Departments

Lung cancer is the third most common cancer in the U.S., but it is the leading cause of cancer-related deaths. The reason is that most lung cancers are diagnosed in late stages of the disease. Hence, early detection is a key for longer survival when lung cancer is only limited to one area of the lung. A diagnosis of lung cancer often begins when a chest X-ray or computed tomography (CT) scan shows a nodule—an area of abnormal tissue—in the lungs. Lung cancer screening is one way to catch cancer early, when it is still a lung nodule. The other way, which is more common, of finding a lung nodule is incidental, while patients are getting lung imaging for other medical problems. Lung nodules that are suspicious or show signs of growth over time often need to be biopsied. Biopsy of lung nodule with bronchoscopy is preferred as risk of complications is very low and lymph node staging can be performed concurrently. However, traditional bronchoscopy has lower success for lung nodule biopsy. At the Yale Robotic Bronchoscopy Program, Yale interventional pulmonologists and thoracic surgeons will perform a next-generation bronchoscopy—robotic-assisted bronchoscopy with novel shape-sensing technology—that will allow them to visualize and biopsy remote parts of the lung that were previously inaccessible, significantly improving the success of lung nodule biopsy. The Yale Robotic Bronchoscopy Program takes a multidisciplinary approach to patient care; it is a joint program between Yale Interventional Pulmonology and Yale Thoracic Surgery, part of the Thoracic Oncology Program, which takes care of more than 40% of lung cancer patients in Connecticut while attracting patients from New England and beyond. The goal of the program is to diagnose potentially cancerous lung nodules in the periphery and hard-to-read parts of the lungs. The robotic bronchoscopy technology will help to biopsy and diagnose those nodules with significantly improved accuracy and safety. Yale New Haven Hospital offers this new technology, which has greater dexterity, reach, vision, and shape-sensing technology that offers greater stability when compared with traditional bronchoscopy. A regular bronchoscope has a camera on one end. The other end is held by a doctor who manually performs the procedure. With a robotic bronchoscopy, the endoscope is attached to a robotic arm, which the doctor operates from an independent console. The Yale doctors will be using robotic bronchoscopy concurrently with 3D fluoroscopy for real time imaging to further improve the accuracy of the procedure. Furthermore, doctors will also perform a procedure called EBUS—endobronchial ultrasound, which allows biopsy of the lymph nodes around the lungs and airways. This helps not just with the diagnosis but with the staging of lung cancer. Performing robotic-assisted bronchoscopy and EBUS under single anesthesia will help reduce the unnecessary waiting times and anxiety that patients may traditionally experience.

The Center for Thoracic Cancers at Smilow Cancer Hospital consists of a multidisciplinary team of experts dedicated to providing evaluation of and treatment for patients with a thoracic malignancy, including lung cancer, esophageal cancer, thymoma, or chest wall tumors. Patients in Connecticut and beyond have access to nationally recognized expert clinicians, who provide an organized, collaborative approach to cancer care, as well as the latest technologies and treatments. Our team consists of a collaboration of specialty physicians, including medical oncology, radiation oncology, thoracic surgery, pulmonary medicine, digestive diseases, pathology, diagnostic imaging, and nursing. In addition to our expert clinicians, patients also receive comprehensive care to help with the physical, emotional, and psychological issues that are part of confronting cancer. Patients also benefit from the attention of the team's care coordinators, who make management of even the most detailed multidisciplinary treatment plan less complicated. Our team is active in clinical research, and focuses on developing advances to care in areas of thoracic oncology where the standard treatment needs improvement and where the optimal treatment approach remains unclear. To provide the best care, most of our patients are enrolled in a clinical trial where they can receive innovative therapy for their advanced disease, including immunotherapy, which was first used in clinical trials at Smilow Cancer Hospital. The Center for Thoracic Cancers offers second opinions that are easy, convenient, and all done remotely. Call (203) 200-LUNG for more information and learn how to schedule a second opinion appointment with one of our providers. Medical Oncology Our medical oncologists are nationally recognized for their leadership and expertise in lung cancer treatment and research, and are dedicated to offering personalized treatment options. Biomarker testing is often performed on the tumor to look for specific mutations that can be targeted by medication. There are currently FDA-approved lung cancer treatments for tumors showing abnormalities in EGFR, KRAS, ALK, ROS1, BRAF V600E, MET, RET , and NTRK genes. Recent studies conducted at Yale have led to FDA approval of drugs for the treatment of lung cancer, such as the immunotherapy drug Tecentriq (atezolizumab), which has been proven to improve patient survival for newly diagnosed NSCLC. This drug is designed to block PD-L1, a protein that was discovered by scientists at Yale and that has been instrumental in improving survival for lung cancer patients. Another FDA-approved drug, osimertinib, which stemmed from Yale Cancer Center and Smilow Cancer Hospital researchers, was approved for the treatment of adults with early-stage NSCLC with EGFR gene mutations. Surgery Many patients in need of surgery are referred for a minimally invasive surgery known as a video-assisted thoracoscopi

