WABIP Newsletter 2026, Issue 1

Volume 14

Issue 01

January 2026

Inside This Issue

Editorial, 2-3

Technology Corner, 4-7

Tips from the Experts, 8-10

Best Image Contest, 11

WABIP News, 12

Research, 13-14

Links, 15

WABIP 2025 Webinar Brings Global Community Together for

Knowledge Exchange in Interventional Pulmonology

WABIP Newsletter

J A N U A R Y 2 0 2 6 V O L U M E 1 4 , I S S U E 1

EXECUTIVE BOARD

Pyng Lee, MD, PhD

Singapore, Chair

Ali Musani, MD

USA, Vice-Chair

Stefano Gasparini, MD

Italy, Immediate Past-Chair

Hind Janah, MD

Morocco, Membership

Commiee Chair

Aleš Rozman, MD, PhD

Slovenia, Educaon Com-

miee Chair

Danai Khemasuwan, MD

USA, Finance Commiee

Chair

Naofumi Shinagawa, MD

Japan, Secretary General

Rajesh Thomas, MD, PhD

Melbourne , President

WCBIP 2026

STAFF

Michael Mendoza

General Manager

Judy McConnell

Administrator

Kazuhiro Yasufuku

Newsleer Editor-in-chief

P A G E 2

The World Association for Bronchology and

Interventional Pulmonology convened its highly

anticipated webinar on September 13-14, 2025,

uniting 1,349 registrants from around the globe

for two intensive days of learning and collabora-

tion. Featuring 32 chairs and speakers across 29

lectures, the event provided a comprehensive

platform for discussing the latest advances in

bronchoscopy and interventional pulmonology

while maintaining focus on evidence-based

practice and equitable global access.

Day 1: From Fiberoptic to Robotic-Assisted Bronchoscopy

The opening day began with a tribute to Dr. Shigeto Ikeda, whose pioneering work laid the foundation for mod-

ern bronchoscopy. Sessions progressed through the evolution of peripheral bronchoscopy techniques, with ex-

perts demonstrating advanced approaches including airway mapping, radial EBUS, and fluoroscopic lung biopsy.

Particular emphasis was placed on navigating challenging peripheral lung nodules using virtual bronchoscopy

combined with real-time imaging and cryobiopsy to maximize diagnostic yield.

A highlight of Day 1 was the comprehensive evaluation of robotic bronchoscopy systems—ION, Monarch, and

Galaxy—examining their navigation technologies, diagnostic performance, and integration with advanced imag-

ing modalities such as augmented fluoroscopy and cone beam CT. Speakers addressed practical challenges in-

cluding CT-to-body divergence, atelectasis management, and optimal patient selection strategies.

The focus then shifted to mediastinal staging, where presenters reinforced EBUS-TBNA as the gold standard for

mediastinal evaluation, having largely supplanted traditional mediastinoscopy. Its critical role in obtaining tissue

for molecular diagnostics—essential for personalized lung cancer treatment—was emphasized. A pathologist's

perspective provided valuable insights into what constitutes "adequate" biopsy samples, stressing that tissue

quality and tumor cellularity often matter more than quantity.

Day 1 concluded with a frank roundtable discussion on balancing technological enthusiasm with pragmatism.

Panelists from diverse healthcare settings emphasized the need for robust randomized controlled trials to

demonstrate real clinical advantages rather than relying on marketing claims alone. Economic barriers to adopt-

ing expensive technologies and the importance of patient-centered care emerged as central themes.

Day 2: From Rigid to Flexi-Rigid Thoracoscopy

The second day explored thoracoscopy's evolution since Jacobaeus, highlighting its transformation from diagnos-

tic to operative applications. The pleural disease session delivered practice-changing insights: thoracic ultrasound

should be routine for pleural effusions, often surpassing CT for malignancy diagnosis. Notably, thoracoscopy of-

fers the highest diagnostic yield (93%) and best molecular marker sufficiency (95%), crucial given that cytology

frequently provides insufficient material for molecular analysis.

