ERS/ATS statement on interventional pulmonology

⇓The purpose of this European Respiratory Society/American Thoracic Society (ERS/ATS) Task Force position paper is to define the field of interventional pulmonology as well as to describe the minimal requirements in methodology and logistics, the indications, contraindications, outcome and training requirements for each interventional procedure. This position paper has been prepared by a group of European and North American experts. Fig. 1.— Schematic illustration of the three main types (a–c) of malignant central airway obstruction shown at the tracheal level, with identical degrees of narrowing of the lumen. a) intraluminal; b) extraluminal; c) mixed obstruction. Fig. 2.— Algorithm for the management of malignant central airway obstructions. Terms in hexagonal boxes are conditions; terms in rectangular boxes are procedures. Two-way arrows indicate the tendency of endobronchial tumours to recur and the repetitive need of multimodality treatment. Interrupted arrows: 1: rare cases of primarily inoperable lung cancers which become secondarily operable after initial therapeutic bronchoscopy usually followed by neo-adjuvant treatment; 2: rare cases of operated lung cancers initially presenting with central airway obstruction and still being operable after careful restaging of an endobronchial recurrence. TNM: tumour staging, including histology; CPR: cardiopulmonary reserves of the patient. Reproduced with permission from 81. Fig. 3.— Interventional pulmonology can be defined as “the art and science of medicine as related to the performance of diagnostic and invasive therapeutic procedures that require additional training and expertize beyond that required in a standard pulmonary medicine training programme”. Disease processes encompassed within this discipline include complex airway management problems, benign and malignant central airway obstruction, pleural diseases, and pulmonary vascular procedures. Diagnostic and therapeutic procedures pertaining to these areas include, but are not limited to, rigid bronchoscopy, transbronchial needle aspiration, autofluorescence bronchoscopy, endobronchial ultrasound, transthoracic needle aspiration and biopsy, laser bronchoscopy, endobronchial electrosurgery, argon-plasma coagulation, cryotherapy, airway stent insertion, balloon bronchoplasty and dilatation …