At Yale Medicine, our thoracic surgery team specializes in treating a wide range of chest-related conditions, from lung and esophageal cancers to other thoracic issues that may not involve cancer. Our highly skilled surgeons understand the importance of a gentle, compassionate approach to patient care, ensuring a supportive experience for those who may be facing challenging diagnoses. Trained in the most advanced surgical techniques, our team uses minimally invasive surgery whenever possible instead of traditional surgery, which typically requires larger incisions. This approach is designed to minimize your discomfort and help you to heal faster. Through the use of less invasive techniques, you can look forward to a quicker recovery, with less time spent in the hospital and better results after surgery. Specialized care is offered in the following areas: Benign esophageal disorders (paraesophageal hernia, reflux disease, narrowing, achalasia) Chest wall tumors Esophageal cancer Lung cancer Mediastinal cancers, located in the area between the lungs

The Smilow Cancer Hospital Lung Cancer Screening Program is a multidisciplinary program that provides lung cancer screening to patients at risk for lung cancer. Our program has a coordinated approach that offers a complete and seamless screening process. Our team includes world-recognized pulmonologists (doctors who treat diseases of the respiratory system), specialized chest radiologists (doctors with advanced skills in reading CT scan images of the lung), thoracic surgeons and thoracic oncologists (doctors who treat lung cancer), tobacco/smoking cessation counselling specialists, and specialized nurse practitioners. Our goal is to provide lung cancer screening in the context of a care process that takes patients from risk assessment to screening to resulting and referral, if needed. Should an abnormal finding be identified, our team will guide and support our patients through next steps. Our program is comprehensive and coordinated, and provides the patient with access to a specialized, expert team of caregivers. Our processes are efficient and seamless. Additionally, our team has the knowledge, experience, and compassion to provide patients with the best lung cancer screening experience. Because of this, our team is available to guide patients throughout the screening process and beyond, if needed. Whether it’s an annual follow-up scan or further evaluation, we have the people and resources to care for each patient. Our team uses nationally established guidelines to care for our patients. Our tobacco treatment services are available in person or via telehealth visits. Read our list of frequently asked questions regarding lung cancer screening . National Cancer Institute: Lung Cancer Screening Lung Cancer Prevention National Lung Screening Trial National Lung Screening Trial - Questions and Answers Lung Cancer Screening (PDQ)- Patient Version Centers for Medicare and Medicaid Services (CMS.gov): NCA - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) American Cancer Society: American Cancer Society Guidelines on Lung Cancer Screening Early Detection, Diagnosis, and Staging Causes, Risk Factors, and Prevention United States Preventive Services Task Force (USPSTF) A & B Recommendations

