Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jul-Sep;12(3):162-170.
doi: 10.4103/atm.ATM_416_16.

Gaining access to the periphery of the lung: Bronchoscopic and transthoracic approaches

Abdelfattah Ahmed Touman  1 , Vlasios V Vitsas  2 , Nickolaos G Koulouris  2 , Grigoris K Stratakos  2
Affiliations
Review

Gaining access to the periphery of the lung: Bronchoscopic and transthoracic approaches

Abdelfattah Ahmed Touman et al. Ann Thorac Med. 2017 Jul-Sep.

Abstract

Globally, lung cancer remains the leading cause of cancer-related death. Annual low-dose computed tomography has been recommended as a screening test for early detection of lung cancers. Implementing this screening strategy is expected to challenge pulmonologist to confirm the nature of the increasing number of detected pulmonary nodules. Clinicians are obliged to use the less invasive and most efficient and safe means to set diagnoses. Hence, the field of diagnostic modalities, especially the advanced diagnostic bronchoscopy is witnessing rapid evolution to fulfill these unmet needs. This review highlights the available diagnostic modalities, describes their advantages and discusses the limitations of each technique. It also suggests an integrated diagnostic algorithm based on the best available evidence. A search of the PubMed database was conducted using relevant terms described at methodology; only articles in English were reviewed by November 2016.

Keywords: Bronchoscopic modalities; image-guided transthoracic needle aspiration; interventional pulmonology; lung cancer; navigation bronchoscopy; peripheral lung nodule.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Algorithm for the management of pulmonary nodules. Diagnosis and management of lung cancer 3rd ed: American College of Chest Physicians guidelines[8]
Figure 2
Figure 2
Diagnostic value of combined conventional bronchoscopic techniques for sampling peripheral pulmonary lesion. Adapted from source 19
Figure 3
Figure 3
(a) The setting needed to perform fluoroscopic guided bronchoscopy. (b) Bronchoscopic biopsy of a peripheral lesion under fluoroscopic guidance
Figure 4
Figure 4
(a) Ultrasound radial probe located within the lesion, (b) ultrasound radial probe adjacent to the lesion (from 4 o'clock to 9 o'clock), (c) is radial probe ultrasonic view in normal lung parenchyma, (d) a vascular structure in relation to the lesion
Figure 5
Figure 5
Suggested algorithm to approach peripheral pulmonary nodules based on risk and benefits of the available techniques
See this image and copyright information in PMC

References

    1. American Cancer Society. Cancer facts and figures 2016. Atlanta: American Cancer Society; 2016.
    1. World Health Organization. Cancer. Fact Sheet Number 297. [Last updated on 2017 Feb]. Available from: http://www.who.int/mediacentre/factsheets/fs297/en/
    1. Groome PA, Bolejack V, Crowley JJ, Kennedy C, Krasnik M, Sobin LH, et al. The IASLC Lung Cancer Staging Project: Validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2:694–705. - PubMed
    1. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409. - PMC - PubMed
    1. Kauczor HU, Bonomo L, Gaga M, Nackaerts K, Peled N, Prokop M, et al. ESR/ERS white paper on lung cancer screening. Eur Respir J. 2015;46:28–39. - PMC - PubMed