REVIEW  COMPETENCE IN INTERVENTIONAL PULMONOLOGY Free access

Panminerva Medica 2019 September;61(3):232-48

DOI: 10.23736/S0031-0808.18.03563-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Competence in flexible bronchoscopy and basic biopsy technique

Ilaria VALENTINI ¹ ✉, Luigi LAZZARI AGLI ¹, Lucio MICHIELETTO ², Margherita INNOCENTI ³, Francesca SAVOIA ⁴, Bruno DEL PRATO ⁵, Laura MANCINO ⁶, Cristina MADDAU ⁷, Annamaria ROMANO ⁸, Antonella PUORTO ⁹, Lorenzo CORBETTA ³, Alessandro FOIS ⁹

¹ Unit of Pneumology, ASL della Romagna, Rimini, Italy; ² Unit of Pneumology, Ospedale dell’Angelo, Mestre, Venice, Italy; ³ Unit of Interventional Pneumology, Careggi University Hospital, Florence, Italy; ⁴ Unit of Pneumology, ULSS 2 Marca Trevigiana, Treviso Hospital, Treviso, Italy; ⁵ Department of Bronchial Endoscopy and Emergency Pneumology, Cardarelli Hospital, Naples, Italy; ⁶ Institute for Oncological Study, Prevention, and Networking (ISPRO), Florence, Italy; ⁷ Unit of Pneumology, San Giuseppe Moscati Hospital, Avellino, Italy; ⁸ Santa Maria Goretti Hospital, Latina, Italy; ⁹ Clinic of Pneumology, Sassari University Hospital, Sassari, Italy

Diagnostic bronchoscopy and tissue sampling techniques using forceps (endobronchial biopsy [EBB] and transbronchial biopsies [TBB]) or needle aspiration (transbronchial needle aspiration-TBNA), all performed with a flexible bronchoscope, are the basic elements of any interventional procedure. The flexible fibrobronchoscopy allows the visualization of the airways and is used both for diagnostic and therapeutic purposes. The working channel of both fibrobronchoscopes with optical fibers and videobronchoscopes, even if of relatively small diameter, allows the insertion of various diagnostic and therapeutic accessories. Fiber optic systems have been widely replaced by video cameras using a miniaturized charge-coupled device camera positioned at the end of the scope that provides electronic transmission of images to a monitor. The indications for both diagnostic and therapeutic fibrobronchoscopy derive from a correct evaluation of symptoms and objective signs of the patient and from the correct interpretation of imaging methods. Although bronchoscopy techniques keep evolving at a rapid pace, basic procedures such as bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration still play a key role in pulmonary disease diagnostics, and therefore, these methods must still be part of the training of interventional pulmonologists. Trainees will acquire a thorough knowledge of thoracic anatomy and become skilled in the interpretation of thoracic imaging, after which they will be given a theoretical and practical training course on virtual reality simulators, on animal or cadaver models, the effectiveness of which has been fully demonstrated by scientific studies. Specific DOPS tests have been developed for a qualitative evaluation of procedures on simulators, on animal models and on the patient.

KEY WORDS: Pulmonary medicine; Bronchoscopy; Fiber optic technology; Diagnostic imaging; Image-guided biopsy