Ahead of the Curve: Pediatric Advanced Diagnostic and Interventional Bronchoscopy

Interventional bronchoscopy, a minimally invasive procedure used to diagnose and treat a variety of lung and airway conditions such as cancer, has been widely available for more than 20 years—for adults. Its applications over that period have expanded tremendously; many things that previously required more invasive procedures such as surgery can now be done without long hospital stays, often on an outpatient basis.

For children, however, such techniques are rarely applied, even today. But at Mount Sinai Kravis Children’s Hospital, interventional bronchoscopy has been offered to children for more than a decade.

“Bronchoscopy is a procedure performed by most pediatric pulmonologists. In fact, it’s a requirement for training,” explains Alfin Vicencio, MD, Chief of the Division of Pediatric Pulmonology. “Interventional bronchoscopy, however, has lagged significantly in the pediatric population for a variety of well-founded reasons. For example, until recently, much of the equipment required to perform these advanced procedures was simply too big to use in young children, and therefore, few practicing pediatric pulmonologists have any experience.”

Dr. Vicencio and his colleague Chantal Spencer Grant, MD, Associate Professor of Pediatrics (Pediatric Pulmonology), happen to be among the few in the country with extensive experience in advanced diagnostic and interventional bronchoscopy for children. Together, they have piloted several techniques in children, including cryotherapy, navigational lung biopsy, and other procedures, sometimes to avoid a more invasive test, and other times because there was no other good option.

Importantly, they also believe that formal education for other practicing pediatric pulmonologists is required so that many more children can benefit. Over the past few years, they have been working collaboratively with colleagues from Cincinnati Children’s Hospital Medical Center, Children’s Hospital of Philadelphia, and Heinrich-Heine Universität Dusseldorf in Germany to disseminate their knowledge and experience, running hands-on skills courses for pediatric pulmonologists around the world. In 2023, Dr. Vicencio became the inaugural pediatric representative for the education committee of the American Association of Bronchology and Interventional Pulmonology, the organization that oversees training for adult interventionalists. He hopes that this is only the first step toward creating a platform for formalized pediatric training in this still-evolving discipline.