WABIP Newsletter 2022, Issue 3

Volume 10

Issue 03

September 2022

Inside This Issue

Editorial, 2-3

Technology Corner, 4-5

Tips from the Experts, 6-7

Humanitarian News, 8-11

Best Image Contest, 12

WABIP News, 13-14

Research, 15-16

Links, 17

Diagnostic Yield: Apples, Oranges, and Paradigm

Incommensurability

WABIP Newsletter

S E P T E M B E R 2 0 2 2 V O L U M E 1 0 , I S S U E 3

EXECUTIVE BOARD

Hideo Saka, MD

Japan, Chair

Stefano Gasparini,

Italy, Vice-Chair

Silvia Quadrelli, MD

Argenna, Immediate

Past-Chair

David Fielding MD

Australia, Treasurer

Naofumi Shinagawa,

Japan,

Secretary General

Philippe Astoul, MD

France, President

WCBIP 2022

Menaldi Rasmin, MD

Indonesia, President

WCBIP 2024

STAFF

Michael Mendoza

General Manager

Judy McConnell

Administrator

Kazuhiro Yasufuku

Newsleer Editor-in-

chief

P A G E 2

In the past two decades, unprecedented advances in

technology have led to the commercializaon of

new bronchoscopy plaorms which have been wide-

ly adopted as standard of care procedures by inter-

venonal pulmonologists around the globe. In the

US and in Europe, these novel medical devices were

cleared by regulatory stakeholders in the absence of

comparave eecveness studies, based on the

assumpon that similaries in form and funcon to

already available devices obviated the need for such

data. Thus, most studies published to date reporng

on the diagnosc test performance of these novel

devices have been single-arm observaonal studies

using the surrogate endpoint of diagnosc yield

(DY). (1)However, DY captures more than the tech-

nical ability of these devices to navigate to the tar-

geted lesion, and is aected by many other relevant

variables, which include targeted nodule characteris-

cs, operator skills and cancer prevalence, among

others. Perhaps more importantly, DY has been de-

ned in many dierent ways in studies published to

date which further complicate comparisons across

single-arm studies.

Diagnosc yield (DY) is strictly dened as the likeli-

hood that a biopsy will provide a histopathological

diagnosis sucient to guide management with con-

dence. Typically, this would include malignant diag-

noses, usually, although not always, uncontroversial,

and benign diagnoses deemed specic enough to

convince the pathologist that the lesion in queson

was indeed adequately sampled. These would in-

clude granulomatous inammaon, robust neutro-

philic inltraon, or hamartomas among others.

Diagnosc yield is oen confused with diagnosc

accuracy, which represents the degree to which histopatho-

logical diagnosis reects the ground truth.(2) Inammaon,

while non-specic and thus excluded from the prior deni-

on, could in fact represent lesional ssue, but oen re-

main inconclusive at the me of diagnosis, leading to subse-

quent intervenons. Thus, diagnosc accuracy requires

sucient clinical follow-up to adjudicate non-specic be-

nign diagnoses. Studies on diagnosc test performance of

bronchoscopy have oen conated these two noons and

used them interchangeably, leading to incommensurable

esmates of diagnosc test performance even when ac-

counng for dierences in paent populaon. We have

been comparing apples to oranges.

The impact of these dierent denions on DY was recently

evaluated in a Monte-Carlo simulaon by Vachani and col-

leagues. In “The Impact of Alternave Approaches to Diag-

nosc Yield Calculaon in Studies of Bronchoscopy”, pub-

lished in CHEST in 2022, a hypothecal cohort of 1000 pa-

ents undergoing diagnosc bronchoscopy was assessed

using 3 commonly used but disnct methods for DY calcula-

on: (1) a strict approach, which corresponds to actual DY

as dened above, (2) an intermediate approach, in which

non-specic benign diagnoses were considered diagnosc if

clinical follow-up did not reveal malignancy, and (3) a liberal

approach, according to which even non-diagnosc samples

(such as normal lung or pleura) were considered diagnosc

if follow-up did not reveal malignancy. Expectedly, es-

mates of “DY” varied considerably, ranging from 67% to

88%, a 21% absolute dierence simply due to an arbitrarily

chosen method of reporng the data.(3)

The implicaon of these observaons is obvious: studies

using dierent denions of DY are dicult, if not impossi-

ble to compare. Denions of DY should be explicitly and

Crisna D. Salmon, MD

Department of Allergy, Pulmonary and

Crical Care Medicine,

Vanderbilt University Medical Center

Fabien Maldonado, MD, MSc

Department of Allergy, Pulmonary and

Crical Care Medicine,

Vanderbilt University Medical Center

W A B I P N E W S L E T T E R

P A G E 3

the proper conduct of methodologically sound comparave

studies, with randomized controlled trials standing rm as the

pinnacle of comparave eecveness research, uniquely able

to account for both known, and unknown confounders.