Our thoracic radiologists are internationally recognized experts in the field of thoracic imaging. Many of the radiologists in our section have advanced fellowship training in cardiothoracic imaging.We specialize in all aspects of lung disorders including: Interstitial lung disease Pulmonary infections Primary and secondary thoracic malignancies Mediastinal masses Pleural disease Occupational disorders Emphysema Diseases affecting the large and small airways (such as asthma, bronchiectasis, and tracheomalacia) We offer our patients a full range of diagnostic examinations, such as chest radiography, chest fluoroscopy, computed tomography (CT) of the chest, high-resolution chest CT, low-dose screening chest CT, and magnetic resonance imaging (MRI) of the chest. We have an active consultation service and work closely with clinicians at Yale New Haven Hospital, including those specializing in pulmonary and critical care medicine, general medicine and its subspecialties, thoracic and general oncology, cardiac and thoracic surgery, pulmonary pathology, radiation oncology, and cardiology. We regularly participate in multidisciplinary conferences that encompass a broad spectrum of comprehensive programs for common lung disorders, including pulmonary diseases rarely encountered elsewhere. In addition, we are a vital part of theYale Cancer Center’s Lung Screening Program.

At the Yale Chronic Obstructive Pulmonary Disease (COPD) program, our highly trained and skilled specialists provide comprehensive and multidisciplinary treatment to patients with COPD, an inflammatory lung disease that obstructs airflow from the lungs, making it increasingly difficult to breathe. We care for individuals: With emphysema With chronic bronchitis With COPD with associated bronchiectasis With asthma/COPD overlap With COPD/obstructive sleep apnea overlap With combined emphysema and pulmonary fibrosis (in conjunction with our interstitial lung disease team) Who experience frequent disease exacerbations and/or hospitalizations Under consideration for surgical therapies for emphysema (such as bullectomy, lung volume reduction surgery, and lung transplantation) Who need a pre-operative respiratory assessment for other forms of surgery With a suspected genetic basis for their disease (such as alpha-1-antitrypsin deficiency) With chronic respiratory failure related to COPD Patients suffering from COPD may experience flare-ups that require hospitalization, leaving them feeling weaker. Our physicians tailor treatment plans to help them manage their COPD so that they can live life to the fullest. Our physicians are also exploring therapies and medications that can help patients in the future. Whether patients have mild symptoms, need rehabilitation, or assisted ventilation, we can help. We also offer lung volume reduction surgery or lung transplantation to eligible patients. The Yale COPD program is staffed by two pulmonologists, a pulmonary specialist nurse practitioner, nurses, and respiratory therapists with special expertise in COPD. We arrange visits for patients with other specialist providers as needed, including cardiologists, thoracic surgeons, thoracic oncologists, palliative care specialists, otolaryngologists, allergists/immunologists, sleep medicine specialists, and health psychologists. The Yale COPD Program receives referrals for patients with difficult-to-control symptoms and/or frequent acute disease exacerbations, those who do not respond well to routine medical therapies, those with co-occurring complex medical conditions or overlap syndromes (as detailed above), those who may require surgical therapies, and those who have advanced disease with chronic respiratory failure. Providers in the COPD Program perform comprehensive evaluations and develop individualized care plans for all patients, with the goal of partnering closely with each patient’s primary care and other specialist providers. In addition, opportunities to participate in clinical research trials of new therapies in COPD are often available through our collaboration with the Yale Center for Asthma and Airways Disease (203-500-3808).

