American Association for Bronchology and Interventional Pulmonology (AABIP) Evidence-Based Guidelines on Bronchoscopic Diagnosis and Staging of Lung Cancer

Russell J Miller^{1

2}, Ara A Chrissian³, Fayez Kheir⁴, Majid Shafiq⁵, Abigail T Chua⁶, Neal Navani⁷, Francisco A Almeida⁸, Abdul H Alraiyes⁹, Paul A Bain¹⁰, Christina R Bellinger¹¹, Cherng H Chao¹², George Z Cheng¹, Rebecca Cloyes¹³, Javier Diaz-Mendoza¹⁴, David M DiBardino¹⁵, Erik Folch⁴, Laura K Frye¹⁶, Yaron B Gesthalter¹⁷, Thomas R Gildea⁸, Amit Goyal¹⁸, Karen M Heskett¹⁹, Van Kim Holden²⁰, Moishe Liberman²¹, Christopher Manley²², Nikhil K Meena²³, Catherine L Oberg²⁴, Jasleen K Pannu¹³, Edward M Pickering²⁵, Michal Senitko²⁶, Jo-Anne O Shepard²⁷, Thomas Vandemoortele²⁸, Atul C Mehta⁸, Kazuhiro Yasufuku²⁹

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, Universityof California San Diego, La Jolla, CA.
² Department of Pulmonary Medicine, Naval Medical Center San Diego, San Diego, CA.
³ Division of Pulmonary, Critical Care, Hyperbaric, and Sleep Medicine, Loma Linda University Health, Loma Linda, CA.
⁴ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁵ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁶ Division of Pulmonary, Critical Care and Sleep Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY.
⁷ Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
⁸ Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH.
⁹ Department of Medicine, Section of Interventional Pulmonology, Rosalind Franklin University of Medicine and Science, North Chicago, IL.
¹⁰ Countway Library of Medicine, Harvard Medical School, Boston, MA.
¹¹ Atrium Health Wake Forest Baptist, Winston-Salem, NC.
¹² Division of Interventional Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA.
¹³ Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
¹⁴ Division of Pulmonary and Critical Care, Henry Ford Health, Detroit, MI.
¹⁵ Section of Interventional Pulmonology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹⁶ Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT.
¹⁷ Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA.
¹⁸ Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL.
¹⁹ UC San Diego Library, University of California San Diego, La Jolla, CA.
²⁰ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Maryland School of Medicine, Baltimore, MD.
²¹ Division of Thoracic Surgery, University of Montreal, Montreal, Québec, Canada.
²² Division of Pulmonary and Critical Care Medicine, Fox Chase Cancer Center - Temple University Health System, Philadelphia, PA.
²³ Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
²⁴ Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY.
²⁵ Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL.
²⁶ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS.
²⁷ Department of Radiology, Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA.
²⁸ Division of Respiratory Medicine, CHUM, University of Montreal, Montreal, Québec, Canada.
²⁹ Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

PMID: 41024606
DOI: 10.1097/LBR.0000000000001034

Practice Guideline

American Association for Bronchology and Interventional Pulmonology (AABIP) Evidence-Based Guidelines on Bronchoscopic Diagnosis and Staging of Lung Cancer

Russell J Miller et al. J Bronchology Interv Pulmonol. 2025.

. 2025 Sep 30;32(4):e1034.

doi: 10.1097/LBR.0000000000001034. eCollection 2025 Oct 1.

