Pharmacoeconomic inequalities in access to antifibrotic treatment for interstitial lung disease in the Asia-Pacific region.

Antifibrotic drugs, available for the best part of the last decade in many parts of the world, has improved outcomes in patients with idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. However, it is unclear whether patients suffering from these devastating conditions have timely and adequate access to antifibrotic therapy in the Asia Pacific region (APAC). In this mixed-methods narrative review of 12 APAC countries, integration of questionnaire-based insights of 31 regional clinical experts in interstitial lung disease (ILD) with publicly available pharmaco-economic information has been used to understand how country-specific challenges impact on antifibrotic accessibility.

Study protocol for a randomized trial comparing cryobiopsy and conventional biopsy for peripheral pulmonary lesions.

Background: The introduction of radial endobronchial ultrasound (R-EBUS) and navigation has improved the diagnostic yield of bronchoscopy for peripheral pulmonary lesions (PPLs). Cryobiopsy could further raise the yield, and the advent of single-use cryoprobes has shown promise in enhancing yields even when used alone. This multicenter randomized controlled trial aims to compare the diagnostic performance of cryobiopsy with that of conventional biopsy during bronchoscopy for PPLs.

A 69-year-old man with generalised lymphadenopathy, glandular swelling and pleural effusion.

https://bit.ly/4eJ0PHT.

Endoscopic ultrasound with bronchoscope-guided transesophageal cryobiopsy: A case series with technical insights, key enablers, and review of literature.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for lung cancer staging and the diagnosis of mediastinal diseases. Recently, the paradigm of EBUS guided mediastinal sampling with conventional cytology has shifted over to histology specimens through the use of cryobiopsy. This case series explores the novel technique, key enablers, and potential advantages of endoscopic ultrasound with bronchoscope-guided transesophageal cryobiopsy (EUS-B-TEC).

Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle.

Background: In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times.

Bronchial branch tracing navigation in ultrathin bronchoscopy-guided radial endobronchial ultrasound for peripheral pulmonary nodule.

Background: Most malignant peripheral pulmonary lesions (PPLs) are situated in the peripheral region of the lung. Although the ultrathin bronchoscope (UTB) can access these areas, a robust navigation system is essential for precise localisation of these small peripheral PPLs. Since many UTB procedures rely on automated virtual bronchoscopic navigation (VBN), this study aims to determine the accuracy and diagnostic yield of the manual bronchial branch tracing (BBT) navigation in UTB-guided radial endobronchial ultrasound (rEBUS) procedures.

Predictive factors for tuberculous peripheral pulmonary lesions during radial endobronchial ultrasound.

Background: Tuberculosis frequently poses diagnostic challenge when it presents as a peripheral pulmonary lesion (TB-PPL). The growing use of radial endobronchial ultrasound (rEBUS) for PPL biopsy highlights the need to identify predictive factors for TB-PPL, which is crucial for procedure safety.

Methods: A six-year retrospective review at our institution on adult patients with TB and malignant-PPL diagnosed from rEBUS procedure from October 1, 2016, to December 31, 2022.

An explorative analysis on the optimal cryo-passes and freezing time of the ultrathin cryoprobe in endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy.

EBUS-guided transbronchial mediastinal cryobiopsy (TBMC) has emerged as a promising biopsy tool for diagnosing hilar and mediastinal pathologies. However, several fundamental technical aspects of TBMC remain unexplored. This study aims to determine the optimal number of cryo-passes and freezing time of the ultrathin cryoprobe in EBUS-TBMC concerning specimen size and procedural diagnostic yield.

Modified two-scope technique for transbronchial lung cryobiopsy of peripheral pulmonary lesions.

Bleeding mitigation is an important part of any transbronchial lung cryobiopsy (TBLC) procedure, either for interstitial lung disease (ILD) or peripheral pulmonary lesions (PPL). The two-scope technique has been previously described for ILD and PPL-TBLC, but it has its own limitations and technical and logistical complexities. In this case series, we describe a modified two-scope technique that enhances the conventional two-scope technique by maintaining a small equipment footprint and longer bronchoscopic vision without the need for intra-procedure switching of bronchoscopes.

Feasibility of Cryobiopsy Specimen Retrieval Through Standard Guide Sheath for Peripheral Pulmonary Lesions Without Bronchoscope Removal.

Background: Transbronchial cryobiopsy is a promising technique for biopsy of peripheral pulmonary lesions (PPL). However, cryobiopsy specimen retrieval can pose problems due to the risk of bleeding during the blind period when the bronchoscope and cryoprobe are removed en bloc. Artificial airways and prophylactic balloon placement are risk-reducing measures, but the latter is challenging in upper lobe PPL.

Improving diagnostic strategies in bronchoscopy for peripheral pulmonary lesions.

Introduction: In the past two decades, bronchoscopy of peripheral pulmonary lesions (PPLs) has improved its diagnostic yield due to the combination of various instruments and devices. Meanwhile, the application is complex and intertwined.

Areas Covered: This review article outlines strategies in diagnostic bronchoscopy for PPLs.

A hypoxic young lady in an acute confusional state.

https://bit.ly/3OodFQA.

Exploring the optimal freeze time and passes of the ultrathin cryoprobe in transbronchial cryobiopsy of peripheral pulmonary lesions.

https://bit.ly/49cbmbW.

Performance of radial endobronchial ultrasound for peripheral pulmonary lesions without automation technology in tuberculous endemic region: real-world experience in a single institution over 6 years.

Background: Peripheral pulmonary lesions (PPLs) in tuberculous endemic regions present a unique diagnostic challenge, as tuberculous PPL can mimic malignancy and potentially delay diagnosis for both conditions without a confirmatory investigation. While bronchoscopic biopsy using radial endobronchial ultrasound (rEBUS) guidance is becoming more common among pulmonologists, it is often performed with additional automation technology such as virtual bronchoscopic and electromagnetic navigation. This study aimed to evaluate the performance of rEBUS without such automation technology over a 6-year period in our institution.

Peripheral transbronchial needle aspiration-guided pinpoint cryobiopsy of lung nodule without bronchus sign: A case report.

Peripheral transbronchial needle aspiration (pTBNA) allows the access of pulmonary nodules without bronchus sign but is limited to cytological examination. A 39-year-old man with left parotid carcinoma presented with an incidental lung nodule. Target localisation was performed with manual airway mapping, virtual bronchoscopic navigation, and pTBNA.

A young lady with prolonged menstruation and a large lung mass.

https://bit.ly/3qLG9Yx.