Practical updates included the new BTS traffic light pH system for pleural infections and evidence supporting

TPA+DNase combination therapy. For malignant effusions, indwelling pleural catheters were positioned as first-

line therapy, offering superior symptom control and shorter hospital stays compared to talc pleurodesis.

Innovation sessions showcased emerging techniques including Fantoni translaryngeal tracheostomy for complex

airway procedures, robotic rigid bronchoscopy development, and custom 3D-printed stents for complex anato-

mies. For benign lung disease, advances included polymer sealants enabling valve placement despite incomplete

fissures in COPD, and cryobiopsy emerging as a robust alternative to surgical lung biopsy for interstitial lung dis-

ease diagnosis.

Global Access and Training: WABIP's Commitment

Perhaps most significant was the concluding discussion on overcoming barriers to technology, training, and exper-

tise access. WABIP's Interventional Pulmonology Institute (IPI) was highlighted as a model program offering free

training and financial support to fellows from developing countries. Panelists from Morocco, Russia, Serbia, and

Portugal shared local challenges and solutions, advocating for a stepwise technology adoption approach—

prioritizing high-impact, cost-effective tools like EBUS over expensive robotics initially.

The webinar reinforced that interventional pulmonology's future depends not merely on adopting advanced tech-

nologies, but on judiciously integrating them based on robust evidence, cost-effectiveness, and patient-specific

needs. Through initiatives like the IPI and sustained international collaboration, WABIP continues championing its

mission: expanding access to high-quality interventional pulmonology care worldwide, ensuring cutting-edge

bronchoscopy becomes both effective and equitably accessible across all healthcare settings.

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

P A G E 3

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

P A G E 4

Technology Corner

External Imaging for Bronchoscopy

Digital Tomosynthesis, Cone Beam Computed Tomography, and Augmented Fluoroscopy

Introducon:

Over the last decade, three external imaging modalies—digital tomosynthesis (DTS), cone-beam computed tomography (CBCT),

and augmented uoroscopy (AF) have emerged as transformave tools in advanced diagnosc bronchoscopy. Each carries unique

physics principles, disncve trade-os in spaal resoluon and radiaon exposure, and varying levels of integraon with roboc

and navigaonal bronchoscopy plaorms. Understanding how these modalies dier is essenal for instuons seeking to opmize

diagnosc yield while balancing paent safety, workow, and cost.

Tradional CT is sll important as it has a broad eld of view (FoV) relave to CBCT and DTS, as well as beer so-ssue resoluon

(the ability to disnguish between objects or structures diering in densies). This superior image quality makes it invaluable for pre

-procedure planning, serving as a virtual map for navigaon during a diagnosc bronchoscopy procedure.

Background:

Intra-operave systems rely on a cone beam emier (as opposed to a fan beam in tradional CT scans), which creates a clinically

useful 2D image in a single shot. Standard uoroscopy systems can only perform limited rotaons, typically 60 to 100 degrees,

which, through post-imaging processing, can be reconstructed to create a three-dimensional image. This is called digital tomosyn-

thesis (DT). More expensive uoroscopy systems can perform a wider sweep, approaching 200 degrees of rotaon, to create a 3D

image, which is termed Cone Beam CT(CBCT). Augmented uoroscopy (AF) is not a standalone imaging modality but rather an over-

lay technique. It superimposes virtual targets onto live uoroscopy in real me.

The aim of intra-operave imaging is to idenfy and minimize discordance between the lung at the me of procedure vs at the me

of the pre-procedure CT. Clinicians have idened CT-body-divergence (CTBD) and atelectasis as causes of discordance that aect

diagnosc yield. Navigaonal plaorms, whether roboc-assisted or using virtual navigaon, rely on a virtual airway map created

from a pre-procedural CT scan to locate target lesions. This CT scan is ideally performed at total lung capacity, which cannot be re-

produced intraoperavely. The discrepancies between expected and real-me lesion locaons—due to changes in lung anatomy—

can lead to errors, known as CT-to-body divergence. Respiratory moon poses a signicant challenge in biopsies, as peripheral nod-

ules can move throughout the respiratory cycle and are also associated with decreased diagnosc yield. Intraoperave imaging can

idenfy atelectasis; however, it cannot migate this, which can be minimized by specialized venlaon strategies.

