent Award of oral presentation, 2015 and 2016. He has published over 110 peer-reviewed journal articles and 6 book chapters. Now his research interests is focused on interventional pulmonology and airway disease.

Application of hybrid operating room in the field of interventional pulmonology

Abstract:
Hybrid operating rooms equipped with cone-beam computed tomography had been applied in the field of interventional pulmonology in recent years. Augmented fluoroscopic bronchoscopic lung marking is particularly useful in cases where lung lesions are small, deep within the lung tissue, or difficult to access by traditional methods. It aids in improving the accuracy and safety of subsequent interventions, such as lung resections or biopsies, by ensuring that the targeted lesion is precisely identified and localized. Image-guided lung ablation is a minimally invasive medical procedure used to treat lung tumors or lesions, particularly for patients who may not be suitable candidates for traditional surgical resection. This technique combines advanced imaging technology with precise ablation methods to target and destroy abnormal tissue within the lungs.

Dr. Shun-Mao Yang

Chief, Thoracic Surgery | National Taiwan University Hospital Hsin-chu
Taiwan

Professional Experience:

Dr. Shun-Mao Yang received his Medical Degree from the National Taiwan University, school of medicine, and completed his General Surgery residency and Thoracic Surgery residency at National Taiwan University Hospital. He is currently working as Clinical Lecturer of School of Medicine, National Taiwan University and Attending Physician in the National Taiwan University Hospital, Hsin-Chu and Biomedical Branch.

Dr. Yang specializes in fields of minimally invasive thoracic surgery, image-guided thoracic surgery, quantitative analysis of thoracic image and interventional pulmonology. Dr. Yang also initiated augmented fluoroscopic bronchoscopy (AFB) localization for image-guided thoracic surgery. He is author of several publications in ATS,EJCTS, JTD and Surgical Endoscopy.

Prof. Chih-Yen Tu

Professor And Chair, Division Of Pulmonary And Critical Care Medicine, Department Of Internal Medicine, China Medical University Hospital | China Medical University Hospital
Taiwan

Professional Experience:

I am a pulmonologist. I am specilized in interventional bronchoscopy and lung cancer diagnosis and treatment.

Dr. Ming-Shyan Huang

Professor of Medicine | E-Da Cancer Hospital, I-Shou University, Kaohsiung
Taiwan

Professional Experience:

Ming-Shyan Huang, MD, PhD, FCCP, FIAC
Professor, Department of Internal Medicine, School of Medicine, E-DA Cancer Hospital and I-Shou University
Deputy Minister of E-Da Healthcare Group. Executive Committee.

Symposium 17：Advances in Diagnostic Bronchoscopy

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