Thorax最新文献

Background: The use of 3D imaging with navigation bronchoscopy has increased with the introduction of mobile cone-beam CT (mCBCT). Shape-sensing robotic-assisted bronchoscopy (ssRAB) integrated with mCBCT has been introduced to correct for CT to body divergence (CT-BD) during the biopsy of peripheral pulmonary nodules (PPNs).

Methods: Prospective observational multicentre study, enrolling patients with a PPN of ≤20 mm suspicious for malignancy, assessing tool-in-lesion (TIL), diagnostic yield, sensitivity for malignancy and incidence of pneumothorax or airway bleeding. Non-malignant index biopsies were followed for 12 months. Descriptive statistics are reported for all variables along with 95% CI for primary endpoints.

Results: 155 consecutive patients were enrolled at six centres. Median nodule size was 14.0 mm (IQR 11.0-17.0), with 54.8% of nodules (85/155) in the upper lobes, 25.8% (40/155) with CT bronchus sign present and median distance to the nearest pleural surface of 8.2 mm (IQR 1.8-20.0). TIL was achieved in 154/155 (99.4%, 95% CI 96.5 to 100.0) procedures. A median of two (IQR 1-3) mCBCT spins were performed, with median dose area product of 25.7 Gy · cm² (IQR 11.0-46.7). Diagnostic yield per the American Thoracic Society/American College of Chest Physicians (ATC/ACCP) definition was 89.0% (n=138/155; 95% CI 83.0 to 93.5) and sensitivity for malignancy was 91.5% (95% CI 86.4 to 96.5). No pneumothorax (0%, 95% CI 0.0 to 2.4) and two Nashville Grade three bleeding events were reported (1.3%, 95% CI 0.2 to 4.6).

Interpretation: The first prospective multicentre study of integrated ssRAB and mCBCT for small peripheral nodules resulted in diagnostic outcomes similar to those reported for transthoracic biopsy with a more favourable safety profile.

Trial registration number: ClinicalTrials.gov ID: NCT05562895.

Objectives: Eosinophilic bronchiectasis is defined by a blood eosinophil count (BEC) ≥300 cells/µL, but blood eosinophils imperfectly reflect airway eosinophilic inflammation. Here, we investigated the relationship between eosinophilic airway inflammation, blood eosinophils and clinical severity in bronchiectasis and explored the phenotype associated with eosinophilic bronchiectasis.

Methods: Sputum from 180 patients with stable CT-confirmed bronchiectasis was utilised to investigate airway levels of eosinophil proteins (eosinophil peroxidase (EPX), eosinophil derived-neurotoxin (EDN), eosinophil cationic protein (ECP), major basic protein (MBP) and Galectin-10 (Gal-10)) using a novel stable isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. To profile eosinophilic bronchiectasis, a nested analysis of patients with BEC <150 cells/µL (n=52) and ≥300 cells/µL (n=49) was conducted.

Results: Sputum concentrations of Gal-10, ECP and EDN were weakly but significantly associated with radiological severity, FEV₁ and sputum culture positivity for Pseudomonas aeruginosa. Airway eosinophil protein concentrations did not associate with exacerbation frequency. Total eosinophil protein concentration moderately correlated with BECs (r=0.33 95% CI 0.14 to 0.49, p=0.0007). Nested analysis revealed increased sputum PCR-positivity for P. aeruginosa (26.7% vs 7.7%, p=0.033) and an increased frequency of patients showing signs of Aspergillus sensitisation (defined as Aspergillus-specific IgE titres >0.35 kUA/L, 24.5% vs 3.8%) in eosinophilic bronchiectasis. Sputum inflammatory biomarkers and clinical parameters did not differ between groups.

Conclusions: LC-MS/MS can detect eosinophilic inflammation within bronchiectasis sputum. Weak associations between elevated airway eosinophil proteins, bronchiectasis severity and P. aeruginosa infection were observed. Direct measurement of eosinophilic airway inflammation provides additional information in addition to BECs. Eosinophilic bronchiectasis associated with P. aeruginosa infection and Aspergillus sensitisation.

Background: The 2025 British Thoracic Society (BTS) Winter Meeting delivered 3 days of cutting-edge science, clinical innovation and networking in wintry Westminster. Over 2500 attendees from 36 countries gathered to share advances shaping the future of respiratory medicine.

Content: The programme opened with a session focused on emerging clinical trial data, showcasing pragmatic and mechanistic studies designed to address real-world challenges in respiratory care, setting the tone for a meeting focused on impact and innovation.Translational research featured strongly throughout the meeting, with organoids, precision-cut lung slices and air-liquid interface cultures providing new perspectives on disease mechanisms and therapeutic targets. Early career investigators presented discoveries in eosinophilic chronic obstructive pulmonary disease biology, microbiome-driven viral susceptibility and resistance risks in novel bronchiectasis therapies, while midcareer leaders advanced understanding of familial interstitial lung disease and virus-host interactions.Plenary sessions tackled pressing challenges, from air pollution and breathlessness diagnostics to genetic drivers of pulmonary hypertension, complemented by guest lectures on immune regulation, vaccine-preventable illness and drug discovery. Additionally, the meeting highlighted workforce transformation, emphasising the role of nurses, allied health professionals and pharmacists in delivering integrated, digitally enabled care.

Conclusion: Reminding us that progress rests on both scientific endeavour and enduring professional bonds, the 2025 BTS Winter Meeting reaffirmed that respiratory research is for everyone-an essential driver of advancement across disciplines. Multidisciplinary working and inclusive engagement will be key to shaping future care and ensuring that innovation translates into better outcomes for patients worldwide.