Jiwoon Chang

All Publications

• Robotic-assisted bronchoscopy for lung nodules and masses - can it replace CT-guided transthoracic biopsy? Current opinion in pulmonary medicine Ko, J., Bedi, H., Chang, J. 2026

  Abstract

  Robotic-assisted bronchoscopy is a rapidly evolving tool for the diagnosis of peripheral lung nodules. This review examines literature from the past 18 months, comparing robotic-assisted bronchoscopy's performance with CT-guided transthoracic lung biopsy.Recent findings: Recent studies confirm that robotic-assisted bronchoscopy has a noninferior diagnostic yield and a better safety profile than CT-guided transthoracic lung biopsy. The clinical utility of robotic-assisted bronchoscopy may be further expanded by its compatibility with various biopsy tools, integrated imaging with navigation, capacity for sampling multiple lesions in a single procedure, and ongoing development of associated ablative therapies.Robotic-assisted bronchoscopy demonstrates a comparable diagnostic yield and a superior safety profile compared to CT-guided transthoracic lung biopsy. The additional features permitted in robotic-assisted bronchoscopy may expand its clinical utility in the future.

  View details for DOI 10.1097/MCP.0000000000001270

  View details for PubMedID 41925197

• Cone Beam Computed Tomography-Guided Bronchoscopy versus Computed Tomography-Guided Transthoracic Needle Biopsy for Peripheral Pulmonary Lesion Diagnosis. Chest Patel, P., Ost, D. E., Shaller, B., Chang, J., Yenepalli, A., Choi, H. J., Free, D., Kang, C. Y., Sumner, E., Cao, C., Bedi, H. 2026

  Abstract

  The identification of peripheral pulmonary lesions (PPLs) has increased significantly, either incidentally or through lung cancer screening, necessitating more biopsies to differentiate between malignant and benign etiologies. Cone beam computed tomography-guided bronchoscopic biopsy (CBCT-GB) and computed tomography-guided transthoracic needle biopsy (CT-TTNB) are commonly used for these biopsies, but their comparative diagnostic abilities have not been studied.How does CBCT-GB compare to CT-TTNB for diagnosing PPLs?This single-center retrospective comparative cohort study analyzed PPLs biopsied at an academic center via either CBCT-GB or CT-TTNB. The primary outcome was diagnostic accuracy at 24-month follow-up, defined as the proportion of cases yielding a specific diagnosis (malignant or non-malignant) or a non-specific diagnosis that remained accurate through 24 months of clinical follow-up. Secondary outcomes included complication rates, procedure duration, radiation exposure, and the need for additional diagnostic procedures.Out of 895 patients analyzed, 340 of 375 (90.7%) in the CBCT-GB group and 440 of 475 (92.6%) in the CT-TTNB group had a diagnostic result (p=0.301, Odds Ratio 0.979, 95% CI: 0.939-1.020). Complications occurred in 4.3% of CBCT-GB patients and 41.6% of CT-TTNB patients (p<0.001). Pneumothorax rates were 1.8% for CBCT-GB and 31.4% for CT-TTNB (p<0.001), while severe bleeding or cardiorespiratory failure occurred in 3.3% and 6.0% of patients respectively (p<0.001). Among patients meeting criteria for upfront invasive mediastinal staging, 86.5% of CBCT-GB patients received it at the time of PPL biopsy, compared to 14.0% after biopsy in the CT-TTNB group (p<0.001). Median effective radiation dose was 8.6 millisieverts in the robotic bronchoscopy CBCT-GB group and 7.5 millisieverts in the CT-TTNB group (p=0.074).CBCT-GB demonstrated a 24-month diagnostic accuracy comparable to CT-TTNB while offering improved safety and concurrent mediastinal lymph node staging. This data supports CBCT-GB as the optimal initial procedure for PPL diagnosis.

