Diagnostic bronchoscopy: state of the art

Abstract

Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.

Figure 1.

Autofluorescence bronchoscopy can discriminate normal from abnormal bronchial mucosa due to the difference in fluorescence emission: normal bronchial mucosa emits a green coloured fluorescence and abnormal bronchial mucosa emits a red-brown coloured fluorescence. Autofluorescence image of a patient with a history of lung adenocarcinoma resected 2 yrs prior (b); the arrows point at a moderate dysplastic lesion on a subsegmental carina which is difficult to identify with white light (a).

Figure 2.

Curved-linear trans-oesophageal endoscopic ultrasound with real time guided fine-needle aspiration of a tumoural mass in the left adrenal gland.

Figure 3.

Curved-linear endobronchial ultrasound with real time guided transbronchial needle aspiration of a paratracheal lymph node in level four right.

Figure 4.

A radial transducer endobronchial ultrasound miniprobe can be introduced through the biopsy channel of a standard bronchoscope to perform endobronchial ultrasonography of a peripheral pulmonary lesion.

Figure 5.

Electromagnetic navigation image: the icon representing the locatable guide (arrow) can be seen 3 mm away from the centre of a small pulmonary nodule in a patient with a history of colon cancer. Cytopathologic assessment confirmed metastatic disease.