Interventional Pulmonology

Interventional pulmonology is an important aspect of thoracic oncology with established place and role in both diagnostic and treatment domain of lung cancer invading central airways (trachea and principal bronchi). While success ratio of interventional techniques is reported to vary in different studies, they remain a vital part of armamentarium with excellent potential and perspective. Increase in number and variety of these techniques led to the development of internationally accepted guidelines for their use. Of diagnostic techniques, white light bronchoscopy, autofluorescence videobronchoscopy, narrow-band imaging, and endobronchial ultrasound have mostly been used in the past. Newer diagnostic techniques, such as electromagnetic navigation, bronchoscopic navigation using cone bean computed tomography, confocal fluorescence microscopy (endoscopy), optical coherence tomography, and ultrathin bronchoscopy, had also shown promise in this field. Of therapeutic techniques with immediate effect, laser photoresection, electrocautery, and argon plasma coagulation remain standard approaches in this domain, while therapeutic techniques with delayed effect, such as balloon dilatation (bronchoplasty), endobronchial brachytherapy cryotherapy, and photodynamic therapy, have also been used with success and, if properly managed, very low toxicity. They are being presented in detail in other chapters.