Volume 05
Issue 02
May 2017
Inside This Issue
Opinion/Editorial, 2
Technology Corner, 3,4
Tips from the Experts, 5,6
Humanitarian News, 7
Educaon and Training, 8,9
BOR News, 10
Research, 11
Bronchoscopy Around the World, 12
WABIP Academy Webcasts, 13
Links, 13
Upcoming Events, 14
a lack of PCP commitment to LCS.
Planning also requires the support
of local leadership and a business
model that includes funding for a
nurse navigator and database devel-
opment or soware plaorm to
manage and track screened pa-
ents, nodules detected, and allows
for data reporng to an accredited
registry. The implementaon phase
should emphasize how to ensure
that screening is only performed in
appropriate individuals, how to per-
form shared decision making and
incorporate tobacco cessaon, the
process for following up abnormal
ndings, and adherence to repeat
imaging. Lastly, maintaining the pro-
gram should involve reviewing quali-
ty metrics and registry data to en-
sure it is operang as intended.
In conclusion, implemenng LCS has
many moving parts with challenges
that may vary based on locally avail-
able resources and enthusiasm for
screening, but it absolutely can be
done. To develop and implement a
program that is eecve and safe
involves buy in from many dierent
disciplines and services. A carefully
planned approach with a focus on
the essenal components for LCS
will do much to ensure a successful
program start and uptake. Finally,
connuing review of system and
paent level outcomes is important
for quality assessment and future
adaptaons of the program.
1. Aberle DR et al. N Engl J Med.
2. Bach PB et al. JAMA. 2012;307
3. Mazzone P et al. Chest. 2015;147
4. Wiener RS et al. Am J Respir Crit Care
Med. 2015;192(7):881-91.
5. Gesthalter YB et al. Chest. 2017
Nichole T. Tanner,
Associate Professor of
Co-Director, Lung Cancer
Screening Program
Medical University of
South Carolina
Core invesgator and Lung Cancer Screening
Health Equity and Rural Outreach Innovaon
Center (HEROIC)
Ralph H. Johnson Veterans Aairs Hospital
Six years ago the landmark Naonal
Lung Screening Trial (NLST) was pub-
lished demonstrang a mortality
benet to screening asymptomac
individuals at high risk based on age
and smoking history with annual low
-dose computed tomography
The number needed to
screen to prevent one death from
lung cancer was 320; a number simi-
lar to that for mammography in
women 60 and older. The NLST also
demonstrated a high number of false
posive results with LDCT screening
with approximately 1 in 4 paents
having a screen detected nodule. The
vast majority of these nodules (96%)
were not malignant in nature and
the potenal risk of downstream
invasive tesng for benign disease
along with paent anxiety gave many
pause to recommend widespread
implementaon of lung cancer
It wasn’t unl 2013 that the United
States Preventave Services Task
Force gave a lung cancer screening
(LCS) with LDCT a grade B recom-
mendaon for high risk individuals.
Following this recommendaon,
broad uptake of LCS did not occur as
many sll had concerns about the
best way to implement LCS and in-
surers were largely not providing
coverage. In March 2016, close to 5
years aer the publicaon of the
NLST, the Centers for Medicare and
Medicaid Services (CMS) approved
coverage for lung cancer screening
for its eligible beneciaries, however
nong the potenal risks, a paent
shared-decision making visit was
mandated prior to LDCT; the rst for
any cancer screening test.
Implemenng lung cancer screening
has become much more than adver-
sing and a scanner; professional
sociees cauon that LCS should be
conducted in a muldisciplinary and
comprehensive program that incor-
porates experse in pulmonary nod-
ule management as well as tobacco
treatment services. In a joint policy
statement, the American College of
Chest Physicians and the American
Thoracic society recommend nine
programmac components to ensure
that LCS is conducted eecvely, with
quality, and safety.
These compo-
nents include standardized protocols
for performing LDCT, reporng re-
sults, and pulmonary nodule evalua-
on. Paent eligibility, frequency and
duraon for LCS comprise as well as
paent and provider educaon are
addional components.
While these essenal components
provide an ideal framework for im-
plementaon, the real-world logiscs
of starng a LCS program can be com-
plicated. The ACCP and ATS outline
strategies for the successful imple-
mentaon LDCT screening programs
into clinical pracce in a separate
policy statement.