Karan Singh, MBBS

Intervenonal Pulmonary Fellow,

University of Chicago

Ali Musani MD

Professor of Medicine and Surgery

Division Chief, Pulmonary Medicine

Director, Western Region Intervenonal

Pulmonology, Northwell Health

Lenox Hill Hospital

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

P A G E 5

Radiaon exposure:

Radiaon dose is derived from two sources: Primary and Scaer. Primary X-ray refers to the radiaon emied directly from the X-ray

beam, constung the dose administered to the paent during imaging. Scaer radiaon happens when the main X-ray beam hits

objects like the paent or table, causing the X-ray beam to deect, causing exposure for the sta in the room. This depends on the

paent's body size, with higher BMI producing more scaer. Reducing scaer radiaon exposure involves three key measures: me,

shielding, and distance. The WABIP has addressed radiaon principles, protecon, and reporng in a published white paper.

Physics:

Digital Tomosynthesis:

Tomosynthesis employs reconstrucon algorithms to generate images from exposures of a cone-beam sweep over a dened angular

range (1). The X-ray source and detector move circularly, capturing roughly 50 images over an angle range of roughly 50°. Images are

reconstructed using an algorithm. The spaal resoluon depends on the angular coverage and the number of images for the recon-

strucon. DT does not produce true volumetric CT data and relies heavily on reconstrucon algorithms to suppress blur. As compared

to CBCT, DT has a shallower depth of focus and, therefore, isocentering the object of interest is key. If the nodule is outside of the

isocenter, the image may be too blurry for proper interpretaon

CBCT:

Cone-beam computed tomography diers from tomosynthesis by employing a wider scan angle around the paent, acquiring 180-

400 images depending on the protocol. Image reconstrucon is complete and lacks blurred versions of the surrounding anatomy.

CBCT oers

visibility in mulple planes showing adjacent structures, including bone, so ssue, and carlage (20). The use of a larger beam, in-

creased angulaon, and a broader eld of view contributes to enhanced image quality, albeit at a higher radiaon dose. As with

tomosynthesis, addional scans will increase the radiaon dose.

Augmented Fluoroscopy:

AF idenes and labels a lung lesion on a standard 2D uoroscopy image as well as the pre-planned pathways, allowing for real-me

visualizaon of the relaonship between the nodule and biopsy tools. There is no addional radiaon from AF.

Clinical Applicaons:

DTS and CBCT are both increasingly used in conjuncon with electromagnec navigaon (EMN) and roboc bronchoscopy. Both can

conrm tool-in-lesion accuracy, but have dierent characteriscs summarized in Table 1

Currently, there are three RAB plaorms on the market: the Monarch plaorm by Auris Health, the Ion endoluminal roboc bron-

choscopy plaorm by Intuive Surgical and the Galaxy System by Noah Medical. The Galaxy System is the only one that integrates

proprietary DTS soware, while other systems can use third-party systems like the AI-powered Lung Vision(Body Vision Medical) or

Illumsite (Medtronic). The Ion system also integrates with mobile CT plaorms like Cios or OEC.

Conclusion:

Digital tomosynthesis, cone-beam CT, and augmented uoroscopy each oer unique contribuons based on their physics principles,

image quality, and safety proles. DTS provides low-dose, rapid quasi-3D lesion visualizaon; CBCT delivers unmatched volumetric

accuracy for small and dicult targets; and AF enhances real-me navigaon through intelligent overlays. Together, these technolo-

gies migate CT-to-body divergence, improve tool-in-lesion conrmaon, and elevate diagnosc yield in peripheral pulmonary lesion

evaluaon. The future of bronchoscopy lies in adapve, mulmodal imaging ecosystems that dynamically pair the right modality with

the right paent and lesion.