References

1. Agrawal A et al. Ann Thorac Surg. 2022 Jan 17;S0003-4975

(22)00042-X.

2. Baratloo A et al. Emerg Tehran Iran. 2015;3(2):48–9.

3. Vachani A et al. Chest. 2022 May;161(5):1426–8.

4. Folch EE et al. J Thorac Oncol O Publ Int Assoc Study Lung

Cancer. 2019 Mar;14(3):445–58.

transparently reported, with data available to allow

reviewers and readers to re-calculate DY based on

their preferred approach. While we do not recom-

mend one method over another, we suggest that

the liberal method be abandoned, as it is most like-

ly to be inuenced by cancer prevalence: for exam-

ple, with a 10% cancer prevalence in the popula-

on studied, the esmate of DY will approach 90%

even if most lesions are missed. Unfortunately, this

method has been the tradional method used in

the bronchoscopy literature unl recently.(4) More

fundamentally, even if the enre bronchoscopy

community was to uniformly agree on a DY deni-

on, variaons in cancer prevalence, nodule char-

acteriscs, operator skillset and biopsy tools used

would sll aect esmates of DY independently of

the actual technical ability of the bronchoscopy

plaorm. Thus, DY should be regarded as a surro-

gate for diagnosc test performance, more accu-

rate esmates of which may only emerge through

W A B I P N E W S L E T T E R

P A G E 4

Technology Corner

Endobronchial Ultrasound-Guided Radiofrequency Ablaon for Lung Cancer

INTRODUCTION

Transbronchial ablaon therapy has been evaluated to reduce the high rate of complicaons associated with percutaneous ablaon

for lung cancer.

1-5

Although there is limited clinical evidence for transbronchial ablaon, preliminary data suggests it has a beer

safety prole than percutaneous ablaon.

3,4

One major challenge with transbronchial ablaon is the placement of the electrodes,

parcularly when there is no single bronchus leading to the tumor (negave bronchus sign).

BACKGROUND

Olympus Corporaon developed a needle-type (19 gauge) bipolar radiofrequency ablaon (RFA) device that is compable with cur-

rent convex-probe EBUS bronchoscopes. The needle’s distal poron serves as an electrode and is echogenic for easier ultrasound

visibility. Once the needle is inside the targeted nodule, a second electrode is deployed from the p. In animal models, we evaluated

the safety of EBUS-guided RFA, as well as the correlaon between energy delivery and ablaon extent.

Room-temperature saline

was connuously injected throughout the ablaon at a predetermined rate via an integrated infusion channel to enhance electrical

conducvity. Promising safety and ecacy data prompted a clinical pilot study of EBUS-guided RFA.

CLINICAL APPLICATION

Study design

A prospecve, single-arm, ablate-and arm, ablate-and-resect trial (ClinicalTrials.gov, NCT03400748) was conducted at Toronto Gen-

eral Hospital (Toronto, Canada). The primary outcome of this pilot study was short-term safety. Immediately following RFA, resec-

on was performed to assess the ablated area histologically, including adjacent healthy peritumoral ssue. Adult paents aged 18

and older who had either (1) pathologically proven stage I or stage II lung cancer with a primary tumor larger than 1 cm, or (2) a met-

astac lung nodule larger than 1 cm, and for whom this tumor/nodule was accessible by convex-probe EBUS bronchoscope were

included in this study.

Procedures

The RFA probe was inserted into the target lung nodule under EBUS guidance followed by ablaon with a total supplied energy of 4

to 8 kJ. The total energy was purposefully determined to avoid complete tumor ablaon, as the objecve of this study was to evalu-

ate the short-term safety of EBUS-guided RFA. During RFA, the posion of the electrodes was monitored using cone-beam CT uor-

oscopy. Aer EBUS-guided RFA, bronchoscopy and a contrast CT were performed to document o-target injuries. Following the ac-

quision of all images, the paent had surgical resecon in the same operang room under the same anesthec.