These praccal
approaches are categorized into
three phases: planning, implementa-
on, and maintenance of LCS. The
planning phase should be guided by a
muldisciplinary steering commiee
that includes engagement and educa-
on of primary care providers. Evalu-
aons of early-adopng LCS pro-
grams at three unique centers sug-
gests that failure to do so resulted in
Guest Opinion/Editorial
WABIP Newsletter
M A Y 2 0 1 7 V O L U M E 5 , I S S U E 2
Zsolt Papai MD
Székesfehérvár, Hun-
Silvia Quadrelli MD
Buenos Aires, Argen-
Hideo Saka MD
Nagoya, Japan
Secretary General
Hojoong Kim MD
Seoul, Korea
Eric Edell MD
Rochester MN, USA
President WCBIP 2018
Quangfa Wang MD
Beijing, China
President WCBIP 2020
Henri Colt MD
Laguna Beach, CA
Immediate Past-chair
Michael Mendoza
General Manager
Judy McConnell
Kazuhiro Yasufuku
Newsleer Editor-in-
P A G E 2
How to set up a lung cancer screening program: more than a glossy brochure and a CT scanner
Technology Corner
Endobronchial blockers for Lung Isolaon in Massive Hemoptysis
Introducon: Balloon-based endobronchial blockers were developed for lung isolaon for thoracic surgical procedures as an alter-
nave to double lumen intubaon. They have been used, however, for lung isolaon in the seng of massive airway bleeding.
There are a variety of endobronchial blockers available on the market, which vary in regards to design and instrucons for use. The
purpose of this essay is to describe the basic specicaons and techniques for using two such devices as they may be applicable to
clinicians encountering massive airway bleeding.
Background: Most paents with massive hemoptysis die due to asphyxiaon. Approximately 150 to 200 milliliters (ml) of blood
could interfere with gas exchange and cause respiratory failure and death. This is because the amount of blood needed to ll the
anatomical dead space in most paents is only about 150 ml. Massive hemoptysis has been dened in dierent series as > 200 to >
600 mL of blood per 24 hours, but due to the rather small quanty of blood needed to ll the anatomic dead space, death will typi-
cally occur prior to exsanguinaon. Bleeding rate of 1,000 ml within a 24-hour period, aspiraon of blood in the contralateral
lung, massive bleeding requiring single-lung venlaon and lung cancer as underlying eologies have all been associated with high-
er mortality. Morbidity and mortality are reportedly less when tuberculosis, bronchis or bronchiectasis were responsible for the
massive hemoptysis. Some series report higher mortality rates in paents who experienced recurrent bleeding following bronchial
artery embolizaon (BAE) for massive hemoptysis.
The rst priority in the management of massive hemoptysis is to maintain a paent airway. While seng up the equipment for
endotracheal intubaon and lung isolaon, the paent should be placed in the lateral safety posion (lateral decubitus posion)
with the bleeding side down so blood does not also ll the unaected lung. Bronchoscopists should be familiar with the use of en-
dobronchial blocker placement as a means to isolate the bleeding lung, control massive hemoptysis and spare airways for gas ex-
change. In fact, transporng a paent to intervenonal radiology or intensive care unit without a secured airway (and isolated
bleeding lung) in cases of massive hemoptysis is considered unsafe in the event of airway occlusion from large blood clots in route.
Commonly used endobronchial blockers mainly vary in steering technique, balloon size, locking mechanism and method of place-
ment. The two blockers described herein need visual guidance for proper placement in the desired airway. A locking system is
available to secure the blocker in the desired locaon and reduce the risk for migraon. There are no published surveys, however,
assessing the operators’ comfort level or user-friendly features for the various available systems. The Arndt endobronchial blocker
(Cook Medical) require the use of a pediatric bronchoscope when the blocker is placed though a regular 7.0-8.5 endotracheal
tubes. An alternave technique can be used, in which the blocker can be inserted in the airway alongside the endotracheal tube,
even by using a regular diagnosc adult bronchoscope (Figure1). The VivaSight EB (Ambu A/S) can be used without the broncho-
scope when inserted through a dedicated endotracheal tube with a built-in camera (VivaSight –SL, Ambu A/S) (Figure 2). To date,
there are no comparison studies between the blockers designed by dierent manufacturers. Familiarity, availability, the feasibility
of using a bronchoscope in emergent situaons and costs impact operators’ selecon of a parcular endobronchial blocker.
Clinical applicaons: The Arndt endobronchial blocker (Cook Medical) and the VivaSight-EB (Ambu A/S) while approved for clinical
use for lung isolaon, have not yet been systemacally studied for massive hemoptysis. There are several issues that require aen-
on when using these devices for lung isolaon in massive hemoptysis:
1. Massive bleeding from the le lung: selecve intubaon of the right main bronchus (RMB) should be performed emergently.
However, because of the short length of the RMB (1.5-2 cm), it is very likely that the takeo of the right upper lobe bronchus
would be occluded if the ETT is properly posioned in the RMB. Venlaon to the right lower lobe (RLL) and right middle lobe
(RML) may not be tolerated, and thus, alternaves have been proposed; a double lumen endotracheal tube could be consid-
ered, but it may not be feasible to place these tubes in emergent situaons for hemoptysis. Thus, an endobronchial blocker
could be placed in the le main bronchus, while keeping the ETT in the trachea (Figure 3). This way, the enre right lung is
being venlated, while prevenng spillage of blood from the le lung.
