Advances in Diagnostic Bronchoscopy

Abstract

Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.

Central airway tumors: interventional bronchoscopy in diagnosis and management

“…Both of them have superior sensitivity comparing with white light bronchoscopy [3][4][5]. Endobronchial ultrasonography (EBUS) is also helpful in evaluating the extent of airway lesion involvement (14,18).…”

Stents Are Associated With Increased Risk of Respiratory Infections in Patients Undergoing Airway Interventions for Malignant Airways Disease

“…We classifi ed respiratory infections using a method similar to those of previously published studies. [3][4][5][6][7][8] We defi ned a lower respiratory tract infection as present on the basis of clinical fi ndings of fever, purulent sputum, and worsening cough, with or without radiographic evidence of pneumonia. We also required that there be documentation by the managing physician of a clinical diagnosis of lower respiratory tract infection and that antibiotics be prescribed for it.…”

“…Most other studies of infection in patients undergoing therapeutic bronchoscopy have used incidence proportions. [3][4][5][6][7][8][12][13][14] As we have shown in our previous work, incidence proportions have signifi cant limitations when used to analyze long-term complications; the incidence rate is a more appropriate measurement because it measures events per persontime at risk. 9 An additional benefi t of using survival analysis methods with time-varying covariates is that we can control for factors that vary over time, such as the degree of airway obstruction and stent removal.…”

Transbronchial Needle Aspiration through a Guide Sheath with Endobronchial Ultrasonography (GS-TBNA) for Peripheral Pulmonary Lesions

“…When we look back at the historical improvements in the diagnosis of a PPL, the development of flexible bronchoscopy in 1966 was probably the first paradigm shift in the realm of pulmonary diagnostics. 2) It brought about an approach to a PPL that is easy and less invasive. The technological advancement of the CT scan made it convenient to identify the bronchus leading to the PPL, but still it was difficult to obtain samples with an acceptable accuracy.…”

“…The paradigm shift brought about by the use of radial probe endobronchial ultrasonography and a guide sheath (EBUS-GS) increased detection rates of bronchoscopy for PPLs. 2,3) The new guidelines of the American College of Chest Physicians now recommends radial EBUS as an emerging technology to diagnose PPLs. 4) It has been noted that when the EBUS probe location is adjacent to the lesion the diagnostic yield is lower compared to when the probe is within the lesion.…”