  View details for DOI 10.1016/j.chest.2026.02.038

  View details for PubMedID 41895580

• State of the art: peripheral diagnostic bronchoscopy. Journal of thoracic disease Sumner, E. T., Chang, J., Patel, P. R., Bedi, H., Shaller, B. D. 2024; 16 (8): 5409-5421

  Abstract

  Lung cancer is the leading cause of cancer related death worldwide and in the United States according to the World Health Organization and National Cancer Institute. Improvements in the diagnosis and treatment of lung cancer are of the utmost importance. A prompt diagnosis is a crucial factor to improve outcomes in the treatment of lung cancer. Although the implementation of lung cancer screening guidelines and the overall steady growth in the use of computed tomography have improved the likelihood of detecting lung cancer at an earlier stage, the diagnosis of peripheral pulmonary lesions (PPLs) has remained a challenge. The bronchoscopic techniques for PPL sampling have historically offered modest diagnostic yields at best in comparison to computed tomography guided transthoracic needle aspiration (TTNA). Fortunately, recent advances in technology have ushered in a new era of diagnostic peripheral bronchoscopy. In this review, we discuss the introduction of advanced intraprocedural imaging included digital tomosynthesis (DT), augmented fluoroscopy (AF), and cone beam computed tomography. We discuss robotic assisted bronchoscopy with a review of the currently available platforms, and we discuss the implementation of novel biopsy tools. These technologic advances in the bronchoscopic approach to PPLs offer greater diagnostic certainty and pave the way toward peripheral therapeutics in bronchoscopy.

  View details for DOI 10.21037/jtd-24-346

  View details for PubMedID 39268128

  View details for PubMedCentralID PMC11388231

• First in human Phase I Clinical Trial of Stereotactic Irradiation to Achieve Lung Volume Reduction (SILVR) in Severe Emphysema. International journal of radiation oncology, biology, physics Kamtam, D. N., Binkley, M. S., Kapula, N., Sadeghi, C., Nesbit, S., Md, H. H., Chang, J., Maxim, P. G., Diehn, M., Loo, B. W., Shrager, J. B. 2024

  Abstract

  Only a subset of patients with severe emphysema qualify for lung volume reduction surgery or endobronchial valves. We previously demonstrated that Stereotactic Ablative Radiotherapy (SABR) of lung tumors reduces lung volume in treated lobes by creating localized lung fibrosis. We aimed to determine the safety and, secondarily, explore the efficacy of Stereotactic Irradiation for Lung Volume Reduction (SILVR) over 18 months following intervention in patients with severe emphysema.We conducted a single-arm prospective clinical trial in eligible patients with severe emphysema treated with unilateral SABR (45 Gy in three fractions) to a target within the most emphysematous region. Primary outcome was safety i.e., incidence of grade≥3 adverse events. Secondary outcomes of efficacy were also explored.Eight subjects received the intervention. Median (range) baseline characteristics were age 73 years (63-78), FEV1% 28.5% (19.0-42.0), DLCO% 40% (24.0-67.0), and BODE index 5.5 (5-9). The incidence of grade≥3 adverse events was 3/8 (37.5%). The relative Δtarget lobe volume was -23.1% (-1.6,-41.5) and -26.5% (-20.6,-40.8) at six and 18 months, respectively. Absolute ΔFEV1% was greater in subjects with BODE index ≤5 vs. ≥6 (+12.0% vs. -2.0%). The mean baseline lung density (in Hounsfield units, reflecting the amount of preserved parenchyma) within the intermediate dose volume (V60BED3) correlated with the absolute Δtarget lobe volume at 18 months.Stereotactic Irradiation for Lung Volume Reduction appears to be safe, with a signal for efficacy as a novel therapeutic alternative for patients with severe emphysema. SILVR may be most safe/effective in patients with lower BODE index and/or less parenchymal destruction.

  View details for DOI 10.1016/j.ijrobp.2024.03.049

  View details for PubMedID 38615887

• Tranexamic Acid in the Treatment Paradigm for Hemoptysis. Chest Chang, J., Ma, K. C. 2023; 163 (5): 1011-1012

  View details for DOI 10.1016/j.chest.2022.12.011

  View details for PubMedID 37164570

• Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL : the journal of teaching and learning resources Dali, S., Atasuntseva, A., Shankar, M., Ayeroff, E., Holmes, M., Johnson, C., Terkawi, A. S., Beadle, B., Chang, J., Boyd, K., Dunn, T. 2022; 18: 11284

  Abstract

  Names are a reflection of identity and often have personal meaning. The chronic mispronunciation of names can undermine one's identity and be experienced as a microaggression. This workshop aims to provide historical context for names as well as resources for correct name pronunciation.We developed a 60-minute interactive virtual workshop with didactics, small-group sharing of personal experiences, and case discussions. We used an anonymous postworkshop survey to evaluate workshop effectiveness.We presented the workshop at one local academic conference and two local educational conferences to learners of all levels from medical students to faculty. We collected postworkshop survey results from 78 participants of diverse racial and ethnic backgrounds. Participants reported learning historical context, ways to ask about correct name pronunciation, correcting name mispronunciation, documenting pronunciation, and sources for applications to practice. The main barriers to implementing workshop lessons included personal and structural factors.This workshop effectively fills an educational gap by addressing the importance of correct name pronunciation in order to provide a more inclusive environment for clinicians and patients alike.