2. Massive bleeding from the right lung: in this scenario, the le lung should be selecvely intubated; this is feasible as the le
main stem bronchus is typically 5 cm in length and a single lumen ETT can be placed in posioned in the LMB. If the bleeding is
from the RML or RLL, however, the ETT can be secured in mid trachea and the blocker posioned in the Bronchus intermedius
(Figure 1), allowing venlaon not only of the le lung but also of the RUL.
P A G E 3
3. Paent safety during and blocker inseron:
A. The balloon should never be overinated; in fact, the balloon should be deated for a few minutes three mes a day in order to
preserve mucosal viability and to check for bleeding recurrence.
B. If venlaon becomes dicult during endobronchial blockade, the balloon should be deated and the its posion inspected as
migraon is possible
C. Higher PEEP and low dal volume may occur during placement due to the presence of scope and blocker in the ETT
Conclusions: The available endobronchial blockers have dierent design, inseron technique and maneuverability. The lack of published
literature makes a fair comparison between dierent blockers in the same paent populaon impossible. We believe that by appropriately
using the endobronchial blockers in the seng of massive hemoptysis, praconers can safely isolate the bleeding lung and potenally
stabilize paents unl denive treatment is oered.
Figure 1
Arndt Endobronchial blocker. Top le: The Arndt endobronchial blocker uses a
guide loop assembly that ts through the lumen of the blocker and exits from the
blocker’s distal end to form a small, adjustable loop. Top center: The bronchoscope
is placed through the diaphragm of the bronchoscopy port of the Arndt Mulport
Airway Adapter; the bronchoscope is advanced through the guide loop. Top right:
Once coupled through the Arndt Mulport Airway Adapter, the bronchoscope and
the blocker are placedon the endotracheal tube and the paent venlated with
100% oxygen. The guide loop should be adjusted to loosely approximate the diame-
ter of the bronchoscope. Boom le: The blocker is inserted in the airway alongside
the endotracheal tube. Boom Center: The blocker can be placed in the bronchus
intermedius (BI) in cases of bleeding form the RML or RLL. Boom right: When
placed in the BI, the RUL bronchus patency is maintained. Photos courtesy of Eric Edell, Mayo Clinic and Sepmiu Murgu, University of Chicago.
Figure 2
Le panel: VivaSight-EB is an endobronchial blocker designated for lung isolaon. It consists of a
sterile, single-use, “steerable” balloon-pped catheter that is visually guided to a selected airway.
The angled distal p of VivaSight-EB can be adjusted to facilitate placement in the desired bronchi.
When used in conjuncon with the VivaSight-SL connuous monitoring throughout the procedure
ensures that dislocaon can be easily detected and corrected. Right panel: For visual guidance
during posioning the blocker can be used in combinaon with the bronchoscope or the VivaSight-
SL single lumen tube (arrow) with integrated camera.
Figure 3
Managing strategies for massive hemoptysis. A. In case of le
lung bleeding, the ETT can be secured in the trachea and the
endobronchial blocker placed either through the ETT or along
its side and posioned in the le main bronchus. The right
upper lobe can be closed o with a right mainstem bronchus
intubaon. B. In cases of right lung bleeding, the le main
bronchus can be intubated over the bronchoscope. This is
possible as the LMB is ~5 cm in length.
1. Sakr L et al. Respiraon 2010; 80: 38-58
2. Shigemura N et al. Ann Thorac Surg 2009;87:849–853.
3. Conlan AA et al. Thorax 1980; 35:901-9044.
4. Kalyanaraman M et al. Otolaryngol Head Neck Surg 1997; 117:56-61.
5. Dweik R et al. Clin Chest Med 1999; 20:89–105
6. Garzon AA, et al. Ann Surg 1978;187:267–271
7. Osakia SI et al. Respiraon 2000;67:412–416. 49
8. Wang GR et al. J Vasc Interv Radiol 2009;20:722–729. 50
9. Van den Heuvel MM et al. Int J Tuberc Lung Dis 2007;11:909–914
W A B I P N E W S L E T T E R P A G E 4
Tips from the Experts
P A G E 5 V O L U M E 5 , I S S U E 2
The Naonal Comprehensive Cancer Network 2017 Clinical Pracce Guidelines for Non-Small Cell Lung Cancer (NSCLC) recommend concom-
itant diagnosis, staging and acquision of adequate material for genec tesng (1). Addionally, it is recommended to ulize the least inva-
sive biopsy with the highest yield. The use of endobronchial ultrasound (EBUS) guided transbronchial needle aspiraon (TBNA) has become
the procedure of choice to diagnose and stage locally metastac lung cancer. NCCN guidelines also recommend broad molecular proling of
samples to idenfy possible targetable mutaons or for eligibility for clinical trials.
