Felix J.F.
Pallav L.
and Daniela
The role of bronchoscopy in the evaluation and treatment of respiratory disease has evolved
dramatically over the last decade. It was initially a tool for examining and sampling the
central endobronchial tree, and techniques available included simple suctioning of
secretions, bronchial washing, bronchial brushing and bronchial biopsies. The latter two are
achieved by inserting either a cytology brush or biopsy forceps through the instrument
channel and sampling the area of direct interest. During the 1990s, there was a transition
from fibreoptic bronchoscopes to video bronchoscopes. The quality of the imaging systems
has improved exponentially thanks to advances in video charged coupled devices (CCDs).
Initially, there was the development of fluorescence bronchoscopy and NBI for the early
detection of cancer. Although these techniques have the potential to identify lesions early,
they have become less important with improvements in image quality. The transition to low
tar cigarettes with filters means the natural history of lung cancer has also changed from
central airway squamous cell carcinomas to more peripheral adenocarcinomas. Techniques
have therefore been developed for sampling peripheral lesions, such as radial ultrasound with
a guide sheath and computer-aided navigation bronchoscopy (LungPoint (Broncus Medical,
Inc., San Jose, CA, USA) and superDimension (Medtronic, Minneapolis, MN, USA)). With
the growth in CT scanning, the identification of peripheral nodules and pulmonary
abnormalities will further increase, which will in turn increase the demand for sampling in
these peripheral abnormalities.
Endosonography and particularly EBUS-TBNA, with the development of the integrated
linear ultrasound bronchoscope, have transformed the staging and diagnosis of lung cancer.
These techniques allow sampling of multiple mediastinal and hilar lymph node stations as
short day-case procedures under conscious sedation. These techniques are also useful for
sampling mediastinal lymph nodes in other conditions such as sarcoidosis, and allow
sampling of abnormalities adjacent to the central tracheobronchial tree.
Bronchoscopy has now truly reached its potential as a therapeutic tool. Central obstructing
tumours can be debulked using either electrocautery, argon plasma photo coagulation, laser
ablation or cryo-extraction. Traditional cryotherapy with repeated freeze–thaw cycles can
also be used but requires a follow-up bronchoscopy to clear up necrotic tissue. PDT is a
further possibility but this requires a photo-sensitiser to be administered intravenously
about 72 h followed by PDT at bronchoscopy and a subsequent procedure to remove the
Copyright ©ERS 2017. Print ISBN: 978-1-84984-091-0. Online ISBN: 978-1-84984-092-7. Print ISSN: 2312-508X. Online ISSN: 2312-5098.
Correspondence: Pallav L. Shah, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. E-mail:
of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, Heidelberg University, Heidelberg, Germany.
Brompton Hospital, London, UK.
and Westminster Hospital, London, UK.
College London, London, UK.
Pulmonology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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