Tips from the Experts

P A G E 6 V O L U M E 1 4 , I S S U E 1

Table 1.

Figure 1. Mul-plane images from xed CBCT of lung mass with biopsy needle in lesion using roboc bronchoscopy.

(A) Sagial secon. (B) Coronal secon. (C) Axial secon. (D) 3D reconstrucon. (3)

Tips from the Experts

P A G E 7 V O L U M E 1 4 , I S S U E 1

References

1. Podder et al. Thoracic Dis. 17(9), 7379.

2. Pritche MA et al. J Bronchology Interv Pulmonol. 2018;25:274-823.

3. Jain A et al. Diagnoscs 2023. 13, 2580. hps://doi.org/10.3390/diagnoscs13152580

Figure 2: Digital Tomosynthesis: digital tomosynthesis on the right with the representave pre-op CT chest on

the le (Author generated gure).

Tips from the Experts

P A G E 8 V O L U M E 1 4 , I S S U E 1

Introducon

The earliest recorded percutaneous tracheostomy dates back to 1626, when an Italian surgeon Sanctorio Sanctorius used a “ripping needle”

to introduce a silver cannula into the tracheal lumen before withdrawing the needle. Percutaneous dilataonal tracheostomy (PDT) has be-

come the most commonly ulized approach in many ICUs across the world for paents needing prolonged mechanical venlaon.

Ultrasound and bronchoscopy serve complementary roles in the performance of this procedure. Ultrasound helps dene anatomy and iden-

fy contraindicaons to the percutaneous approach and bronchoscopy allows idencaon of the correct interrcarlagenous space be-

tween the tracheal rings for puncture, measurement of distance from the cords and also facilitates sucon to clear bloody secreons. The

rates of procedural complicaons are similar with either technique(1)

Planning for Tracheostomy using Ultrasound

Pre-procedure ultrasound serves as a roadmap, allowing clinicians to tailor the approach to each paent. Ultrasound anatomy of the trachea

and its surrounding structures was rst described in 1995(2), and the rst real-me ultrasound-guided PDT was reported in 1999(3). Alt-

hough pre-procedural ultrasound is ideally used in every paent, it is especially valuable in those with obesity or short necks where anatomy

may be obscured and in paents with prior neck surgery or radiaon, raising uncertainty about vascular anatomy.

A high frequency vascular probe is preferred for its superior image quality. While its depth of penetraon is limited compared with phased-

array or curvilinear probes, this is not a drawback for this procedure. Scanning is performed in both transverse and longitudinal planes, with

careful aenon to idenfy the innominate artery. The probe is posioned in the sternal notch to visualize the pleural line as a hyperechoic

band between the acousc shadows of the sternoclavicular juncon. The probe is then swept caudally to cephalad unl the innominate ar-

tery is idened as a pulsale structure crossing anterior to the trachea. Occasionally, a high riding innominate artery is seen (Figure 1)

which is a contraindicaon to this procedure.

Next, the pre tracheal structures are idened. Tracheal rings appear as inverted U-shaped structures with a hyperechoic line in the posteri-

or region that are accompanied by reverberaon arfacts at the mucosa-air interface. The thyroid lobes and isthmus are located lateral and

anterior to the trachea, respecvely. They are idened as isoechoic structures posterior to the sternohyoid muscle. Occasionally, veins can

be idened in the path of the puncture site. Veins larger than 4mm are associated with an increased bleeding risk (Figure 2) and may be

considered a relave contraindicaon(4). . Almost all fatal complicaons of PDT result from vascular injury(5) and preoperave ultrasound

may idenfy paents at higher risk.