Molecular tesng has undergone a tremendous evoluon in the past decade: unl recently comprehensive molecular proling required mul-
ple tests for single mutaons or translocaons (eg: PCR, Sanger sequencing, Fluorescence in situ hybridizaon, immunohistochemistry)
which could incur a high cost in terms of nances, me, and quanty of ssue samples (2). Next Generaon Sequencing (NGS) ulizes a sin-
gle test to idenfy thousands of mutaons from hundreds of genes allowing for the examinaon of the enre cancer genome and transcrip-
tome. The use of formalin xaon of cytology specimens and possibly the centrifugaon required for cell block preparaon have been
shown to result in signicant degradaon of macromolecules, whereas air-dried cytology smears result in improved preservaon of nucleic
acids (3,4). Therefore, the ability to run NGS tesng on cytology smears may oer a benet in molecular tesng accuracy. In fact, cytology
smears have been recently shown to provide a beer DNA quality for NGS than resected specimens and core biopsies (5). Most important-
ly, slide cellularity and adequacy can be assessed at the me of the procedure (rapid on site examinaon), whereas cell block and/or core
biopsy adequacy cannot be assessed unl aer processing.
EBUS Procedure:
EBUS procedure is performed as per standard of pracce for staging NSCLC: N3, N2, N1 nodes in sequence; minimum of three aspirates per
Per roune pracce at our instuon, aer obtaining informed consent, the paent undergoes general anesthesia. Complete EBUS explora-
on of the mediasnal and hilar lymph node staons is performed in a systemac manner. On examinaon, if a lymph node greater than 5
mm is idened, EBUS guided transbronchial needle aspiraons of the lymph node are performed using a EBUS-TBNA needle (25 or 22
gauge). This process connues through the remaining lymph node staons.
Sample Processing:
In our instuon, aer the sample is aspirated, the needle is removed from the EBUS scope and the sample is discharged onto a glass slide,
rst by replacing the needle stylet followed by injecon of air using an empty syringe aached to the stylet hub. The drop of material dis-
pelled on the glass slide and the slide is then smeared with a second slide, resulng in two smears. One of the smears is then air-dried for
ROSE using Di-Quik stain. The second slide is sprayed-xed with alcohol for future Pap staining. The remaining aspirate material is placed
into Cytolyt soluon or formalin, which will subsequently be processed into a cell-block.
Rapid On-Site Evaluaon (ROSE):
Slides are then stained by a cytotechnologist and reviewed by the cytopathologist on-site. Slides are considered adequate if evidence of tar-
get sampling was present. For example, when sampling a lymph node, the presence of lymphocytes, anthracosis, granulomas or tumor
would be considered adequate (Figure 1). Examples of inadequate samples include the presence of blood or benign bronchial cells (pick-ups)
only. If malignant cells are present, the tumor is then subtyped if possible based on cytomorphology alone. If the diagnosc subtype is fa-
vored to be non-small cell carcinoma, the smear is then evaluated to determine if adequate tumor is present for molecular studies. In our
molecular lab approximately 2000 tumor cells are required for Oncoscreen panel ( 50 genes) and 20,000 tumor cells for the OncoPlus panel
( > 1000 genes). The esmaon of cellularity is based on the experience of the cytopathologist, but more objecve tools should be applied
for clinical trials.
EBUS specimen handling for next generaon sequencing (NGS)
Jerey Mueller, MD
Associate Professor of Pathology
The University of Chicago
Tips from the Experts
P A G E 6 V O L U M E 5 , I S S U E 2
If more than half of the slide has tumor, the cellularity is considered adequate for both panels (Figure 2). If the smear is considered adequate
for diagnosis but inadequate for molecular studies, addional passes are performed and evaluated unl an adequate smear is obtained. If
needed, several smears may be combined to achieve the minimum cellularity requirement.
Molecular Pathology Evaluaon:
The selected smears are then submied to the molecular laboratory for next generaon sequencing (NGS). This tesng includes the lung
fusion panel (ALK/RET/ROS1 fusion gene tesng) and the Oncoscreen solid tumor mutaon panel, which includes all currently targetable mu-
taons in NSCLC
In my opinion, using Rapid-Onsite Evaluaon in conjuncon with EBUS is far superior to a non-ROSE method for assessing adequacy for com-
prehensive molecular tesng and allows the most benet to the paent by minimizing excessive procedures, obtaining diagnosc and staging
informaon and adequate material for molecular tesng. This pracce adheres to the current lung cancer guidelines.
