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Contemporary Concise Review 2024: New Techniques in Interventional Pulmonology.

Phan Nguyen1,2, Pallav L Shah3,4

  • 1Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Respirology (Carlton, Vic.)
|July 9, 2025
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Summary

Navigational bronchoscopy and cone beam computed tomography (CBCT) guided bronchoscopy offer similar diagnostic yields to traditional needle biopsies for lung nodules. Robotic assisted bronchoscopy (RAB) with advanced imaging further enhances diagnostic accuracy.

Keywords:
artificial intelligencebronchoscopyinterventional pulmonologylung cancerrobotics

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Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Percutaneous transthoracic needle biopsy (PTNB) is a standard for lung nodule diagnosis.
  • Navigational bronchoscopy and cone beam computed tomography (CBCT) guided bronchoscopy offer alternative approaches.
  • Robotic assisted bronchoscopy (RAB) and endobronchial ultrasound (EBUS) represent advancements in minimally invasive diagnostics.

Purpose of the Study:

  • To compare the diagnostic yields of various bronchoscopic techniques with PTNB for lung nodules.
  • To evaluate the impact of advanced imaging and robotic assistance on diagnostic accuracy.
  • To discuss emerging technologies and future directions in minimally invasive lung nodule diagnosis.

Main Methods:

  • Comparison of diagnostic yields between navigational bronchoscopy, CBCT-guided bronchoscopy, and PTNB.
  • Assessment of diagnostic yield improvements with RAB and advanced imaging (CBCT, digital tomosynthesis).
  • Evaluation of endobronchial ultrasound (EBUS) guided nodal cryobiopsy efficacy.

Main Results:

  • Navigational bronchoscopy and CBCT-guided bronchoscopy demonstrate comparable diagnostic yields to PTNB.
  • RAB combined with advanced imaging significantly improves diagnostic yield.
  • EBUS-guided nodal cryobiopsy shows potential in specific clinical scenarios.

Conclusions:

  • Advanced bronchoscopic techniques, particularly RAB with advanced imaging, offer high diagnostic yields for lung nodules.
  • Emerging technologies like thin EBUS-CP bronchoscopes may address diagnostic challenges in the middle airway.
  • Guidelines and expert consensus are valuable in the absence of extensive trial data; AI shows promise for training.