We care for children with a variety of allergic and immunologic disorders, and chronic respiratory diseases. Our highly specialized, board-certified clinicians diagnose and treat everything from the most common to the very rare conditions. Nasal and eye allergies Asthma Hives Medication allergy Chronic sinusitis Angioedema Hereditary angioneurotic edema Common variable immunodeficiency Secondary immune deficiencies Cystic fibrosis Sleep disorders Chronic lung disease in infants and older children Acute respiratory failure Treatments we offer include: Allergen vaccine immunotherapy (allergy shots) Asthma environmental controls and pharmacological controller therapy Intensive antihistamine regimens Biological therapy for hereditary angioneurotic edema Intravenous and subcutaneous immunoglobulin replenishment Aspirin desensitization Desensitization to antibiotics and other medications Our services include: Pediatric pulmonary function testing:We evaluate and follow lung disease in children with a full spectrum of tests, including diffusion analysis, challenge tests, and exercise. Physicians may order a pulmonary function test by calling 203-688-4667. Bronchoscopy:Bronchoscopy is the examination of the bronchi (the main airways of the lungs) using a flexible tube (bronchoscope). Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue and/or fluid, and/or to help remove a foreign body. Bronchoscopies are performed in the pediatric operating room, and in the Pediatric Intensive Care Unit. Our pulmonologists who perform this procedure have extensive experience with flexible bronchoscopy, including its use in newborns. In many cases, flexible bronchoscopy, which can be safely and comfortably performed under conscious sedation, eliminates the need for an exam under general anesthesia.

Unsedated transnasal endoscopy (TNE) is a procedure that can biopsy the gastrointestinal (GI) tract without needing sedation. In a typical endoscopy, a patient is brought to the operating room and given anesthesia to go to sleep. Once asleep, a camera is inserted through the mouth and into the GI tract. Once the procedure is over, the patient recovers in the post-anesthesia unit until they are ready to go home. Although the endoscopy itself is short, the whole experience usually takes several hours, requires at least a few hours of not eating or drinking, and requires anesthesia to complete. During a transnasal endoscopy, a smaller camera is used to enter through the nose and then into the GI tract. Before the procedure starts, a numbing spray is applied to the nose and mouth. The patient then wears a pair of VR goggles and watches a show or movie. The procedure is then performed, typically taking 10 to 20 minutes. Once the needed biopsies are obtained, the patient is able to go home. Although this procedure isn’t for everyone, there are a lot of advantages to a TNE compared to a traditional endoscopy. For instance, With TNE, there is no need for IVs, sedation, or recovery time. Patients only fast for 2 hours before the procedure and can eat or drink right after. They can also return to normal activities as soon as they feel ready, without missing a whole school day or afternoon of extracurricular activities. Yale is the only hospital in Connecticut performing this procedure, and it was one of the first programs in the country to do so.

At Yale Medicine, our pulmonary, critical care, and sleep medicine physicians focus on your respiratory health. We have a team of specialists to diagnose, treat, and manage respiratory conditions that affect your lungs and breathing. From asthma to complex lung diseases, our goal is to help you breathe easier. Our doctors are board-certified in internal medicine, pulmonary medicine, critical care, and sleep medicine. These expert physicians work closely with specialists in cardiology, diagnostic radiology, and pathology to provide you with comprehensive care for your respiratory condition. Office visits take place at the Winchester Center for Lung Disease in North Haven, Connecticut. Our sleep specialists treat most types of sleep disorders and see patients at our sleep centers at 3 locations in New Haven County. Specialized care is offered in the following areas: Adult cystic fibrosis Asthma and airway diseases Bronchiectasis and chronic pulmonary infections Cardiorespiratory exercise testing Chronic obstructive pulmonary disease (COPD) Clinical research in a wide range of lung diseases Interstitial lung disease Lung cancer screening and pulmonary nodule evaluation Medical intensive care unit for pulmonary conditions Multidisciplinary sleep care Pulmonary embolism Pulmonary function laboratory Pulmonary vascular disease Sleep apnea and other sleep disorders Thoracic interventional pulmonary embolism Thoracic oncology Tuberculosis