Tsukasa Ishiwata, MD, PhD

University Health

Network

Alexander Gregor, MD

University Health

Network

Kazuhiro Yasufuku MD, PhD

University Health

Network

W A B I P N E W S L E T T E R

P A G E 5

Study results

In ve dierent individuals, ve primary lung malignancies were ablated (adenocarcinoma in four cases, squamous cell carcinoma in

one case). For 4 kJ, 6 kJ, and 8 kJ, the mean ablaon mes were 13.8 min, 8.4 min, and 15.6 min, respecvely. Throughout the RFA

procedure, the posion of the RFA device was connuously monitored and veried within the target using EBUS. The average proce-

dure me was 36.2 min (range, 26-51 min). There were no signicant immediate complicaons related to EBUS-guided RFA. Parcu-

larly, neither during inseron, deployment of the second electrode, nor ablaon was there any major hemorrhage that required for

intervenon. On post-RFA bronchoscopic examinaon, there was no evidence of thermal injury to the bronchial wall. The post-RFA

contrast CT revealed no pneumothorax or hemothorax.

Advantages

As the RFA probe does not pass through the pleura, the transbronchial approach naturally has a lower risk of pneumothorax than the

transthoracic approach. Doppler mode EBUS can help avoid intervening vessels, which may lower the risk of bleeding or development

of bronchovascular stulas. The study design did not allow evaluaon for late sequelae of bronchial thermal injury; however, the ab-

sence of acute injury is reassuring. This technique's ulmate goal is to treat lung tumors in the middle- and central-third lung elds.

The current 6.9 mm-EBUS bronchoscope has limited access to lung lesions not adjacent to the central airways. It will probably be nec-

essary to combine EBUS-guided RFA with a thin EBUS bronchoscope to improve access to the periphery. Our team has published the

performance of a prototype thin bronchoscope (distal end outer diameter: 5.9 mm), showing noceably enhanced access to the sub-

lobar bronchi.

Transbronchial RFA in the middle lung eld may have even further advantages over central RFA. This includes poten-

al improvements in safety (greater distance from the heart, large vessels, central airway, and esophagus) and ecacy (reduced heat

sink eect due to decreased vessel diameter in the lung periphery).

CONCLUSION

This pilot study showed that EBUS-guided RFA may access lung tumors close to airways, enabling real-me monitoring of the elec-

trode deployment and ablaon with no immediate complicaons. EBUS-guided ablaon may avoid some of the morbidity of percuta-

neous ablaon.

References

1. Tsushima K et al. Eur Respir J. 2007;29:1193-200.

2. Suzuki H et al. J Bronchology Interv Pulmonol. 2011;18:211-7.

3. Koizumi T et al. Case Rep Oncol Med. 2013;2013:515160.

4. Xie F et al. Respiraon. 2017;94:293-8.

5. Sa S et al. Lung Cancer. 2018;124:125-9.

6. Tsuboi E et al. Cancer. 1967;20:687-98.

7. Motooka Y et al. Semin Thorac Cardiovasc Surg. 2020;32:570-8.

8. Ishiwata T et al. J Thorac Cardiovasc Surg. 2022; 164(4):1188-

1197

9. Ishiwata T et al. Transl Lung Cancer Res. 2022;11:1292-301.

Figure: A representave case of EBUS-guided RFA. (A) A pre-

RFA CT axial view (71-year-old male with stage IB squamous

cell carcinoma. (B) Fluoroscopic conrmaon of the elec-

trode posion. (C) An EBUS image before ablaon. The RFA

electrode was connuously observed throughout the abla-

on. (D) Gross pathological examinaon of the resected

specimen.

Tips from the Experts

P A G E 6 V O L U M E 1 0 , I S S U E 3

Introducon

Endobronchial ultrasound transbronchial needle aspiraon (EBUS-TBNA) has an excellent diagnosc yield for primary pulmonary malignan-

cies, but the amount of ssue might be insucient to allow for a rm diagnosis of lymphoproliferave disorders or even sarcoidosis. These

enes, especially lymphomas, require histopathologic rather than cytologic samples for the evaluaon of the overall background architec-

ture and correct subtyping (1). Cryobiopsy is an endoscopic technique mostly used in the diagnosc approach to intersal lung disease,

based on rapid cooling, crystallizaon, and subsequent collecon of ssue. Herein we share our approach in performing EBUS-TBNA and

transbronchial mediasnal cryobiopsy (TMC) during the same procedure for diagnosc purposes of mediasnal lesions and lymph nodes.

Indicaons

1. Proven or suspected malignancy, either of solid or hematologic origin and sarcoid suspicion.

2. Mediasnal lymph nodes with diameter ≥ 1 cm in the short axis.

3. Paents with at least one mediasnal/hilar lesion irrespecve of the lymph node staon.

4. Necessity to undergo endoscopic mediasnal assessment for diagnosis, staging or molecular characterizaon.

5. Paents with previous non diagnosc EBUS-TBNA.

Planning

The planning for performing a TMC begins with the CT or PET-CT images. If it´s a diagnosc procedure, and feasible, we recommend se-

lecng the hilar staons rst; in our experience the 1.1 mm cryo-probe (Erbecryo 20402-401, Tubingen, Germany) enters these areas more

smoothly than the mediasnal ones. It is important to idenfy the lymph node staons that are closest to the bronchial or tracheal wall,

since those that are further away will be more dicult to access with the cryoprobe, making the procedure longer and more complex.