Authors

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, Universityof California San Diego, La Jolla, CA.
² Department of Pulmonary Medicine, Naval Medical Center San Diego, San Diego, CA.
³ Division of Pulmonary, Critical Care, Hyperbaric, and Sleep Medicine, Loma Linda University Health, Loma Linda, CA.
⁴ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁵ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁶ Division of Pulmonary, Critical Care and Sleep Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY.
⁷ Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
⁸ Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH.
⁹ Department of Medicine, Section of Interventional Pulmonology, Rosalind Franklin University of Medicine and Science, North Chicago, IL.
¹⁰ Countway Library of Medicine, Harvard Medical School, Boston, MA.
¹¹ Atrium Health Wake Forest Baptist, Winston-Salem, NC.
¹² Division of Interventional Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA.
¹³ Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
¹⁴ Division of Pulmonary and Critical Care, Henry Ford Health, Detroit, MI.
¹⁵ Section of Interventional Pulmonology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹⁶ Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT.
¹⁷ Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA.
¹⁸ Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL.
¹⁹ UC San Diego Library, University of California San Diego, La Jolla, CA.
²⁰ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Maryland School of Medicine, Baltimore, MD.
²¹ Division of Thoracic Surgery, University of Montreal, Montreal, Québec, Canada.
²² Division of Pulmonary and Critical Care Medicine, Fox Chase Cancer Center - Temple University Health System, Philadelphia, PA.
²³ Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
²⁴ Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY.
²⁵ Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL.
²⁶ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS.
²⁷ Department of Radiology, Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA.
²⁸ Division of Respiratory Medicine, CHUM, University of Montreal, Montreal, Québec, Canada.
²⁹ Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

PMID: 41024606
DOI: 10.1097/LBR.0000000000001034

Abstract

Background: Lung cancer remains a predominant cause of cancer-related deaths worldwide, and there are notable geographic and institutional differences in both diagnostic and staging approaches. To address this, the American Association for Bronchology and Interventional Pulmonology (AABIP) convened a multidisciplinary committee to craft evidence-based and evidence-informed recommendations for diagnosing peripheral pulmonary nodules and performing convex probe endobronchial ultrasound (CP-EBUS)-guided mediastinal staging.

Methods: A modified Delphi method guided the creation and refinement of 9 Population, Intervention, Comparator, Outcome (PICO) questions. A systematic literature review, updated through March 2023, served as the basis for drafting recommendations. The panel used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence and relied on National Institute for Health and Care Excellence (NICE) language to express the strength of each recommendation. Where suitable, meta-analyses were completed; otherwise, systematic reviews and consensus among experts provided the evidence for guidance.

Results: Nine recommendations were ultimately proposed: 6 were supported by meta-analyses and 3 by systematic reviews. The topics include comparing diagnostic yield and complication rates between peripheral bronchoscopy and transthoracic needle biopsy, the use of multiple biopsy instruments and the role of rapid on-site evaluation (ROSE) during peripheral bronchoscopy, and best practices for CP-EBUS-guided mediastinal staging. Several critical considerations emerged, such as lesion size, evolving technologies in bronchoscopy, and the importance of both available resources and local expertise.

Conclusion: These guidelines aim to standardize and streamline recommendations for the bronchoscopic diagnosis and staging of lung cancer. Since rapid technological progress and observational data play significant roles in this field, ongoing research and evidence updates will be vital to refining best practices. Clinicians are advised to tailor these recommendations according to local circumstances, the unique needs of their patients, and any new findings as they develop.

Keywords: bronchoscopy; endobronchial ultrasound (EBUS); lung cancer; mediastinal staging; peripheral pulmonary nodule.

Copyright © 2025 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

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Conflict of interest statement