One limitaon of ultrasound is that the needle can be visualized only unl it enters the trachea and inadvertent posterior wall puncture can-

not be idened. Nonetheless, ultrasound can measure the pretracheal distance and the distance to the tracheal midpoint, helping opera-

tors assess the margin of safety for needle inseron and even decide on type of trachesotomy tube selecon ( i.e. choosing a proximal XLT )

While ultrasound is used as a “point and poke” modality, real-me needle tracking can be applied in challenging cases.

Post procedure, pneumothorax can be idened with ultrasound as well. While the sensivity of ultrasound for idenfying pneumothorax is

higher than chest radiography, it is not very specic. For this reason, lung sliding is assessed both before and aer the procedure, with new

absence of sliding suggesng pneumothorax and allowing early conrmaon before obtaining a chest radiograph. Chest radiograph can

idenfy other complicaons beside pneumothorax and should be considered in paents where bronchoscope guidance was not used or

where operator noted diculty with procedure(5,6)

Ultrasound and Bronchoscopy for Tracheostomy

Karan Singh, MBBS

Division of Intervenonal

Pulmonology, University

of Chicago

William Gao, MD

Division of

Otorhinolaryngology,

University of Chicago

Shreya Podder, MD

Division of Intervenonal

Pulmonology, University

of Chicago

Tips from the Experts

P A G E 9 V O L U M E 1 4 , I S S U E 1

Performing the tracheostomy with bronchoscopy

Bronchoscopic visualizaon allows for conrmaon of midline placement of the needle and guide wire, safe withdrawal of the endotracheal

tube, and avoidance of paratracheal placement or injury to the posterior tracheal wall. Potenal drawbacks include hypercapnia, increased

cost and damage to the bronchoscope from the needle. The degree of venlatory impairment is inversely proporonal to the size of the en-

dotracheal tube (ETT). Usage of a disposable bronchoscope negates the fear of bronchoscope damage but may increase overall cost and

there are environmental sustainability concerns about single use scopes.

Our pracce begins with a quick airway examinaon through the endotracheal tube (ETT). The ETT is then slowly retracted under broncho-

scopic guidance to the level of the cricoid carlage aer which the cu is deated. Retracon of ETT is connued unl the cricothyroid mem-

brane is visualized, allowing idencaon of the cricoid carlage. The ETT p is posioned at the level of the cricoid carlage and the cu of

the ETT is re-inated. Bronchoscopy then conrms midline placement of the needle, and cannula and idenes any injury to the tracheal

rings during dilaon. Proper posioning of the tracheostomy tube is also conrmed bronchoscopically with care taken to make sure there is

no pressure on the posterior wall or sidewalls of then trachea, which could promote granulaon ssue formaon(Figures 3-6)

Aer placement of the tracheostomy tube, we document the distance from carina to the distal tracheostomy tube as well as distance from

vocal cords to the stoma.

Quality Control

Incorporation of ultrasound ndings and bronchoscopic conrmaon into procedural notes fosters accountability and provides traceable

documentaon for morbidity reviews. Storing short video clips of needle entry or tracheal visualizaon can be a valuable educaonal and

quality improvement tool as well.

Conclusion

Incorporang ultrasound and bronchoscopy into PDT is not just about using more tools–it is about seeing more, understanding more, and

reducing uncertainty. Ultrasound renes entry while bronchoscopy safeguards the airway. Together, they transform tracheostomy from a

technically feasible act to a precisely guided, team-based intervenon.

References

1. Gobao ALN. Intensive Care Med. 2016 Mar;42(3):342-351. doi: 10.1007/s00134-016-4218-6. Epub 2016 Feb 1. PMID: 26831676

2. Bertram S et al. J Oral Maxillofac Surg 1995;53(12):1420–4

3. Susc A et al. Acta Anaesthesiol Scand 1999;43(10):1078–80

4. Meredith S et al. J Intensive Care Med. 2024 May;39(5):447-454. doi: 10.1177/08850666231212858. Epub 2023 Nov 6. PMID: 37931902

5. Gilbey P. Am J Otolaryngol. 2012 Nov-Dec;33(6):770-3. doi: 10.1016/j.amjoto.2012.07.001. Epub 2012 Aug 22. PMID: 22921243

6. Daa D et al. Chest. 2003 May;123(5):1603-6. doi: 10.1378/chest.123.5.1603. PMID: 12740280

7. Yeo WX et al. Clin Otolaryngol. 2014 Apr;39(2):79-88. doi: 10.1111/coa.12233. PMID: 24575958

Figure 1.