  View details for DOI 10.15766/mep_2374-8265.11284

  View details for PubMedID 36524099

  View details for PubMedCentralID PMC9705275

• Bleeding risk with combination intrapleural fibrinolytic and enzyme therapy in pleural infection - an international, multicenter, retrospective cohort study. Chest Akulian, J., Bedawi, E. O., Abbas, H., Argento, C., Arnold, D. T., Balwan, A., Batra, H., Uribe Becerra, J. P., Belanger, A., Berger, K., Burks, A. C., Chang, J., Chrissian, A. A., DiBardino, D. M., Fuentes, X. F., Gesthalter, Y. B., Gilbert, C. R., Glisinski, K., Godfrey, M., Gorden, J. A., Grosu, H., Gupta, M., Kheir, F., Ma, K. C., Majid, A., Maldonado, F., Maskell, N. A., Mehta, H., Mercer, J., Mullon, J., Nelson, D., Nguyen, E., Pickering, E. M., Puchalski, J., Reddy, C., Revelo, A. E., Roller, L., Sachdeva, A., Sanchez, T., Sathyanarayan, P., Semaan, R., Senitko, M., Shojaee, S., Story, R., Thiboutot, J., Wahidi, M., Wilshire, C. L., Yu, D., Zouk, A., Rahman, N. M., Yarmus, L., Interventional Pulmonary Outcomes Group (IPOG) 2022

  Abstract

  BACKGROUND: Combination intrapleural fibrinolytic and enzyme therapy (IET) has been established as a therapeutic option in pleural infection. Despite demonstrated efficacy, there is a sparsity of studies specifically designed and adequately powered to address complications. The safety profile, the effects of concurrent therapeutic anticoagulation and the nature/extent of non-bleeding complications remain poorly defined.RESEARCH QUESTION: What is the bleeding complication risk associated with IET use in pleural infection?STUDY DESIGN AND METHODS: This was a multicenter, retrospective observational study conducted in 24 centers across the United States and the United Kingdom. Protocolized data collection on 1851 patients treated with at least one dose of combination IET for pleural infection between January 2012 and May 2019 was undertaken. The primary outcome was the overall incidence of pleural bleeding defined using pre-hoc criteria.RESULTS: Overall pleural bleeding incidence was 76/1833=4.1% (95%CI 3.0% to 5.0%). Using a half-dose regimen (tPA 5mg) did not significantly change this risk (6/172=3.5%; p=0.68). Therapeutic anticoagulation (AC) alongside IET was associated with increased bleeding rates (19/197=9.6%) compared to temporarily withholding AC prior to administration of IET (3/118=2.6%, p=0.017). As well as systemic AC, increasing RAPID score, an elevated serum urea and platelets <100x109 L were associated with a significant increase in bleeding risk. However, only RAPID score and use of systemic AC were independently predictive. Apart from pain, non-bleed complications were rare.INTERPRETATION: IET use in pleural infection confers a low overall bleeding risk. Increased rates of pleural bleeding are associated with concurrent use of AC but can be mitigated by withholding AC prior to IET. Concomitant administration of IET and therapeutic AC should be avoided. Parameters related to higher IET related bleeding have been identified which may lead to altered risk thresholds for treatment.

  View details for DOI 10.1016/j.chest.2022.06.008

  View details for PubMedID 35716828

• COVID-19 Test Correlation Between Nasopharyngeal Swab and Bronchoalveolar Lavage in Asymptomatic Patients. Chest Chang, J. n., Swenson, K. E., Sung, A. n., Bedi, H. n. 2020

  View details for DOI 10.1016/j.chest.2020.11.006

  View details for PubMedID 33217415