Radiological and nuclear medicine methods play a fundamental role in the diagnosis and staging of patients with lung cancer. Imaging is essential in the detection, characterisation, staging and follow-up of lung cancer. Due to the increasing evidence, low-dose chest computed tomography (CT) screening for the early detection of lung cancer is being introduced to the clinical routine in several countries. Radiomics and radiogenomics are emerging fields reliant on artificial intelligence to improve diagnosis and personalised risk stratification. Ultrasound- and CT-guided interventions are minimally invasive methods for the diagnosis and treatment of pulmonary malignancies. In this review, we put more emphasis on the new developments in the imaging of lung cancer.

Background: Lung cancer is the leading cause of cancer-related death worldwide. Early diagnosis is crucial to increased survival rates. Radial endobronchial ultrasound (rEBUS) and electromagnetic navigation bronchoscopy (ENB) have been developed for the diagnosis of small lung lesions. The aim of this systematic review was to evaluate whether the combination of rEBUS and ENB is superior to ENB alone. Method: A systematic search was performed using MEDLINE, Embase, and Cochrane Library databases on “ENB,” and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The project was registered with PROSPERO, number CRD42020214682. Results: In total, 2,092 studies were identified through a literature search. Five studies were included in the final review. One study found that the addition of rEBUS increased diagnostic yield, while another concluded the converse. Three studies did not have significant results. Meta-analysis was not feasible due to heterogeneity and the small number of studies. Conclusion: As the current evidence on the topic is sparse and heterogeneous, it is not possible to conclude whether the addition of rEBUS to ENB has a significant impact on diagnostic yield. Further studies are needed to illuminate this question in order to ensure optimal choice of endoscopic technique as well as used time and resources. The project received funding from the Region of Southern Denmark’s PhD fund.

Background: Patients with lung cancer exhibit increased risk of pulmonary embolism (PE). While the contrast phase of computed tomography of the chest in the diagnostic work-up of suspected chest malignancy does not allow reliable detection of PE, it may be feasible to screen for present PE during endobronchial ultrasound (EBUS) examination. Objectives: The aim of this study was to establish if screening during EBUS for PE in patients with suspected lung cancer is feasible and if positive findings are predictive of PE. Methods: Patients undergoing EBUS due to suspicion of malignancy of the chest were prospectively enrolled. The pulmonary arteries were assessed during EBUS using a standardized protocol. Patients in whom PE suspicion was raised were referred to confirmatory imaging. Results: From December 2020 to August 2021, 100 patients were included. Median time for vascular assessment during EBUS was 2 min (Q1–Q3: 1–3 min). EBUS identified two suspected PEs (2%), and the number needed to scan was 50. The positive predictive value of EBUS for PE was 100%. Conclusion: EBUS for PE screening seems feasible and with limited time use. The PPV of positive findings for the diagnosis of PE is high, but the utility is somewhat limited by a high number needed to scan even in a high-risk population. Based on our findings, we believe that EBUS assessment of the pulmonary vasculature may have a role as a routine screening tool for PE. The assessment for PE should be implemented in EBUS training programmes, as operators should be able to recognize incidental PEs.

AI and robotic bronchoscopy boost early lung cancer detection, dual-energy CT and cardiac MRI advance pulmonary vascular imaging, evidence-based standardised ultrasound training progresses. Innovation is reshaping respiratory medicine. https://bit.ly/454pPX3

Background: Pneumothorax is a common complication after CT-guided transthoracic lung biopsy. Pneumothorax is most often diagnosed with a conventional chest X-ray after a two-hour observation period. Ultrasound has been shown to be superior to conventional X-rays in diagnosing pneumothorax in some settings and it can be repeated without radiation exposure. Purpose: The aim of the study was firstly to explore the sensitivity and specificity of thoracic ultrasound compared to conventional chest x-ray following CT-guided transthoracic lung biopsy, and secondly to investigate the dynamic changes of pneumothorax size using ultrasound. Methods: This prospective study was conducted at Odense University Hospital in the Department of Radiology. Adult patients undergoing CT-guided lung biopsy were eligible for inclusion. A total of 26 patients were included in the study and were scanned five times in sitting upright and supine positions during the two-hour observation time using the FLUS Protocol. Results: Pneumothorax was diagnosed via chest x-ray in 11 (42%) patients. With the patient in an upright position, the ultrasound had a sensitivity of 63.6% and a specificity of 93.3%. These numbers rose to 72.3% and 100% in the supine position. Monitoring the pneumothoraces showed a slight increase in size during the two hours. Conclusions: Ultrasound can be used to diagnose pneumothorax after CT-guided lung biopsy. All pneumothoraxes that were identified by ultrasound were detected within the first 30 min. The dynamic changes of pneumothoraxes showed that the size of the pneumothorax did not increase to a level where the patient needed intervention or admittance.

Diagnosing lung cancer using a flexible bronchoscope is a safe procedure with a very low risk of complications. Bronchoscopy has high diagnostic accuracy for endobronchial lesions, but it falls short when sampling peripheral lesions. Therefore, several modalities have been invented to guide the bronchoscope to the lesion and confirm the location of the tumor before tissue sampling. Fluoroscopy is used during bronchoscopy to provide a 2D X-ray image of the thorax during the procedure. The bronchoscope and tools will be visible, as well as lesions if larger than 2.0-2.5 cm. Radial endobronchial ultrasound (rEBUS) consists of an ultrasound probe, small enough to be inserted into the working channel of the bronchoscope. The ultrasound probe is used to differentiate between consolidated tissue, such as tumor tissue, and normal air-filled lung parenchyma. Electromagnetic navigation bronchoscopy (ENB) creates a 3D model of the bronchial tree from computed tomography (CT) scans of the patient. Prior to the bronchoscopy, a route from the trachea to the lesion is planned, to create real-time guidance of the bronchoscope to the lesion during the procedure, similar to the Global Positioning System. The aim of this article is to describe a stepwise approach to performing bronchoscopy with rEBUS and fluoroscopy, bronchoscopy with ENB, rEBUS, and fluoroscopy. In the discussion section, the pros and cons of each modality will be discussed.