A.H.A.: Intuitive-Consulting fees; A.G.: Intuitive-Consulting fees; C.L.O.: Intuitive-Consulting fees (scientific/educational), Medtronic-Consulting fees (scientific/educational), Cook Medical-Consulting fees (scientific/educational), Olympus-Consulting fees (scientific/educational), Boston Scientific-Consulting fees (scientific/educational), Noah Medical-Consulting fees, Nuance-Consulting fees; C.M.: Johnson & Johnson-Consulting fees/educational speaker, Johnson & Johnson-Research funding, Mauna Kea-Research funding, Aquyre Bioscience-Research funding; D.M.D.: Cook Medical-Consulting fees, Olympus-Consulting fees, Johnson & Johnson-Consulting fees, Noah-Consulting fees, Intuitive Surgical-Consulting fees, Galvanize Therapeutics-Research grants, Erbe-Research grants, Johnson & Johnson-Research grants, Philips-Research grants; E.M.P.: Noah Medical-Consulting fees; E.F.: Boston Scientific-Consulting fees, Medtronic-Consulting fees, Intuitive-Consulting fees, Pinnacle Biologics-Consulting fees, Siemens-Consulting fees, Cook-Consulting fees, Intuitive-Institutional research support, Lung Therapeutics-Institutional research support; G.Z.C.: Olympus-Consulting fees, Cook Medical-Consulting fees, Boston Scientific-Consulting fees, Intuitive Surgical-Consulting fees; J.O.S.: Elsevier-Royalties (book publications); K.Y.: Olympus-Research grants/Consulting fees/Advisory board membership, Johnson & Johnson-Research grants/Consulting fees/Advisory board membership, ODS Medical-Research grants, Medtronic-Consulting fees/Advisory board membership, AstraZeneca-Consulting fees, Merck Canada Inc-Consulting fees, OKF Technology-Research collaboration; L.K.F.: Olympus-Honoraria, Intuitive-Consulting fees, Steris-Consulting fees; M.S. (Senitko): Intuitive Inc. -Consulting fees; M.L.: Ditch Labs-Chief Medical Officer, AssistIQ-Chief Medical Officer, Endocision-Chief Medical Officer, Olympus-Research/educational grants, Johnson & Johnson-Research/educational grants, Merck-Research/educational grants, AstraZeneca-Research/educational grants, Boston Scientific Research/educational grants, Cook-Research/educational grants, Intuitive-Research/educational grants, BMS-Research/educational grants; N.N.: Amgen-Honoraria/Advisory board, AstraZeneca-Honoraria/Advisory board, AXANA-Honoraria/Advisory board, BeiGene-Honoraria/Advisory board, Boehringer Ingelheim-Honoraria/Advisory board, BMS-Honoraria/Advisory board, EQRx-Honoraria/Advisory board, Fujifilm-Honoraria/Advisory board, Guardant Health-Honoraria/Advisory board, Intuitive-Honoraria/Advisory board, Janssen-Honoraria/Advisory board, Lilly-Honoraria/Advisory board, Merck Sharp & Dohme-Honoraria/Advisory board, Olympus-Honoraria/Advisory board, Roche-Honoraria/Advisory board, Sanofi-Honoraria/Advisory board; R.C.: Optellum-Research support; T.R.G.: Olympus-Consulting fees/Speaking honoraria/Clinical research/institutional CME support, Intuitive-Consulting fees/Speaking honoraria/Clinical research/institutional CME support, Medtronic-Consulting fees/Speaking honoraria/Clinical research/institutional CME support, Johnson & Johnson/Ethicon-Consulting fees/Speaking honoraria/Clinical research/institutional CME support, Siemens-Consulting fees/Speaking honoraria/Clinical research/institutional CME support; V.K.H.: Ambu-Consulting fees; Y.B.G.: Lead Optik-Consulting fees, Intuitive Surgical-Honoraria, Olympus-Honoraria, Patient Power-Medical board membership; M.S. (Shafiq): Ambu A/S-Consulting fees, PulmonX-Research grants, Olympus-Research grants; A.A.C.: Intuitive-Consulting fees. Russell J. Miller, MD, CAPT, MC, USN is a military service member or federal/contracted employee of the United States government. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. The views expressed in this article reflect the results of research conducted by the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government. For the remaining authors, there is no conflict of interest or other disclosures.

References

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American Association for Bronchology and Interventional Pulmonology (AABIP) Evidence-Based Guidelines on Bronchoscopic Diagnosis and Staging of Lung Cancer

Affiliations

American Association for Bronchology and Interventional Pulmonology (AABIP) Evidence-Based Guidelines on Bronchoscopic Diagnosis and Staging of Lung Cancer

Authors

Affiliations

Abstract

Conflict of interest statement

References

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LinkOut - more resources

Full Text Sources

Medical

Miscellaneous