Figure 2.

Tips from the Experts

P A G E 10 V O L U M E 1 4 , I S S U E 1

Figure 3.

Figure 4.

Figure 5.

Figure 6.

WABIP Best Image Contest 2026

Image 1 of 3

Pleural Diseases

Multiple enumerous pleural hydatid cysts

Credits / Image courtesy of

Ahmed Gad

Best Image Contest

P A G E 11

This image is 1 of 3 selected among 100+ submissions to our Best Image Contest held in late 2025. Our next

Image Contest will open later this year. We look forward to receiving your image submissions.

WABIP NEWS

P A G E 12

We are thrilled to announce that the 24th World Congress of Bronchology and Intervenonal Pulmonology (WCBIP 2026) will take

place 3–6 December 2026 in the vibrant city of Melbourne, Australia.

Hosted by the World Associaon for Bronchology and Intervenonal Pulmonology in partnership with the Thoracic Society of Austral-

ia and New Zealand, this premier global event will bring together leading experts, innovators, and thought leaders to share cung-

edge research, clinical pracces, and advancements in intervenonal pulmonology.

The Congress will be led by an exceponal team:

Key Dates to Remember

22 January 2026 – Earlybird registraon and abstract submissions open

24 September 2026 – Earlybird registraon deadline

3–6 December 2026 – Congress dates

Registraon

Registraon fees are structured to ensure accessibility for the global intervenonal pulmonology community, with discounted rates

based on country income classicaon (World Bank Index), professional posion, and registraon ming.

Earlybird rates (unl 24 September 2026) start from:

AUD $550 for students and non-physicians

AUD $700 for physicians from lower-middle and low-income countries

AUD $1,100 for physicians from high and upper-middle-income countries

Please note: Workshop spaces are limited and expected to sell out quickly, so early registraon is strongly encouraged.

Call for Abstracts

Abstract submissions are now OPEN at hps://wcbip2026.com/abstracts Presenng your research at WCBIP 2026 is an incredible

opportunity to gain internaonal recognion, receive valuable feedback from leading experts, and contribute to shaping the future of

bronchology and intervenonal pulmonology.

For more informaon and to register when applicaons open, visit hps://wcbip2026.com

Electrifying insights in bronchoscopic Pulsed Electric Field (PEF) ablation

Recent advances in bronchoscopic pulsed electric eld (PEF) ablaon are reshaping the therapeuc landscape for paents with metastac ma-

lignancies, including lung cancer. PEF ulizes short, high-voltage pulses to permeabilize cell membranes, a process termed electroporaon [1,2].

This disrupts membrane integrity, induces nanopore formaon, and triggers intracellular signaling cascades, leading to nonthermal cell death,

while preserving the extracellular matrix and minimizing collateral damage to adjacent crical structures. Disnct from other modalies of abla-

on, PEF acvaon may also lead to the release of tumor angens, which promote immune acvaon. The immune response may lead to sec-

ondary benets beyond the focal ablaon (abscopal eect), which can be synergisc or addive to other treatment modalies [1-3].

PEF ablaon can be performed using a transthoracic or roboc bronchoscopic approach when targeng pulmonary nodules or masses, or under

endobronchial ultrasound guidance when targeng mediasnal and hilar lymph nodes [1, 2]. Following tool-in-lesion conrmaon, the nodule

dimensions are measured, and PEF energy is then administered through the needle (termed a PEF acvaon), ensuring controlled ablaon of

the lesion with minimal impact on surrounding ssue [1], as shown in Figure 1.

