Lung cancer is the most lethal cancer type in Taiwan and worldwide. Early detection and treatment advancements have improved survival. However, small peripheral pulmonary nodules (PPN) biopsy is often challenging, relying solely on bronchoscopy with radial endobronchial ultrasound (EBUS). Augmented fluoroscopy overlays the intra-procedural cone-beam computed tomography (CBCT) images with fluoroscopy enabling real-time three-dimensional localization during bronchoscopic transbronchial biopsy. The hybrid operating room (HOR), equipped with various types of C-arm CBCT, is a perfect suite for PPN diagnosis and other interventional pulmonology. This study shares the single institute experience of EBUS transbronchial biopsy of PPN with the aid of augmented fluoroscopic bronchoscopy (AFB) and CBCT in an HOR. We retrospectively enrolled patients who underwent robotic CBCT, augmented fluoroscopy-guided, radial endobronchial ultrasound-confirmed transbronchial biopsy and cryobiopsy in a hybrid operating room. Patient demographic characteristics, computed tomography images, rapid on-site evaluation cytology, and final pathology reports were collected. Forty-one patients underwent transbronchial biopsy and 6 received additional percutaneous transthoracic core-needle biopsy during the same procedure. The overall diagnostic yield was 88%. The complications included three patients with pneumothorax after receiving subsequent CT-guided percutaneous transthoracic needle biopsy, and two patients with hemothorax who underwent transbronchial cryobiopsy. Overall, the bronchoscopic biopsy of PPN using AFB and CBCT as precise guidance in the hybrid operating room is feasible and can be performed safely with a high diagnostic yield.

Characteristics of the Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD) caused by distinct subspecies remain uncertain. This study was conducted from 2013 to 2015 in three hospitals in Taiwan. Among the 144 patients with MAC-PD, 57(39.6%), 37(25.7%), 37(25.7%), and 13(9.0%) were infected with M. intracellulare subspecies intracellulare (MIsI), M. avium subspecies hominissuis (MAsH), M. intracellulare subspecies chimaera (MIsC), and others, respectively. Patients with MAsH-PD were younger (P = 0.010) with higher human immunodeficiency virus infection rate (27.0%, 0.0%, 0.0% and 7.7% for MAsH-PD, MIsC-PD, MIsI-PD and others, respectively; P < 0.001). Twenty-two (15.3%) patients reported spontaneous culture-negative conversion, but 15 (10.4%) and 33 (22.9%) patients developed radiographic progression and unfavorable outcomes, especially MAsH-PD. The susceptibility rates to clarithromycin and inhaled amikacin were both 98.6%. MAsH demonstrated the lowest rate of resistance to moxifloxacin (66.7%, 97.3%, 89.1% and 92.3% for MAsH-PD, MIsC-PD, MIsI-PD and others, respectively; P = 0.001) and MIsI isolates had the highest rate of resistance to intravenous amikacin (25%, 13.5%, 38.2% and 15.4% for MAsH-PD, MIsC-PD, MIsI-PD and others, respectively; P = 0.024). Pulmonary disease caused by distinct MAC subspecies had different outcomes and drug susceptibility. The local prevalence of species needs to be monitored.

Background/Objectives: Percutaneous transthoracic needle biopsy (PTNB) using advanced navigation techniques is increasingly performed; however, pulmonologists’ experience remains limited. This study reports an interventional pulmonologist’s initial experience with cone-beam computed tomography (CBCT) laser-guided PTNB and the diagnostic performance for lesions with diameters greater than or less than 20 mm. Methods: We retrospectively analysed the data of patients who underwent PTNB in a C-arm CBCT-equipped hybrid operating room between July 2020 and March 2024. All patients underwent the biopsy procedure under local anaesthesia. This was preceded by an initial 3D scan for planning of the needle route, followed by coaxial needle insertion. A post-procedural scan was also performed to identify complications. Results: Seventy-seven patients were enrolled in the study. The median distances of the needle path from the skin to the pleura and from the pleura to the lesion were 33.4 mm and 31.7 mm, respectively. The median number of tissue samplings was 4.9 ± 1.8. The median operating room duration was 51.5 ± 25.7 min, respectively. The median total dose area product was 8485.4 ± 5819.9 µGym². The sensitivity and specificity of our study findings were 93.3% (56/60) and 100%, while the accuracy was 94.8% (73/77). The overall complication rate was 13%. Conclusions: PTNB procedure by pulmonologists is a feasible and safe, single-operator workflow in a hybrid operating room. It can be performed under CBCT laser guidance with a similar diagnostic yield, acceptable radiation exposure and procedure duration, and minimal or manageable complications.

