Lung Nodule Management

An Interventional Pulmonology Perspective

Udit Chaddha, MBBS; Jonathan S. Kurman, MD, MBA; Amit Mahajan, MD, FCCP; D. Kyle Hogarth, MD

Disclosures

Semin Respir Crit Care Med. 2018;39(6):661-666. 

In This Article

Bronchoscopy-guided Ablation of Peripheral Lung Tumors

Ever-improving navigational technologies have augmented our ability to reach almost any part of the lung and accurately guide flexible catheters to peripheral lesions. This has enabled research into use of bronchoscopy-guided ablation therapies to treat early-stage peripheral lung tumors.

Safety and feasibility studies using bronchoscopically delivered radiofrequency ablation (RFA),[53,54] microwave ablation,[55,56] photodynamic therapy (PDT),[57] and laser interstitial thermal therapy[58] to ablate peripheral lung tumors have been conducted in animals. Small human studies now demonstrate that bronchoscopically guided cooled RFA probes can be used to successfully ablate peripheral lung tumors, with CT-guidance,[59] and more recently, with the use of an EMN platform to confirm probe position.[60] The use of interstitial PDT via bronchoscopic guidance has also been shown to be feasible in studies by Usuda et al (used a composite-type optical fiberscope to treat three patients with peripheral stage IA lung cancer [<2 cm])[61] and Chen and Lee (successfully ablated three patients with a mean nodule size of 21.3 mm).[62] While these technologies still remain under investigation, early data are promising. A benefit of the bronchoscopic techniques compared to the more well-studied percutaneous methods is the lower pneumothorax rates. While none of the bronchoscopically guided RFA cases developed a pneumothorax in the very small studies conducted thus far, there has been a 5 to 60% reported pneumothorax rate with the percutaneous technique.[63,64]

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