A recent mulcenter retrospecve analysis of 41 paents with progressive stage IV non-small cell lung cancer (NSCLC), who had failed prior sys-

temic therapies, demonstrated a marked survival advantage for those treated with PEF [1]. The 1-year progression-free survival (PFS) was 63.2%

and overall survival (OS) was 74.3% in the PEF cohort, compared to 11.8% and 33% in a propensity-matched control group receiving standard

systemic therapy. Hazard raos for PFS and OS were 3.66 and 3.5, respecvely, both stascally signicant, underscoring the potenal of PEF to

improve outcomes in a populaon with otherwise poor prognosis.

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 13

Associate editor:

Dr. Ali Musani

Associate editor:

Dr. Sepmiu Murgu

Ali Musani MD

Professor of Medicine and Surgery

Division Chief, Pulmonary Medicine

Director, Western Region Intervenonal

Pulmonology, Northwell Health

Lenox Hill Hospital

Mateus Fernandes, MD

Chief Fellow, Division of Pulmonary,

Crical Care and Sleep Medicine

Lenox Hill Hospital, Northwell Health,

New York, NY.

P A G E 14

Research

Prospecve data from the AFFINITY trial further support the ecacy of PEF ablaon. The AFFINITY trial is a prospecve, open-label study eval-

uang the safety, immunological eects, and preliminary ecacy of the Aliya PEF system in paents with stage IV lung cancer or with meta-

stac disease to the lung [2]. PEF acvaons were performed with primarily roboc bronchoscopy to treat lesions in 28 paents, who were

then followed closely and received adjuvant therapy at the discreon of the treang physician. Six-month imaging revealed stable disease in

67% of the ablaon-only group, while the remaining 33% had a local paral response. In those who received adjuvant therapy, 38% achieved

stable disease, 50% had local paral response, and 1 paent showed complete local response. Across both cohorts, only 1 out of 28 paents

had local disease progression. These results suggest that PEF can achieve durable local control even in the absence of systemic therapy [2],

however longer-term follow-up study is required.

As noted earlier, a unique feature of PEF ablaon is its capacity to modulate the tumor microenvironment and smulate systemic an-tumor

immune response [1-3]. The AFFINITY trial and related translaonal studies have demonstrated dynamic changes in circulang immune cell

populaons following PEF, including acvaon of T cells and plasma cell expansion. In the AFFINITY trial, 58% of paents exhibited increased

tumor-specic IgG anbodies post-PEF (measured via ELISA following treatment), with a strong correlaon (R=0.80) between anbody levels

and plasma cell expansion. [3]

While these early results are compelling, further prospecve randomized trials are needed to conrm ecacy, dene opmal paent selec-

on, and clarify the role of PEF in combinaon with systemic therapies. Ongoing research will further elucidate the mechanisc basis of PEF-

induced immune acvaon and its clinical implicaons. Larger studies are also needed to assess for less common adverse events.

In summary, bronchoscopic PEF ablaon oers a novel, nonthermal approach to local and systemic cancer control in advanced lung cancer,

with robust safety, promising ecacy, and unique immunological benets. The use of roboc bronchoscopy and the tool-in-lesion technique

in the AFFINITY trial highlights the precision and safety of this approach in clinical pracce.

References:

1. Moore WH et al. Lung Cancer. 2025;204:108575. doi:10.1016/j.lungcan.2025.108575.

2. Moreno-Gonzalez A et al. Cancers. 2025;17(21):3495. doi:10.3390/cancers17213495.

3. Nae E et al.. J Clin Oncol. 2025;43(16 suppl):e20503. doi:10.1200/JCO.2025.43.16_suppl.e20503.

Figure 1: Acvaon and eects of pulsed electrical eld acvaon within a target lesion. Acvaon creates a focal ablaon zone,

leads to nanopore formaon, and may release tumor angen, thus inducing an immune response.

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

P A G E 15