Recent developments in advanced diagnostic bronchoscopy

Abstract

The field of bronchoscopy is advancing rapidly. Minimally invasive diagnostic approaches are replacing more aggressive surgical ones for the diagnosis and staging of lung cancer. Evolving diagnostic modalities allow early detection and serve as an adjunct to early treatment, ideally influencing patient outcomes. In this review, we will elaborate on recent bronchoscopic developments as well as some promising investigational tools and approaches in development. We aim to offer a concise overview of the significant advances in the field of advanced bronchoscopy and to put them into clinical context. We will also address potential complications and current diagnostic challenges associated with sampling central and peripheral lung lesions.

FIGURE 1

Hybrid endobronchial ultrasound bronchoscope and high-definition image of the airway. a) Tip of the flexed endobronchial ultrasound bronchoscope. b) Endobronchial view. c) Convex area of the scope. d) Needle extending through the work channel.

FIGURE 2

Real-time radial endobronchial ultrasound biopsy tool.

FIGURE 3

Distal tip of radial endobronchial ultrasound biopsy tool with separation between the ultrasound probe and the needle.

FIGURE 4

a) Illustration of various possible needle puncture scenarios seen on cone-beam computed tomography imaging. Needle b) entering in the center of the lesion, c) from the periphery, d) going too distally through the lesion, e) just adjacent to the lesion, and f) missing the lesion completely.