1. Enger DS et al. JNCCN. 2017; 15(4), 504–35
2. Shao D et al. Sci Rep. 2016; 6(1), 22338. hp://doi.org/10.1038/srep22338
3. Fischer AH et al. JCO. 2011; 29(24), 3331–2– author reply 3332–3. hp://doi.org/10.1200/JCO.2011.35.2534
4. Vincek V et al. Lab Invest. 2003; 83(10), 1427–35
5. Treece AL. et al. Cancer Cancer Cytopathol. 2016; 124(6), 406–14. hp://doi.org/10.1002/cncy.21699
Figure legends
A. Benign lymphoid cells
B. Benign lymphoid cells and anthracosis
C. Granuloma
D. Adenocarcinoma
E. Adequate tumor for molecular studies
Humanitarian News
W A B I P N E W S L E T T E R P A G E 7
The World Bronchology Foundaon Connues to Help Physicians Save Lives and Expand Their Bronchoscopic
Pracce in Guayaquil, Ecuador
In 2012, the World Bronchology Foundaon (WBF) donated a exible bronchoscope to the Hospital de Especialidades - Teo-
doro Maldonado Carbo in Guayaquil, Ecuador. This Hospital serves most of the workers in Guayaquil, as well as many people
coming from afar to receive treatment. Despite numerous improvements in infrastructure and programs in previous years,
the Hospital did not have a bronchoscope. In addion to donang equipment, members of the WBF provided a week-long
bronchoscopy training program (conducted by Dr. Henri Colt & Dr. Silvia Quadrelli) in order to assist increasingly well-trained
Respiratory Medicine sta. Through these eorts, the WBF started a new era in Guayaquil, an era during which the Respira-
tory Medicine Unit was to provide bronchoscopic diagnoses to their many paents. Today more than 30 bronchoscopies are
performed by this unit every month.
Four years later and as part of a connuous growth of the public health care sector in Ecuador, the hospital obtained a new
videobronchoscope from the government. The WBF had been tracking clinical acvies related to the use of originally do-
nated equipment as well as the connuous educaon in bronchoscopy of many members of the Respiratory Medicine Unit.
As part of ongoing follow-up, Dr. Quadrelli (Vice-chair of the WABIP) spent three days in Guayaquil in December, 2016. The
purpose of this trip was to help physicians of the Respiratory Medicine Unit become familiar with new equipment and assist
in training sta in the performance of transbronchial biopsies, only occasionally performed before. Training consisted of dis-
cussing paent scenarios, reviewing paent-care plans, and helping doctors perform 10 procedures under supervision. As a
result, Drs. Ulloa, De Janon & Figueroa gained condence in their abilies to perform transbronchial biopsies, now incorpo-
rated into their daily bronchoscopic pracce.
The WBF is proud of its ability to follow-up with equipment donaon and companion training programs around the world.
The excellent use made of the originally donated exible bronchoscope to the Guayaquil group prompted a change in clinical
pracce, and expanded the abilies of Ecuadorean doctors to assist hundreds of paents with lung diseases. The Foundaon
congratulates members of the Respiratory Medicine Unit for the progress they make each year. Thanks to the eorts of
charitable donaons, educators, and physicians eager to improve paent care, The World Bronchology Foundaon connues
to be a unique channel through which respiratory care is improved for paents in many countries around the world.
Figure 1: Physicians performing transbronchial lung biopsy using a new videobronchoscope in Guayaquil, Ecuador.
*The views expressed in this arcle are those of the author 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. Dr. Silvia Quadrelli is Vice-chair of the WABIP.
WABIP Train the Trainer and Introducon to Flexible Bronchoscopy Program, Maceio, Brazil 2017
Maceió, Brazil, a beauful city in the state of Alagoas, hosted the 2017 Train the Trainer and Introducon to Flexible Bronchoscopy program
conducted by the WABIP in April. Eleven leading bronchoscopists and university educators from several dierent regions in Brazil devoted ener-
gies to learning new educaonal methodologies and exploring their sense of movaon and dedicaon to changing the educaonal paradigm
in the country. As they became familiar with new teaching instruments such as the 4 box praccal approach, bronchoscopy assessment tools
and checklists, also employing role-playing exercises and applying step-by-step instruconal techniques, it became increasingly obvious that
change was needed. This was the second me an experience like this occurs in Brazil, allowing a new group of parcipants to get in touch with
Bronchoscopy Educaon Project philosophy. Priorizing “learner-centered” approach, models were used for “step-by-step” instruconal tech-
niques and to evaluate using competency-oriented validated assessment tools such as the BSTAT (Bronchoscopy Skills and Tasks Assessment
Tool). They had also the opportunity of using checklists to assure knowledge of me out, informed consent, and moderate sedaon, in conjunc-
on with simulaon scenarios and group exercises presented in the Bronchoscopy Educaon Training Manual.
Throughout this two and a half day seminar, didacc lectures, interacve sessions, group exercises, and key discussion points were facilitated
by Henri Colt (Immediate past Chair WABIP and author of The Essenal Bronchoscopy Series of books). A one-day Introducon to Flexible Bron-
choscopy program was held for sixteen Brazilian physicians in-pracce or in-training. This program provided opportunies for parcipants in the
Train the Trainer program to apply their newly learned skills and ideas. Increasing interacon between students and faculty is the key to ac-
quire cognive, aecve, and experienal knowledge.
