A practical framework for physicians and researchers to assess diagnostic bronchoscopy technologies in lung cancer

Advancements in bronchoscopic technologies have improved the diagnosis of peripheral pulmonary nodules, yet inconsistent methodology and outcome definitions in observational studies hinder interpretation and comparison.

The American Thoracic Society (ATS) and American College of Chest Physicians (ACCP) have published a Delphi consensus definition of diagnostic yield and reporting standards for diagnostic testing in respiratory medicine. Recognition that bronchoscopy is a multi-disease test has highlighted limitations of traditional dichotomous accuracy metrics.

This review summarizes these methodologic advances and provides a practical framework for clinicians to critically appraise diagnostic bronchoscopy studies, compare technologies, and apply results to individual patients with suspected lung cancer. Emphasis is placed on appropriate reference standards, recognition of bronchoscopy as a multi-disease test, and the superiority of disease specific sensitivity over diagnostic yield for cross-study comparisons.