Interventional bronchoscopy in lung cancer treatment

Abstract

Interventional bronchoscopy has seen significant advancements in recent decades, particularly in the context of lung cancer. This method has expanded not only diagnostic capabilities but also therapeutic options. In this article, we will outline various therapeutic approaches employed through either a rigid or flexible bronchoscope in multimodal lung cancer treatment. A pivotal focus lies in addressing central airway obstruction resulting from cancer. We will delve into the treatment of initial malignant changes in central airways and explore the rapidly evolving domain of early peripheral malignant lesions, increasingly discovered incidentally or through lung cancer screening programmes. A successful interventional bronchoscopic procedure not only alleviates severe symptoms but also enhances the patient's functional status, paving the way for subsequent multimodal treatments and thereby extending the possibilities for survival. Interventional bronchoscopy proves effective in treating initial cancerous changes in patients unsuitable for surgical or other aggressive treatments due to accompanying diseases. The key advantage of interventional bronchoscopy lies in its minimal invasiveness, effectiveness and favourable safety profile.

FIGURE 1

a and b) Computed tomography images of polypoid metastasis in the trachea of a patient with severe dyspnoea and haemoptysis. c) Tumour was removed by coring with rigid bronchoscope. d) Basis of the tumour was treated by argon plasma coagulation to stop bleeding and prevent recurrence.

FIGURE 2

a) Atelectasis of the left lung as a consequence of combined (endobronchial/extramural compression) malignant stenosis of the left main bronchus. b) Atelectasis was resolved after stent placement and the patient improved enough to receive further multimodal treatment.

FIGURE 3

Patient with severe central airway stenosis due to extramural tumour compression. a) Computed tomography image in which stenosis of trachea and right main bronchus is evident. b) Flow–volume loop before stent placement. c) Flow–volume loop after stent placement. d) Stent in the trachea several months later after successful chemoradiotherapy with almost complete remission. e) Removed stent. f) Trachea after stent removal is fully patent.

FIGURE 4

Cryotherapy is effective for additional treatment of the basis of removed polypoid tumours or minor lesions in the central airways. Its effect extends deeply, with a low risk of perforation.

FIGURE 5

Early squamous cell carcinoma in the central airways (arrows), discovered accidentally.