This 2017 program was directed and organized by Master Instructor, Dr. Viviana Figueiredo (Sao Paolo), and Dr. Tadeu Lopez (Maceio). The
courses were ocially endorsed by the Brazilian Society for Thoracic Surgery (SBCT) and the Brazilian Society for Pneumology and Tisiology
(SBPT). Guest instructors included Hugo Oliveira (cered instructor, Porto Allegre, Brazil) and Patricia Vujacich (Chair of the WABIP Educaon
Commiee, Buenos Aires, Argenna).
Each Train the Trainers Seminar is dierent. This me, closing remarks on acve listening, learner centered approach, case based problem solv-
ing, role-playing educaonal techniques, presentaon skills, lecturing and condenal self-assessment made it exceponal in terms of mova-
on. Iniaves of translang into Portuguese several materials of Bronchoscopy Internaonal were undertaken. So far, numerous university
programs have adopted BSTAT, Step-by-Step, Praccal Approach, and the Informed Consent Checklist into their training programs.
As soon as more learning materials become available in Portuguese it is our hope to expand training to other regions in 2018, and to connue
to disseminate Bronchoscopy Educaon Project philosophy and learning tools throughout Brazil.
Figures 1 and 2 above: Learning to apply technical skill training Step-by-Step during the Train the Trainer program using BSTAT in an inanimate
airway model (Drs. and thoracic surgeons/bronchoscopists Filipe Andrade and Spencer Camargo). Small group workshops provide students in
the Introducon to Flexible Bronchoscopy course an opportunity to implement a common learning for secreon and mucosal ndings using
Education and Training
P A G E 8
Figure 3: Opinion leaders from throughout Brazil gathered to parcipant in the 2017 Train the Trainers Program hosted by Dr. Vivian Figueiredo
(sing, middle) and Dr. Tadeu Lopez (standing right, dark blue shirt). Master Instructors Patricia Vujacich (Argenna) and Hugo Oliveira (Brazil)
are seated to the right of Vivian. Figure 4: Small group case-based praccal approach and BSTAT exercise during the Introducon to Flexible
Bronchoscopy program held in Maceio, Brazil.
XI Biennial Congress of the South American Society for Respiratory Endoscopy (ASER)
This year’s congress was held in Lima, Peru hosted by ASER President Hugo Boo (Argenna) and Congress President Pedro Garcia Manlla
(Peru). A record number of parcipants from throughout Lan America came to Lima for three days of collegiality, friendship, and scienc
engagement. The program included a sponsored Symposium on Thoracic Oncology, chaired by Dr. Silvia Quadrelli, Vice-Chair of the WABIP,
with parcipaon of known Oncologists (Brian Hunnis from Florida University and Carlos Silva from Argenna), a Peruvian intervenonal pul-
monologist on sta at Henry Ford Hospital (Dr. Javier Diaz-Mendoza) and a Peruvian Radiaon Oncologist (Gustavo Sarria).
With more than 100 aendees, congress parcipants included dozens of foreigners from Argenna, Bolivia, Brazil, Chile, Colombia, Spain, Para-
guay, and the United States, as well as 66 Peruvians (58 from Lima and 8 from the Provinces). Faculty numbered 35 speakers and instructors of
which 23 came from abroad and 12 were from Peru. Overall, 72 people aended hands-on workshops organized by Dr. Fernando Monge from
the Peruvian Associaon for Bronchology and Dr. Javier Diaz-Mendoza, with generous support from Industry. Conference aendees unani-
mously say they le Lima with renewed enthusiasm and knowledge of new approaches and techniques that improve their clinical pracce.
Workshop sessions included:
Dicult Airway and Pediatric Bronchoscopy
PDT, Percutaneous Cricothyrotomy, and Bronchoscopy Intubaon
Interacve Sessions: Informed Consent and Praccal Approach exercises for cTBNA
Mediasnal Anatomy and EBUS TBNA
Intervenonal Pleura Procedures and Thoracic Ultrasonography
Rigid Bronchoscopy Intubaon, Stent Placement
Central Airway Obstrucon: Electro and Cryosurgery, including Foreign Body Removal
During the ASER’s business meeng, Chile was chosen to host the next ASER XII Congress. Similar to regional bronchology associaon meengs
in Europe and Asia, the ASER meeng will now be held every two years interposed with the Biennial World Congress of the WABIP. Also during
the congress, the WABIP held a meeng for all South American regents. News from this meeng will be announced in the WABIP Newsleer,
including iniaves proposed by Regents to further the adopon of Bronchoscopy Educaon Project materials across Lan America, and ways
to enhance Regents’ parcipaon in both global and regional acvies of the WABIP.