Sampling and Procedure

We perform the procedure under conscious (moderate) sedaon. Herein we describe the step-by-step approach applying our method (2)

through a clinical case descripon. A 42-year-old female was referred to our Intervenonal Pulmonology Unit (IPU) due to enlarged medias-

nal and hilar lymph nodes. The PET-CT scan showed an increased FDG uptake at staons 7 and 11L (Figure 1A). Aer idencaon of an

enlarged staon 7 lymph node on EBUS (Pentax Medical EB19-J10U), we performed three passes of TBNAs with 22-gauge needle

(SonoTip

TopGain: Medi-Globe) (Figure 1B). Aer inial puncture with the TBNA needle, a 1.1 mm cryo-probe was introduced into the work-

ing channel of the EBUS bronchoscope. The cryo-probe is advanced towards the puncture site and inserted gently through the previous

puncture site created by the TBNA needle. The EBUS image conrmed the cryo-probe posion within the lymph node. The cryo-probe was

cooled down for 4 s, and then retracted with the bronchoscope and the frozen biopsy ssue aached to the p of the probe (Figure 1C-G).

The cryobiopsy site was immediately examined and no bleeding was observed (Figure 1H). Cryobiopsies were retrieved in saline and xed in

formalin (Figure 1I). Samples conrmed the diagnosis of sarcoidosis (Figure 2).

EBUS-GUIDED TRANSBRONCHIAL MEDIASTINAL CRYOBIOPSY

Javier Pérez Pallarés

Intervenonal Pulmonologist

Cartagena Hospital, Spain

Miguel Ariza Prota, MD

Intervenonal Pulmonologist

Asturias Central University Hospital, Spain

Rosa Cordovilla, MD, PhD

Director of Intervenonal Pulmonology Unit

Salamanca University Hospital, Spain

Tips from the Experts

P A G E 7 V O L U M E 1 0 , I S S U E 3

Quality Control

It is important to menon that our method for performing TMC is mainly based on always introducing the cryoprobe under ultrasound guid-

ance; we do not focus on trying to introduce the cryoprobe through the puncture site only. We are guided by the track le in the lymph node

by EBUS-TBNA needle. It is key to introduce the cryoprobe at the same angle in which the previous EBUS-TBNA punctures were performed.

Every me we obtain a TMC, we immediately return with the EBUS to the punctured staon and spend ~ 2 min visualizing its ultrasonograph-

ic characterisc under Doppler mode, looking for signs of bleeding within the lymph node.

Zhang et al. conducted a trial that included a total of 197 paents who underwent EBUS-TBNA and TMC in the same procedure to assess the

diagnosc yield and safety of this technique. For TMC they performed a small incision in the tracheobronchial wall adjacent to the medias-

nal lesion using a high-frequency needle-knife (3). An important dierence in our method is the way we perform the procedure. We have

shown that the high-frequency needle knife is not essenal, and we eliminated this step of the process by directly introducing the 1.1 mm

cryo-probe always under echo guidance through the puncture site created by the EBUS-TBNA needle. This modied technique allows us to

perform the procedure in a faster and less invasive way. Prior studies reported an intranodal forceps biopsy (IFB) strategy for mediasnal

lesions, which emphasizes the essenality of sample amount for improving diagnosc sensivity (4). Agrawal et al. performed a meta-analysis

and concluded that the addion of EBUS-IFB to EBUS-TBNA improves the overall diagnosc yield of sampling intrathoracic adenopathy when

compared with EBUS-TBNA alone. The complicaon rates of the combined approach were higher than with EBUS-TBNA (5). In our pracce,

TMC does not have greater complicaons than EBUS-TBNA. It would be interesng to compare the diagnosc yield and complicaons be-

tween TMC and IFB in the future.

Conclusion

We believe EBUS-guided TMC, compared to EBUS-TBNA, provides more adequate histological samples, adding value to current diagnosc

approaches for mediasnal diseases, especially for lymphoproliferave disorders, or when more ssue is needed for molecular determina-

ons. Further studies are needed to address safety and outcomes of this technique.

