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Semin Respir Crit Care Med 2022; 43(04): 480-491
DOI: 10.1055/s-0042-1749368
Review Article

Therapeutic Bronchoscopy for Lung Nodules: Where Are We Now?

Erik Folch
1   Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Yanglin Guo
2   Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi
,
Michal Senitko
2   Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi
3   Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
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Abstract

Lobar resection has been the established standard of care for peripheral early-stage non—small cell lung cancer (NSCLC). Over the last few years, surgical lung sparing approach (sublobar resection [SLR]) has been compared with lobar resection in T1N0 NSCLC. Three nonsurgical options are available in those patients who have a prohibitive surgical risk, and those who refuse surgery: stereotactic body radiotherapy (SBRT), percutaneous ablation, and bronchoscopic ablation. Local ablation involves placement of a probe into a tumor, and subsequent application of either heat or cold energy, pulsing electrical fields, or placement of radioactive source under an image guidance to create a zone of cell death that encompasses the targeted lesion and an ablation margin. Despite being in their infancy, the bronchoscopic ablative techniques are undergoing rapid research, as they extrapolate a significant knowledge-base from the percutaneous techniques that have been in the radiologist's armamentarium since 2000. Here, we discuss selected endoscopic and percutaneous thermal and non-thermal therapies with the focus on their efficacy and safety.

Keywords

microwave ablation - radiofrequency ablation - non—small cell lung cancer - percutaneous - bronchoscopy - CT-guided - outcomes


Publication History

Article published online:
14 September 2022

© 2022. Thieme. All rights reserved.

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