Figure 1: Dr. Javier Diaz-Mendoza teaching at the EBUS workstaon. Figure 2: Parcipants and faculty at the hands-on workshops of ASER, Peru
Education and Training
P A G E 9
Board of Regents News
(Le to right: Dr. Bilaceroglu, Dr. Encheva, Dr. Flandes, Dr. Arshad Husain, Dr. Musani and Dr. Niwa)
P A G E 10
NEW Board of Regents Members (updated April 2017) - The WABIP is honored and pleased to welcome six new members on the
Board of Regents. The new Regents are doctors: Semra Bilaceroglu (Turkey – EABIP), Milena Encheva (Bulgaria), Javier Flandes
(Spain AEER), Syed Ar- shad Husain (UK – BBG), Ali Musani (USA – AABIP) and Hiroshi Niwa (Japan – JSRE)
WABIP Rare Lung, Airway and Pleura Disorders - A brand new Facebook group for this section is currently live. We invite you to
join this growing group, with now 127 participants from around the world. Click the below link to begin:
Featured WABIP Member Society - Founded in 2002 by Dr. Heinrich Becker, Dr. Chris Bolliger and Dr.
Felix Herth, the European Associaon for Bronchology and Intervenonal Pulmonology (EABIP) is
dedicated to the promoon of high standards in clinical pracce, educaon and research in diagnosc
and therapeuc intervenonal pulmonology including bronchoscopy and thoracoscopy, as well as in the
educaon and training of endoscopy sta, in Europe. With the ECBIP congress just wrapping up only
weeks ago to an astounding success, we invite you to learn more about the society, its leaders and
members. More at hp://www.eabip.org/
New WABIP website We are pleased to present to you a brand new website funconalies & design that takes the WABIP for-
ward as one of the leading medical associaons in the digital and mobile era. Without further ado, have a look at the new site at
WABIP Pediatric BronchoscopyYou are cordially invited to join our new Pediatric Bronchoscopy WhatsApp Group , which has
154 parcipants on board at the me of this wring. Click the following link on your WhatsApp enabled mobile device to join:
With over 50 members strong, the WABIP Board of Regents is the principal governing body of our organizaon. Members of the
BOR vote on Vice-chair candidates in biennial elecons, Bylaws amendments, WCBIP host candidates and other maers central to
governing the WABIP. The BOR is comprised of all members on the WABIP Execuve Board and a minimum of one representave
from every WABIP Member Society.
Annual Board of Regents Meeng –We are proud to announce that the annual meeng held in February 2017 was a success, and
that the business items of reviewing and vong on the prior year and current year acvity & nancial reports were carried out
eecvely. We wish to thank all 29 (out of 52) parcipang Regents in providing valuable eort and support in execung the mis-
sion of the WABIP.
Endobronchial Ultrasound Guided Transbronchial Needle Aspiraon: Beer than Transbronchial
Biopsy for PD-L1 Proling in Lung Cancer
Several recent studies have raised the queson of validity of Endobronchial Ultrasound Guided Transbronchial Needle Aspiraon (EBUS –TBNA)
in sampling for Programmed Death Ligand 1 (PD-L1). The quesons spanned from the amount of cells obtained to the severity of crushed cells
rendering specimen uninterpretable. It was suggested that perhaps the surgical specimens were beer for its size and minimal crushing of the
Well, EBUS-TBNA has shown its dominance in ssue sampling yet again. In samples obtained from lymph nodes in the paents with lung mass-
es who also underwent Transbronchial Biopsy (TBBX) and in some cases resecon of the lesion, the number of cells obtained were signicantly
more than the TBBX and the amount of crushed cells were signicantly less than TBBX. Hence, oering a much beer quality specimen for PD-
L1 analysis. The specimens obtained by EBUS-TBNA also showed a high concordance rate with the surgical specimens in both, primary tumors
and metastac diseases (1).
A recent study from Japan (1), prospecvely looked at 97 paents with EBUS-TBNA specimens, 20 of whom also had TBBX done. These speci-
mens were evaluated for PD-L1 expression as well as the morphological health of the cells (lack of crush/destrucon eect). The study showed
that the total number of cells obtained from EBUS-TBNA were stascally signicantly (P<.001) more than the cells obtained from the TBBX
and the crush eect on biopsy samples was also signicantly lower (P<.001) than TBBX. The PD-L1 expression on EBUS-TBNA specimen showed
good concordance rate with the TBBX, primary tumor and the metastac nodes.
The ability of EBUS-TBNA in providing large number of high quality cells with minimal crush eect and its feasibility for broad spectrum molecu-
lar assays including EGFR (Epidermal Growth Factor Receptor), ALK (Anaplasc Lympho-Kinase) (2)(3) and the likes and now PD-L1 conrms it
as a robust, minimally invasive, high yield, cheap, and quick test for lung cancer diagnosis, staging, and personalized therapy. With the growing
numbers of aconable bio-markers such as above menoned, the signicance of EBUS-TBNA is limitless.
