Small pulmonary lesions localized in peripheral airways or lung parenchyma are mostly not visible by means of flexible or rigid bronchoscopy for they are distal to the inspectable airway caliber. Therefore fluoroscopy is necessary to direct the flexible biopsy forceps or biopsy needle to the lesion. Even a two-dimensional fluoroscopic guidance does not guarantee an access to the focus. Therefore we investigated a method to overcome these problems. In 9 patients with peripheral lung lesions where the conventional method had failed to provide sufficient biopsies CT-guided bronchoscopy was done. Central airways were carefully inspected, and the flexible forceps was introduced into the bronchial branch leading to the focus under fluoroscopic control. Then the forceps was localized in the axial plane by CT and guided directly to the lesion. Subsequently the forceps was opened and contact to the lesion was confirmed by CT scan before the biopsies were taken. Thus the three-dimensional control of the position of the forceps made it possible to get biopsies directly from the region of interest. The method provides the possibility of reaching even small peripheral lesions that have been missed by the conventional techniques, thereby, although technically more difficult for the examiner, providing a smaller risk of complications and no additional discomfort for the patient.

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The M cells of the lung are specialized epithelial cells overlying the luminal bronchus-associated lymphoid tissue. The present state-of-the-art paper, based on a review of recent studies, scrutinizes their morphology and probable tasks. They seem to perform specific functions of transport, permitting antigens to penetrate the barrier of the mucosa and thereby enabling contact with immunocompetent lymphatic cells. Although many particulars have not yet been exhaustively explored, the evidence so far suggests that the M cell may perform an important task in the immune system of the lung

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