References:

1. Franke K et al. Lung. 2012;190:227–32.

2. Ariza M et al. Arch Bronconeumol. 2022 May 30:S0300-2896(22)00390-8.

3. Zhang J et al. Eur Respir J. 2021;58:2100055.

4. Herth F et al. Ann Thorac Surg. 2008 Jun;85(6):1874-8.

5. Agrawal A et al. Ann Thorac Surg. 2022 Jul;114(1):340-348.

Figure 1. PET-CT scan showed an increased FDG uptake at staons 7 and

11L (A). Performing EBUS-TBNA in staon 7; TBNA needle sheath (B). Punc-

ture site made by TBNA needle, black arrow (C). Tip of the cryo-probe ap-

proaching the puncture site (D), and a p of the cryo-probe completely

inside the node (E). EBUS image showing the p cryo-probe within the

lymph node, black arrow (F). Tip of the probe has the lymph node ssue

obtained by cryo-nodal biopsy (G). Bronchoscopic view of the puncture site

aer performing cryo-nodal biopsy, black arrow (H). Samples obtained

from transbronchial mediasnal cryobiopsy (I).

Figure 2. Gross-micro view of the cryobiopsy specimen, with 0.5 cm

fragments (A-B). Histological secon (H&E). Hypercellular areas orga-

nized in nodules are observed (arrows). No necrosis (C). Nodular areas

composed of epithelioid cells clusters (+), forming granulomas. Non-

necrozing granulomatous lymphadenis, compable with sarcoido-

sis (D).

Humanitarian News

W A B I P N E W S L E T T E R P A G E 8

WABIP’s Instute of Intervenonal Pulmonology

Wrien by Ali I. Musani

The World Associaon for Bronchology and intervenonal Pulmonology (WABIP) has come a long way since its incepon,

parcularly in the last decade. The membership has grown steadily over the years to almost 10 thousand. The educaonal,

philanthropic, and social endeavors have expanded at an impressive pace. WABIP has shown remarkable progress, and its

leadership should be proud of these achievements.

Focusing on our organizaon's fundamental goals and concerted eorts to achieve them is vital. WABIP's goals, as outlined

in the mission and goal statement of the WABIP, are "to strengthen global es between regional and naonal sociees or

groups from around the world to enhance paent care, research, and educaon in bronchology and related elds."

I rmly believe that we are at an inecon point in our society's history to do something far beyond what we have done.

With our thousands of experts worldwide, access to rapidly developing and state-of-the-art technologies, close relaonship

with industry, and our unied mission across connents, we have an enormous potenal to do great things for the dissemi-

naon of science and the eld of Intervenonal Pulmonology. We can genuinely democraze the eld of Bronchology and

Intervenonal Pulmonology and eventually disseminate the knowledge, skills, and technology to improve paent care across

the globe. We desperately need to blur the line between resource-poor and resource-rich areas worldwide. Those lines are

men made, aer all.

I have a dream!

WABIP Intervenonal Pulmonology Instute (IPI)

For the last ten years, I have been quietly exploring locaons, business models, educaonal structure, organizaonal feasibil-

ity, and other aspects of developing several instutes of Intervenonal Pulmonology around the globe. I have had signicant

breakthroughs in the last three years, rst in Kuala Lumpur, Malaysia, and then in Istanbul, Turkey.

Both sites have most, if not all, the prerequisites for a fantasc training site for doctors from around the world regardless of

their country of origin, nancial, and social background. We (local IP leaders in Malaysia, Turkey, and me) have had numer-

ous meengs with the leadership of both instuons. We have developed a memorandum of understanding (MoU) and ne-

goated the basic tenets of our partnerships. We presented the progress report of our potenal collaboraon to the board

of directors and the board of regents of the WABIP. The project received overwhelming support, ocial approval, and nan-

cial support from the execuve board of the WABIP to move forward. I have accepted the honor of chairing the ad hoc com-

miee of the WABIP for the development of IPI and formed mulple commiees to achieve these projects' administrave

and educaonal goals. Fundamentally, the IPI will have a mulfaceted educaon, training, technology transfer, and research

mission. Please see below for the details.

IPI Concept:

WABIP will collaborate with public and private hospitals and local IP experts aliated with WABIP around the world. In part-

nership with the host hospital, WABIP will set up Instutes of Intervenonal Pulmonology to oer IP educaon and training

for doctors worldwide and IP-related health services to regional paents.

The host hospital will provide:

• The host hospital will provide the infrastructure for educaon, training, and health care delivery, including a facility

equipped with operang rooms, bronchoscopy suite, pre and post-operave areas, a clinic, an oce, a conference room,

and an in-paent facility.