1. Sakakibara R et al. cllc.2016.12.002
2. Navani N et al. Am J Respir Crit Care Med 2012; 185:1316-22.
3. Nakajima T et al. Chest 2007; 132:597-602
Editorial Staff
Associate editor: Dr. Ali Musani
Associate editor: Dr. Sepmiu Murgu
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief
WABIP Newsleer
c/o Judy McConnell
101 College St., TMDT 2-405
Toronto, Ontario M5G 1L7
Phone: 416-581-7486
E-mail: newsleer@wabip.com
P A G E 11
P A G E 12
Malaysia has an esmated populaon of 31 million. There are about 60 pulmonologists in the country.
The Malaysian Associaon for Bronchology and Intervenonal Pulmonology (MABIP) was founded on 31
December 2013 and has a
membership of about 90 local and overseas members.
In 2007, a group of local pulmonologists organised the rst Naonal intervenonal bronchoscopy course. Before 2007, intervenonal
bronchoscopy in Malaysia was patchy and there was no concerted eort to promote the experse. Most pulmonologists then per-
formed basic diagnosc bronchoscopy. Cases that required intervenonal approach would be referred to thoracic surgeons. Encouraged
by the overwhelming response, the intervenonal course was held annually and always had excellent parcipaon from South East Asia
delegates. In 2013, it was felt that a society dedicated to intervenonal pulmonology was needed to promote the growth and pracce in
Malaysia. This annual event which started inially as a course in 2007 has now become a fully edged scienc meeng under the MA-
Bronchoscopy is included in the curriculum of the local pulmonary medicine fellowship. Since 2015, the MABIP runs an annual assembly
for pulmonologists specically devoted to intervenonal pulmonology. It includes didacc lectures, symposia, hands-on workshops, live
cases and free papers. This annual assembly is also aended by pulmonologists from all over Asia. Training in rigid bronchoscopy is
oered by 4 centres, 2 in West Malaysia and 2 in East Malaysia (photo aached).
Basic bronchoscopy, pleuroscopy (including rigid thoracoscopy) and convenonal TBNA are performed in most university and public
hospitals in Malaysia. More than 90% of bronchoscopists are pumonologists. Some general physicians are given privileging in basic bron-
choscopy. As rigid bronchoscopy is only available in 4 centres, other hospitals usually refer their cases to these 4 centres. Therapeuc
bronchoscopy (debulking, airway dilataon, stent placement, electrocautery) is available in these 4 centres. Currently, only 1 centre
performs addional advanced diagnoscs and therapeucs (cryobiopsy, electromagnec navigaon, bronchial thermoplasty and endo-
bronchial valves). 9 centres have linear EBUS and 1 centre has a radial EBUS and a YAP laser respecvely.
The main indicaons for bronchoscopy in Malaysia are in the invesgaon of hemoptysis and lung cancer. Tuberculosis is endemic in
Malaysia and therefore it is sll an important diagnosc indicaon. Sedaon is rounely performed in all instuons, in some centres
using TIVA with the cooperaon of anaesthesiologists for rigid bronchoscopy.
The strong support from the WABIP has allowed the MABIP to conduct its annual assembly and promote the growth of intervenonal
pulmonology in Malaysia and Asia.
P A G E 12
P A G E 13
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
www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)
www.thoracic.org American Thoracic Society
www.ctsnet.org The leading online resource of educaonal and
scienc research informaon for cardiothoracic
www.jrs.or.jp The Japanese Respirology Society
Asociación Sudamericana de Endoscopía Respiratoria
P A G E 13
P A G E 14
EBUS and Advanced Diagnosc Bronchoscopy: The Sixth Year (MD, USA)
When: July 20-21, 2017
Where: Hya Regency Chesapeake Bay, Cambridge, MD
Program Director: Lonny Yarmus, DO, MD
Program Type: Educaonal seminar (postgradua,te may include physicians in pracce and trainees)
Hands-on workshop, Conference (didacc lecture 3rd Annual MABIP Assembly (Malaysia))
When: 3-5 OCTOBER 2017
Program Director: ROSMADI ISMAIL, MD
Program Type: Hands-on workshop, Conference (didacc lectures)
Asian-Pacic Congress on Bronchology and Intervenonal Pulmonology 2017 (Indonesia)
When: November 2-4, 2017
Where: Ayodya Nusa Dua Bali, Indonesia
Program Director: Wahyu Aniwidyaningsih, MD, PhD, MD
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees)
Hands-on workshop Conference (didacc lectures)
P A G E 14
Introducon to Flexible Bronchoscopy (La Habana, Cuba)
3rd Annual MABIP Assembly (Malaysia)
Date: June 9-10, 2017
Venue: Hospital Neumológico de la Habana. Universidad de Medicina Salvador Allende. La Habana, CUBA
Program Directors: Manuel Sarduy, MD and Patricia Vujacich, MD
Program Type: Bronchoscopy course - Introducon to Flexible Bronchoscopy