[Modern examination methods in pneumology]

In addition to qualitative establishment of diagnosis the aim of modern investigational procedures is quantitative analysis of disease extension and of functional impairment. The most important endoscopic-bioptical techniques for establishment of diagnosis are bronchoscopy and thoracoscopy. In bronchology flexible bronchoscopy with a relative share of about 90% clearly holds now a dominant position versus the rigid technique. Suspected cancer is the most prominent indication (ca. 60%). Visible intrabronchial lesions can be diagnosed in more than 90%. In extrabronchial and peripheral bronchopulmonary disease technical aids like transbronchial needle aspiration (TBNA), bronchoalveolar lavage (BAL) or transbronchial biopsy (TBB) are required, resulting in a diagnostic yield, that may range between 30 and 90% depending on the particular disease entity. Thoracoscopy is the second most important endoscopic procedure and accounts for about 1/10 of the investigational frequency of bronchoscopy. Pleural - generally exsudative - effusion provides by far the most frequent indication with a relative incidence of 75%. Etiological diagnosis can be established in about 90% of pleural effusions. The maximum yield of 100% may be achieved in tuberculous effusions, in malignant effusion sensitivity comes close to 100%. Non-endoscopic bioptical techniques include guided perthoracic needle aspiration and "blind" pleural biopsy. Diagnostic escalation or tumor staging may require surgical procedures, which can be performed by conventional techniques (mediastinoscopy, minithoracotomy) or video-assisted thorascopy. Explorative thoracotomy is the most extensive investigation. For functional evaluation of number of "classical" techniques are available (spirometry, gas transfer analysis, spiroergometry) more recently expanded by radionuclide perfusion and ventilation studies. Besides grading of functional impairment they allow clinical diagnosis of diseases characterized by specific functional patterns (asthma, bronchitis, emphysema, sleep associated disorders) and serve preoperative assessment in surgery. Increasingly important modern imaging techniques like computed tomography (CT), nuclear magnetic resonance (NMR) or ultrasonic investigation are not featured in this clinically focused article.