Advanced Bronchoscopic Diagnostic Techniques in Lung Cancer

Abstract

The increasing incidence of incidental pulmonary nodules necessitates effective biopsy techniques for accurate diagnosis and treatment planning. This paper reviews the widely used advanced bronchoscopic techniques, such as radial endobronchial ultrasound-guided transbronchial lung biopsy, electromagnetic navigation bronchoscopy, and the cutting-edge robotic-assisted bronchoscopy. In addition, the cryobiopsy technique, which can enhance diagnostic yield by combination with conventional biopsy tools, is described for application to peripheral pulmonary lesions and mediastinal lesions, respectively.

Keywords: Biopsy; Bronchoscopy; Cryobiopsy; Electromagnetic Navigation Bronchoscopy; Endobronchial Ultrasound; Lung Cancer; Robotic-Assisted Bronchoscopy.

Fig. 1.

Penetrating biopsy tools used in NAVIGATE study (https://www.medtronic.com/covidien/en-us/products/interventional-lung-solutions/pulmonary-and-biopsy-tools.html).

Fig. 2.

(A) Monarch Platform. (B) Screen during navigation (https://www.jnjmedtech.com/en-US/product-family/monarch).

Fig. 3.

(A) Ion endoluminal system. (B) Shape-sensing catheter technology (https://www.intuitive.com/en-us).

Fig. 4.

A case in which a specimen containing adenocarcinoma was obtained through three crybiopsies (H&E stain, ×5). (A) The arrow indicates bronchial mucosa, and the dotted arrow indicates cartilage—‘adjacent to’ on radial endobronchial ultrasound (rEBUS). (B) Atypical cells are observed in the dotted oval—‘adjacent to’ on rEBUS. (C) Adenocarcinoma observed in dotted circle—‘within’ on rEBUS.

Fig. 5.

Size comparison of lymph node between specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and cryobiopsy (A) 21G EBUS-TBNA—the diameter of the area containing adenocarcinoma is 270 μm. (B) A 1.1 mm cryoprobe—1,950 μm (H&E stain, ×2).