Central airway tumors: interventional bronchoscopy in diagnosis and management

Abstract

The diagnosis of central airway tumors is usually challenging because of the vague presentations. Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction.

Keywords: Central airway obstruction; ablative technologies; bronchoscopy; intervention; stents.

Figure 1

Specimens comparison between traditional forceps biopsy (left) and cryotechnology (right).

Figure 2

Types of central airway obstruction.

Figure 3

Cryotherapy successfully recannulized airway obstruction secondary to silicone stent induced granulation.

Figure 4

Self-expandable metallic stents (SEMS) implanted successfully for covering tracheoesophageal (TE) fistula in patient who was under mechanical ventilation without fluoroscopy guidance.