Flexible bronchoscopy in adults: Associated diagnostic and therapeutic procedures
- Shaheen Islam, MD, MPH, FCCP
Shaheen Islam, MD, MPH, FCCP
- Ohio State University Medical Center
Both diagnostic sampling and therapeutic interventions can be performed during flexible bronchoscopy. Common diagnostic and therapeutic procedures are reviewed in this topic. An overview of flexible bronchoscopy, indications, contraindications, complications, and technical aspects of the procedure are discussed separately. (See "Flexible bronchoscopy in adults: Overview" and "Flexible bronchoscopy in adults: Indications and contraindications" and "Flexible bronchoscopy in adults: Preparation, procedural technique, and complications".)
All patients should be consented for bronchoscopic airway inspection and for any pre-planned procedures. Consent, preparation, and the procedural details of airway inspection are discussed separately. (See "Flexible bronchoscopy in adults: Preparation, procedural technique, and complications".)
Many diagnostic procedures can be performed using a flexible bronchoscope with the aim of establishing a diagnosis of benign or malignant disease involving the airway (figure 1), parenchyma, and/or mediastinum. Typically airway inspection is coupled with one or more procedures.
Standard conventional white light bronchoscopy can be used for all of the diagnostic procedures discussed in this section. (See 'Endobronchial brushing' below and 'Bronchoalveolar lavage' below and 'Bronchial washing' below and 'Endobronchial biopsy' below and 'Transbronchial biopsy' below and 'Needle aspiration' below.)
Diagnostic procedures that can be performed with other types of flexible bronchoscopy are provided separately:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hautmann H, Henke MO, Bitterling H. High diagnostic yield from transbronchial biopsy of solitary pulmonary nodules using low-dose CT-guidance. Respirology 2010; 15:677.
- Rittirak W, Sompradeekul S. Diagnostic yield of fluoroscopy-guided transbronchial lung biopsy in non-endobronchial lung lesion. J Med Assoc Thai 2007; 90 Suppl 2:68.
- Ost DE, Ernst A, Lei X, et al. Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med 2016; 193:68.
- Eapen GA, Shah AM, Lei X, et al. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry. Chest 2013; 143:1044.
- Chen A, Chenna P, Loiselle A, et al. Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience. Ann Am Thorac Soc 2014; 11:578.
- Boiselle PM, Ernst A. Recent advances in central airway imaging. Chest 2002; 121:1651.
- Vining DJ, Liu K, Choplin RH, Haponik EF. Virtual bronchoscopy. Relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest 1996; 109:549.
- Asano F, Eberhardt R, Herth FJ. Virtual bronchoscopic navigation for peripheral pulmonary lesions. Respiration 2014; 88:430.
- Buchbender C, Herbrik M, Treffert J, et al. Virtual 18F-FDG PET/CT bronchoscopy for lymph node staging in non-small-cell lung cancer patients: present and future applications. Expert Rev Med Devices 2012; 9:241.
- Herbrik M, Treffert J, Geiger B, et al. Diagnostic accuracy of virtual 18F-FDG PET/CT bronchoscopy for the detection of lymph node metastases in non-small cell lung cancer patients. J Nucl Med 2011; 52:1520.
- Gershman E, Fruchter O, Benjamin F, et al. Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases. Respiration 2015; 90:40.
- Hernández-González F, Lucena CM, Ramírez J, et al. Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost-effectiveness analysis. Arch Bronconeumol 2015; 51:261.
- Griff S, Schönfeld N, Ammenwerth W, et al. Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med 2014; 14:171.
- Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 2014; 19:900.
- Choosing the type of procedure
- Endobronchial brushing
- Bronchoalveolar lavage
- Bronchial washing
- Endobronchial biopsy
- Transbronchial biopsy
- Needle aspiration
- Choosing the therapeutic procedure
- - Laser resection
- - Argon plasma coagulation
- - Photodynamic therapy
- - Electrocautery
- - Cryosurgery
- - Balloon dilatation
- - Brachytherapy
- - Airway stenting
- - Valve placement
- - Bronchial thermoplasty
- SUMMARY AND RECOMMENDATIONS