Diagnostic yield: what is sufficient?

Advances in diagnostic bronchoscopy seek to optimize diagnostic yield while maintaining the safety profile of conventional bronchoscopy. Despite rapid technological progress, inconsistent outcome definitions have hindered pooling of data across studies and comparisons across technologies. This review aims to clarify how a standardized definition of diagnostic yield can enhance comparability and clinical interpretation in advanced diagnostic bronchoscopy.

The recent ATS/CHEST consensus statement provides a rigorous framework for defining and reporting diagnostic yield, enabling meaningful cross-study comparisons. Beyond definitions of diagnostic outcome measures, optimization of tissue acquisition and processing through close collaboration between bronchoscopists and pathologists is critical. Current evidence supports the use of coordinated sampling strategies to secure sufficient, high-quality material for molecular testing, particularly for large-panel next-generation sequencing (NGS). Advances in EBUS-TBNA, cryobiopsy, and robotic bronchoscopy have improved sample yield and quality for genomic profiling. In parallel, liquid biopsy using circulating tumor DNA provides a minimally invasive adjunct, particularly valuable when tissue is limited, exhausted, or longitudinal monitoring is required; however, its sensitivity remains constrained in low-shedding diseases.

Adherence to a strict definition of diagnostic yield, combined with optimized sampling and integrated molecular testing, ensures that technological innovation in bronchoscopy translates into clinically meaningful, precise, and patient-centered diagnosis of lung cancer.