Humanitarian News

W A B I P N E W S L E T T E R P A G E 9

• The host hospital will provide devices necessary for training IP and paent care, such as exible and rigid bronchoscopes,

Endobronchial Ultrasound (EBUS), Radial ultrasound (REBUS), Navigaon bronchoscopy system, pleuroscope, airway stents,

laser, and electrocautery.

• The host hospital will also provide nancial support for the educaonal program, including airfare, transportaon, resi-

dence, and food for up to 24 faculty (provided by the WABIP) per year.

• The host hospital will arrange malpracce insurance for the faculty.

• The host hospital will aid in obtaining a short-term medical license without going through extensive tesng or documenta-

on from the local government to allow WABIP physicians and trainees to perform procedures on local paents.

• WABIP and the host hospital will seek funding from philanthropic organizaons, individuals, and industry to support the

mission of IPI. They will also collect device donaons (new, used, or refurbished) from industry and hospitals in the resource-

rich parts of the world.

WABIP will provide:

• Expert faculty for teaching and training as well as for performing state-of-the-art procedures on the local paents

• Curriculum and training infrastructure for IP fellowship/mini-fellowship/training for the internaonal trainees

• The Fellowship commiee will screen, invite, train, and cerfy internaonal doctors in dierent disciplines of the IP

WABIP Fellowship:

The fellowship commiee comprised of world experts of IP educators will develop fellowships in specic IP-related areas

such as advanced diagnosc bronchoscopy (including EBUS, Radial EBUS, peripheral bronchoscopy), therapeuc bronchosco-

py (including rigid bronchoscopy, ablaon, and airway stenng), and Pleurology (including pleural procedures). They will

develop policies and processes for selecng fellowship applicants, curriculum, create or use already established standardized

educaonal tools and training methods, and cercaon processes. A cered fellow from WABIP IPI will be able to start an

IP program in their country and train others aer a necessary period of pracce.

WABIP will strive to train fellows who would be able to set up IP programs in their countries with their personal/naonal or

WABIP resources and teach more people and open more centers in the region (the trickle-down eect)

Where are we now?

We selected the rst partner site with the help of Dr. Jamalul Azizi in Kuala Lumpur, Malaysia. Dr. Azizi is the Chair of the

Malaysian Associaon of Bronchology and Intervenonal Pulmonology and a well-known naonal and internaonal leader in

IP. The Cardiac Vascular Sentral of Kuala Lumpur (CVSKL) has a state-of-the-art medical facility where Dr. Azizi pracces IP.

We had several meengs with the leadership of CVSKL, including Mr. Khairul Amin Mohd Nordin, Director of the Clinical Ser-

vices Division, Tan Eng Ghee, CEO, and others. Basic MoU has been negoated. We are nalizing some last details and hope

to discuss and complete the legal contract in three to six months.

Humanitarian News

W A B I P N E W S L E T T E R P A G E 10

Meengs between the IPI (WABIP) leadership and Cardiac Vascular Sentral Kuala Lumpur (CVSKL) leadership.

Top le, Dr. Jamalul Azizi Abdul Rahaman; Top right, Dr. Ali Musani; Middle le, Lim Wang Ying, Head of Health Screening;

Middle right, Tan Eng Ghee, CEO; Boom, Khairul Amin Mohd Nordin, Director of Clinical Services Division

Our second partner site is Liv Hospital Group, Istanbul, Turkey, led by Dr. Levent Dalar.

Dr. Dalar is a well-respected Intervenonal Pulmonologist in Europe. He has served Turkish and the World Associaon of

Bronchology and Intervenonal Pulmonology for several years. I met with the CEO of the Liv Hospitals in Istanbul in Febru-

ary of 2022 and then with the CEO of the enre hospital group mulple mes via zoom. Our progress in Istanbul has been

swi. We have ironed out most of the signicant aspects of our collaboraon through a detailed MoU. The two most rele-

vant areas recently sorted out include medical licenses and malpracce coverage for internaonal physicians. The Turkish

government will allow WABIP faculty to perform procedures for educaonal purposes as a guest lecturer, temporarily ap-

pointed at the İsnye University, the academic partner of the Liv Hospital Group. The fellows will be covered to do proce-

dures under the supervision of the faculty. The hospital will provide malpracce insurance for all faculty and fellows.

Dr. Mehmet Akif Benk, CEO-General Manager Liv hospital Istanbul and Dr. Levent Dalar, Intervenonal Pul-

monologist at Liv hospital, on the right.

Top right, Dr. Levent Dalar; boom right, Meri Isro, CEO of Liv hospital system Turkey.

