An international survey of practices in the investigation of peripheral pulmonary lesions amongst interventional pulmonologists

T. Soumagne^a (Dr), H. Dutau^b (Dr), GA. Eapen^c (Dr), N. Guibert^d (Prof), CA. Hergott^e (Dr), F. Maldonado^f (Prof), H. Saka^g (Dr), M. Fortin*^h (Dr)

^a Assistance Publique des Hôpitaux de Paris, Paris, FRANCE ; ^b Assistance Publique des Hôpitaux de Marseille, Marseille, FRANCE ; ^c MD Anderson Cancer Center, Houston, UNITED STATES ; ^d Hôpital Larrey, Toulouse, FRANCE ; ^e Foothills Medical Center, Calgary, CANADA ; ^f Vanderbilt University Medical Center, Nashville, UNITED STATES ; ^g Matsunami General Hospital, Gifu, JAPAN ; ^h Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec City, CANADA

* marc.fortin@criucpq.ulaval.ca

Introduction: The investigation of peripheral pulmonary lesions (PPL) can be challenging. Several modalities, endoscopic or percutaneous, can be used to biopsy PPL but data comparing modalities is scarce. This international survey was conducted to describe current medical practices in PPL investigation among interventional pulmonologists (IP).

Methods: This survey was sent to all members of the Group d’Endoscopie Thoracique de Langue Française (GETIF), Canadian Thoracic Society Procedures Assembly (CTS-PA), American Association for Bronchology & Interventional Pulmonology (AABIP) and World Association for Bronchology & Interventional Pulmonology (WABIP). The survey was composed of 51 questions to establish a portrait of techniques used to investigate PPL by IP around the world.

Results: Three hundred IP responded to the survey. Most of them practice in Europe (n = 117, 39%), North America (n = 94, 31%) and Asia (n=44, 15%). 58% of responders perform more than 100 endoscopic procedures for PPL per year. General anesthesia and conscious sedation are used in similar proportions (54% and 46% respectively). Rapid On site Examination (ROSE) is used when sampling PPL by 44% of IP. Peripheral EBUS (67%), fluoroscopy (55%) and electromagnetic navigation (26%) are the most widely available and used techniques. Most IP combine techniques (66%). Robotic bronchoscopy (15%) and cone beam CT (7%) are almost exclusively used in the United States of America where, respectively, 58% and 23% of responders reported using these two techniques. Self-evaluated diagnostic yield for endoscopic PPL procedures varied among techniques and centers. Investigation strategies widely varied for each clinical case presented. Finally, only 12% of bronchoscopists currently had access to endoscopic treatment modalities for PPL. However, half of the remaining IP plan to acquire an endoscopic therapeutic modality in the next 2 years.

Conclusion: Practices worldwide vary significantly in endoscopic techniques used to sample PPL, type of sedation and presence of ROSE.

Disclosure of funding source(s): none