Improving diagnostic strategies in bronchoscopy for peripheral pulmonary lesions

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Imaging

Background:

• Bronchoscopy for peripheral pulmonary lesions (PPLs) has evolved significantly.
• Diagnostic yield has improved due to combined instruments and devices.

Purpose of the Study:

• To review strategies for diagnostic bronchoscopy of PPLs.
• To summarize the utility and evidence of key instruments and devices.
• To discuss future perspectives in PPL bronchoscopy.

Main Methods:

• Review of clinical trials and evidence for diagnostic bronchoscopy tools.
• Analysis of combined navigation, imaging, and approach technologies.
• Evaluation of biopsy techniques and on-site assessment.

Main Results:

• Improved accuracy in reaching PPLs with navigation, ultrasound, tomosynthesis, and CBCT.
• Advancements in ultrathin bronchoscopes and robotic-assisted bronchoscopy.
• Needle aspiration and cryobiopsy offer expanded diagnostic options, with yields comparable to transthoracic needle biopsy.

Conclusions:

• Modern bronchoscopy techniques achieve diagnostic yields for PPLs comparable to transthoracic needle biopsy.
• Technological advancements are paving the way for transbronchial treatment of PPLs.
• The integration of various tools enhances the diagnostic capability for PPLs.