We are entering the nal stages of the MoU for IPI, aer which we will draw a formal, legally binding contract for both par-

es. We will then put together a list of faculty for each IPI and apply for local approval and malpracce through the respec-

ve hospital/university menoned above. We hope to achieve these by the rst quarter of 2023 and start the programs soon

aer, with an expected ramp-up period of two years. We will be looking for many WABIP faculty to volunteer for teaching

and training at these instutes.

Our industry and markeng eorts have already started. Dr. Dalar and I met with several European device industry repre-

sentaves. The group outlined many areas of collaboraon, including fellowship sponsorships, device donaons, and nan-

Humanitarian News

W A B I P N E W S L E T T E R P A G E 11

cial donaons. We look forward to meeng with a much larger industry liaison group in Marseille during the WCB to launch a

large-scale campaign for IPI.

Aer these two projects are up and running, I want to establish more instutes in North Africa and South America in the

next few years.

*The views expressed in this arcle are those of the author (Ali Musani) and do not necessarily reect the ocial posions of

the Execuve Board or Internaonal Board of Regents of the WABIP.

Best Image Contest 2022 (3 of 3)

Descripon:

Diuse Malignant Inltraon by Lung Cancer

A: Malignant nodules on the diaphragm, B: Malignant nodules on the parietal pleura, C: Malignant nodules

on visceral pleura

Submiers:

Dr. Pree Vidyasagar, Dr. Hari Kishan Gonuguntla

Best Image Contest

P A G E 12

This image is the 1 of 3 selected among 100+ submissions to our Best Image Contest held in late 2021. Please

stay tuned to the next Image Contest opening later this year. Find the above image and more at the WABIP

Academy Image Library at hps://www.WABIPacademy.com/imagelibrary

P A G E 13

WABIP News

Celebrang the 2022 WABIP Awards

We are happy to announce the results of the 2022 WABIP Awards. The below list of awardees are recognized for

their accomplishments and commitments to bronchology and intervenonal pulmonology, and it is with great

honor to celebrate these recipients at our Awards ceremony of our upcoming WCBIP congress in Marseille

France.

Gustav Killian Centenary Medal 2022 Recipient

Marn Phillips, MD (Australia)

WABIP-Dumon Award 2022 Recipient

Sepmiu Murgu, MD (USA)

WABIP Lifeme Achievement Award 2022 Recipient

Teruomi Miyazawa, MD (Japan)

P A G E 14

WABIP News

Celebrang the 2022 WABIP Awards (cont.)

Disguished WABIP Regent Award 2022 Recipient

Spasoje Popević, MD (Serbia)

Heinrich Becker Young Invesgator Awards for Research and Clinical Innovaon 2022 Recipients:

1. Keisuke Kirita, MD (Japan) for the WCBIP accepted abstract tled:

Development of arcial intelligence system classifying malignant and benign cells for rapid on-site cytologic

evaluaon (ROSE) samples of bronchoscopy

2. Øyvind Ervik, MD (Norway) for the WCBIP accepted abstract tled:

Automac idencaon and segmentaon of mediasnal lymph nodes and blood vessels in endobronchial

ultrasound (EBUS) using a deep neural network

3. Sandip Saha, MD (USA) for the WCBIP accepted abstract tled:

A First for Roboc Navigaonal Bronchoscopy and the Use of “Tele-ROSE” in diagnosing lung pathology

We are pleased to have already 850 conrmed on-site aendees at our com-

ing WCBIP in Marseille France. This is the perfect opportunity for delegates to

network and learn from some of the top experts in the eld.

If you can't aend in person, you can sll parcipate via Zoom (virtual), as we

will broadcast live selected sessions. Addionally, on-demand playback of all sessions will be available aer the

congress.

• View the Program Schedule Virtual

• View the Program Schedule ALL

• REGISTER HERE

The Devil Is In The Detail

Lung cancer accounts for almost 1.8 million deaths yearly and is responsible for more than 18% of cancer-related mortality worldwide. Lung cancer

is tradionally classied by histology; small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is more common than SCLC and is

further subdivided into squamous and non-squamous categories. Adenocarcinomas constute most non-squamous NSCLC cancers. Tobacco smok-

ing is strongly associated with SCLC and squamous cell carcinoma but remains associated with all histologic subtypes. Recently, a greater under-

standing of disease biology and the idencaon of oncogenic driver alteraons has revoluonized the therapeuc landscape of NSCLC. Conse-

quently, the new classicaon algorithms of NSCLC characterize them molecularly into aconable mutaons with targeted therapies.