We offer state-of-the-art evaluation and treatment for patients with a wide range of lung disorders, including asthma, chronic obstructive pulmonary disease (COPD), emphysema, lung cancer, and undiagnosed or general respiratory problems. Many patients come to us with work-related pulmonary disease or with sleep disorders. They might not have a diagnosis, but have symptoms such as persistent or nagging cough, or shortness of breath at rest or with exertion. Our skilled, experienced specialists can diagnose and take care of difficult or unusual problems. The history of our center dates back more than a century, when it was set up through a bequest from Sarah Winchester in memory of her husband, William Wirt Winchester, and their young daughter, both of whom succumbed to tuberculosis. This gift resulted in the establishment of the original Winchester Hospital in West Haven, dedicated to the care of patients with tuberculosis. Today, the Winchester Center for Lung Disease at Yale New Haven Hospital is committed to the integration of cutting-edge patient care, education, and research across the full spectrum of pulmonary disorders. Our specialists are faculty members of the Yale School of Medicine Section of Pulmonary, Critical Care and Sleep Medicine, with national and international expertise in treating even the most challenging lung conditions. The center is continually evolving to meet changing needs. Most recently, in response to COVID-19, the center developed a Post-COVID-19 Recovery Program , which offers pulmonary-focused, multidisciplinary evaluation and care for patients recovering from COVID-19. In addition to our comprehensive general pulmonary practice, we offer the specialty center programs listed below. For more information about any of these programs, call the Winchester Center for Lung Disease at 203-495-2410. Adult Cystic Fibrosis Center Cystic fibrosis (CF) was previously thought of as a childhood disease, but is now considered a chronic disease because more adults in the U.S. are living longer with CF and maintaining good quality of life. The Adult CF Program provides team-based care for adults with CF on both an inpatient and outpatient basis. Our comprehensive program includes diagnosis, treatment, and counseling for sinus, pulmonary, gastrointestinal, liver, nutritional, endocrine, mental health, and reproductive issues. Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease that blocks airflow from the lungs and makes it difficult to breathe. The COPD Program (including emphysema, chronic bronchitis, and asthma/COPD overlap syndrome) provides a personalized treatment plan for each patient to help manage their COPD. Whether patients have mild symptoms, need rehabilitation, or require assisted ventilation, we can help. Chronic Pulmonary Infection Research and Treatment (CPIRT) This program is focused on the leading innovative care and research for acute

The Yale Thoracic Pathology Program specializes in analysis of tissue obtained from the thorax, including lungs, trachea, and chest wall, for evaluation for neoplastic (e.g. lung cancer, mesothelioma, other tumors) conditions, as well as specific non-neoplastic conditions (inflammatory lung disease, including specific infections and fibrotic [scarring] diseases of the lung). We also evaluate prognostic features relative to tumor immunotherapy (PD-L1 expression levels). Our services include examination of the following: Lung cancer Interstitial lung disease Lung fibrosis Occupational lung disease Chronic extrinsic hypersensitivity pneumonitis Early lung cancer Small cell carcinoma Neuroendocrine carcinoma Adenocarcinoma Bronchial biopsies Thoracoscopic biopsies Mesothelioma Thymoma Sarcoidosis Emphysema, Asthma and airway diseases

We focus on diseases of the pancreas, biliary tract, and gastrointestinal tract, and evaluate patients with a variety of symptoms and diseases, many of whom require advanced endoscopic procedures. Our team members work closely with referring physicians to promptly perform procedures, consultations, and discuss management options. Using a multidisciplinary approach to complex conditions, we collaborate with pathologists, cytologists, surgeons, oncologists, and radiologists to deliver care. Our endoscopic ultrasound program is among the largest of its kind in New England, and our experienced physicians perform approximately 1,500 procedures annually. This sophisticated procedure includes fine-needle aspiration of masses, cysts, and lymph nodes located in and around the digestive tract. This highly sophisticated technique is used to stage malignancies of the esophagus, rectum, and pancreas. Other outpatient endoscopic procedures we perform include: Esophagogastroduodenoscopy (EGD), a diagnostic endoscopic procedure for the upper gastrointestinal tract Enteroscopy, an endoscopic procedure used to examine the small intestine Colonoscopy with difficult polyp removal Sigmoidoscopy stenting of the esophagus, duodenum and colon to treat obstructions