Bronchoscopic biopsy techniques in the diagnosis and staging of lung cancer

In a review of the bronchoscopic biopsy techniques currently available for the diagnosis and staging of lung cancer, the author individually analyses the sampling instruments and procedures used in cancer of the central airways, peripheral lung lesions, and in the study of hilar and mediastinal lymph nodes. With regard to central bronchial lesions, data concerning diagnostic yield, the advantages and limits of forceps biopsy, brushing, washing and transbronchial needle aspiration are reported. With the integration of two or more of the sampling methods, a cytohistological diagnosis can be obtained in almost all cases. In the field of peripheral lung cancer, the diagnostic possibilities of the transbronchial approach are described. The experience of the Regional Hospital of Ancona, Italy on 1,027 patients affected by peripheral pulmonary nodules or masses is reported. The biopsy technique is based on the integration of transbronchial (using forceps biopsy and transbronchial needle aspiration) and percutaneous approaches, and on a team approach with the close co-operation of a pulmonologist, a radiologist and a cytopathologist, all simultaneously present in the diagnostic suite during the procedures. On the basis of the results obtained, the author suggests that, in peripheral pulmonary lesions, the transbronchial approach should generally be performed before the percutaneous needle aspirate, especially in patients who are candidates for surgery. The transbronchial approach has the advantages of allowing an examination of the tracheobronchial tree and staging of lymph nodes with a lower incidence of complications. In addition, the diagnostic yield of transbronchial needle aspiration in the study of hilar and mediastinal lymph nodes is analysed. This method, if positive, plays a major role in the staging of lung cancer and makes it possible to avoid unnecessary surgical procedures. Knowledge of the advantages and limits of different sampling instruments and procedures, and of their integration, is essential to optimize the diagnostic management of each patient with lung cancer. The goal is to maximize the diagnostic possibilities whilst minimizing risk and reducing costs.