Introduction: Circulating tumor DNA (ctDNA)-based molecular residual disease (MRD) testing is emerging as a tool to refine relapse risk and guide surveillance after curative-intent therapy for non-small cell lung cancer (NSCLC). Tissue-free (plasma-only) MRD assays may improve feasibility where tumor tissue is limited. Prospective and trial-embedded studies have established that ctDNA MRD detected after curative-intent therapy is prognostic for recurrence in NSCLC, but how tissue-free MRD testing is deployed in routine care in Asia-Pacific and the Middle East (AMEA) has not been described. We characterized ordering patterns and first-test positivity in an AMEA cohort. In this descriptive cohort (159 NSCLC patients; 257 samples), 40.9% of patients underwent more than one MRD test, with a median interval of 4.9 months between the first two tests; first-test MRD positivity was 15.7% (25/159; 95% CI 10.9–22.2) with rates of 0% (0/9; 95% CI 0.0–29.9), 8.8% (5/57; 95% CI 3.8–18.9), 21.5% (17/79; 95% CI 13.9–31.8) and 21.4% (3/14; 95% CI 7.6–47.6), respectively, across stages I, II, III, and oligometastatic stage IV disease. No hypothesis testing was performed, and the stage I and oligometastatic stage IV subgroups are small, so the confidence intervals overlap widely and apparent between-stage differences should not be interpreted as a stage effect. Case Presentation: Six illustrative cases involving patients with stage II–IVB describe the use of MRD testing in routine clinical care. The cases were selected purposively, not consecutively, to span the contexts in which the results were interpreted: a positive result shortly before radiographic nodal recurrence (Case 1); a positive result during long-term adjuvant osimertinib preceding isolated mediastinal relapse (Case 2); a transient positive result with subsequent clearance and radiographic regression (Case 3); a positive result that prompted PET-CT revealing occult metastatic disease (Case 4); serially negative results concordant with sustained radiographic remission (Case 5); and a positive result that prompted comprehensive genomic profiling identifying an actionable KRAS G12C alteration (Case 6). Conclusions: Across Asia-Pacific and the Middle East, tissue-free MRD testing in NSCLC was used primarily during surveillance and often serially; first-test positivity was 15.7% (95% CI 10.9–22.2) overall, with wide and mutually overlapping confidence intervals across stages. The cases illustrate that MRD results may prompt diagnostic evaluation when interpreted alongside imaging and other clinical findings, but they are purposively selected, and treatment changes that followed a result are reported as description, not as evidence of benefit. No assay performance characteristic is estimated. These findings are hypothesis-generating; prospective, MRD-directed trials with standardized timepoints, thresholds, confirmatory strategies and pre-specified clinical actions are needed before MRD results can guide treatment.

Background: Advanced interventional pulmonology (IP) increasingly depends on cone-beam computed tomography (CBCT) and hybrid imaging workflows for the diagnosis and management of intrapulmonary lesions. However, globally, many IP teams still lack a dedicated pulmonology procedure suite in their institution and instead perform cases in rooms originally designed for cardiovascular, neurovascular, interventional radiology, or surgical use. Methods: This review evaluates ceiling-mounted single-plane systems, floor-mounted systems, older and newer biplane angiography suites, robotic CBCT hybrid operating room systems and mobile CBCT systems and their suitability for IP procedures. Results: Based on available literature and institutional experience, ceiling-mounted single-plane systems may offer ergonomic advantages for bronchoscopic IP because they preserve head-side access and procedural ergonomics. Floor-mounted systems remained usable, particularly in older institutions, but could restrict airway-side positioning. Biplane-suite capabilities varied by system generation and configuration; some newer configurations provided CBCT and overlay functions that may facilitate pulmonary workflows. Robotic hybrid systems may provide broad procedural flexibility for complex and combined procedures but require greater institutional support. Mobile CBCT systems represented a practical entry strategy for centers without dedicated infrastructure, while conventional multidetector CT remained valuable for selected percutaneous interventions. Successful adaptation across all platforms depended on room layout, workstation capability, team familiarity, anesthesia support, and multidisciplinary collaboration. Conclusions: Advanced IP programs can be developed without a purpose-built pulmonology suite. Careful adaptation of existing imaging environments may allow centers to expand precision bronchoscopic and percutaneous capabilities according to local resources and workflow realities.