Molecular tesng has become a mandatory component of the NSCLC workup. There are almost a dozen NSCLC molecular targets that have ap-

proved therapies. The detecon of EGFR, BRAF, and MET mutaons and ALK, ROS1, RET, and NTRK translocaons is now the standard of care. Tar-

geted therapies for EGFR exon 19 deleon and L858R mutaons and ALK and ROS1 rearrangements are well established. Several other biomarkers,

e.g., KRAS G12C substuons and HER2 acvang alteraons, are becoming mainstream in NSCLC workup with ancipated targeted therapies.

Most centers now rounely perform analysis of PD-L1 protein expression to ulize immune checkpoint inhibitors. The immune checkpoint inhibi-

tors in the NSCLC management also contributed to the signicant improvement of disease outcomes, parcularly in paents lacking TKI-sensizing

mutaons.

Molecular characterizaon of NSCLC requires analysis of biological markers such as DNA, RNA, and proteins, which in turn requires mulple

plaorms such as PCR, FISH, and DNA sequencing. High throughput sequencing technologies such as next-generaon sequencing (NGS) have

served very well in this regard. However, it's me-consuming (10 or more working days) and expensive. Hopefully, this technology will become

Editor-in-Chief: Dr. Kazuhiro Yasufuku

Research

Primary Business Address:

Kazuhiro Yasufuku, Editor-in-Chief WABIP

Newsleer

c/o Judy McConnell

200 Elizabeth St, 9N-957

Toronto, ON M5G 2C4 Canada

E-mail: newsleer@wabip.com

P A G E 15

Associate editor:

Dr. Ali Musani

Associate editor:

Dr. Sepmiu Murgu

Ali I. Musani MD, FCCP

University of Colorado School of Medicine,

Denver

more ecient and cost-eecve.

Approximately 50–70 % of Asian and 30–40 % non-Asian NSCLS (non-squamous) paents carry targetable mutaons (g 1) and, when treat-

ed appropriately, show signicantly (several folds) improved survival. Unfortunately, most of this progress has not translated into squamous

cell carcinoma paents. Regardless, the last decade has shown a tremendous improvement in personalized and precision therapy of NSCLC

and is exemplary in medical oncology.

When ssue sampling is not feasible in situaons such as recurrent disease, liquid biopsy can provide important informaon about tumor

evoluon during the treatment course. It does, though, require a high tumor burden. There are assays ulizing circulang tumor cells. How-

ever, it is not clear whether they are representave of the enre tumor or a fracon of heterogeneous cancer. The amount of circulang

tumor DNA correlates with tumor response or lack thereof and can be ulized as a marker of the ecacy of therapy.

The tremendous promise lies in more profound discoveries in tumor biology, broad-based clinical trials, and rapid drug development.

References:

1. Tan AC et al. J Clin Oncol. 2022 Feb 20;40(6):611-625. doi: 10.1200/JCO.21.01626. Epub 2022 Jan 5. PMID: 34985916.

2. Imyanitov E et al. Crit Rev Oncol Hematol.2021 Jan;157:103194

Research

P A G E 16

Figure 1. Frequency of targetable oncogenic driver

molecular alteraons in NSCLC (adenocarcinoma).

Incidences of oncogenic driver alteraons extract-

ed from the studies by Burne et al,Dearden et

al,Jordan et al, Shi et al,and Solomon et al.d, dele-

on; ex, exon; ins, inseron; NSCLC, non–small-cell

lung cancer. (1)

P A G E

WABIP ACADEMY- WEBCASTS

The WABIP has started a new educaon project recently: THE WABIP ACADEMY. The WABIP Academy will pro-

vide free online webcasts with new and hot topics that will interest pulmonologists and intervenonalists.

Current webcast topic: Tissue acquision for biomarker directed therapy of NSCLC

You can reach these webcasts by using this link: hp://www.wabipacademy.com/webcast/

www.bronchology.com Home of the Journal of Bronchology

www.bronchoscopy.org Internaonal educaonal website for

bronchoscopy training with u-tube and

facebook interfaces, numerous teachiing

videos, and step by step tesng and assess

ment tools

www.aabronchology.org American Associaon for Bronchology and I

ntervenonal Pulmonology (AABIP)

www.eabip.org European Associaon for Bronchology and

Intervenonal Pulmonology

W A B I P N E W S L E T T E R

Links

www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)

NetWork

www.thoracic.org American Thoracic Society

www.ctsnet.org The leading online resource of educaonal and

scienc research informaon for cardiothoracic

surgeons.

www.jrs.or.jp The Japanese Respirology Society

sites.google.com/site/asendoscopiarespiratoria/

Asociación Sudamericana de Endoscopía Respiratoria

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