Advanced Bronchoscopic Technologies for Biopsy of the Pulmonary Nodule: A 2021 Review

Abstract

The field of interventional pulmonology (IP) has grown from a fringe subspecialty utilized in only a few centers worldwide to a standard component in advanced medical centers. IP is increasingly recognized for its value in patient care and its ability to deliver minimally invasive and cost-effective diagnostics and treatments. This article will provide an in-depth review of advanced bronchoscopic technologies used by IP physicians focusing on pulmonary nodules. While most pulmonary nodules are benign, malignant nodules represent the earliest detectable manifestation of lung cancer. Lung cancer is the second most common and the deadliest cancer worldwide. Differentiating benign from malignant nodules is clinically challenging as these entities are often indistinguishable radiographically. Tissue biopsy is often required to discriminate benign from malignant nodule etiologies. A safe and accurate means of definitively differentiating benign from malignant nodules would be highly valuable for patients, and the medical system at large. This would translate into a greater number of early-stage cancer detections while reducing the burden of surgical resections for benign disease. There is little high-grade evidence to guide clinicians on optimal lung nodule tissue sampling modalities. The number of novel technologies available for this purpose has rapidly expanded over the last decade, making it difficult for clinicians to assess their efficacy. Unfortunately, there is a wide variety of methods used to determine the accuracy of these technologies, making comparisons across studies impossible. This paper will provide an in-depth review of available data regarding advanced bronchoscopic technologies.

Robotic-assisted Navigation Bronchoscopy

“…In assessing patients with lesions that require tissue sampling, providers consider which modalities are the safest, the highest yield, and the least invasive procedure that can be performed. 59 In addition, qualities of the target lesion, such as target size, target location, and morphology must be taken into account when deciding which approach would be best. 60 Given the high diagnostic yield shown in the primary analysis, and low rates of complications seen in our meta-analysis, these results together may have implications on the risks and benefits when comparing RANB versus other modalities for peripheral nodule biopsy.…”

“…Advancements in the methods of tissue sampling for the detection of malignancies and other pulmonary pathology have provided a multitude of diagnostic options for interdisciplinary teams. In assessing patients with lesions that require tissue sampling, providers consider which modalities are the safest, the highest yield, and the least invasive procedure that can be performed 59 . In addition, qualities of the target lesion, such as target size, target location, and morphology must be taken into account when deciding which approach would be best 60 .…”

Diagnosis and Pattern Identification of Intrathoracic Malignant Melanoma Metastasis: A Retrospective Single Center Analysis

“…Furthermore, it can reach many different thoracic nodal stations compared with other diagnostic techniques, also with the concomitant use of the echobronchoscope through the esophagus [ 22 ]. On the other hand, when the pathology involves primarily the lung parenchyma, the endoscopic tool we have is represented by the TBB with different guide systems and instruments (fluoroscopy, radial EBUS, thin and ultrathin scopes, lung navigation systems): this specific technique has evolved through years and has reached higher accuracy also for more peripheral and smaller lung lesion, with an excellent safety profile [ 23 , 24 , 25 ]. Focusing on the other procedures used, MT is another established endoscopic technique with a high diagnostic yield and an excellent safety profile [ 26 ], especially if compared with other diagnostic techniques [ 27 ].…”

Diagnostic outcomes of radial endobronchial ultrasound bronchoscopy guided by manual navigation in the evaluation of peripheral pulmonary lesions: An observational study

“…One of the difficulties in sampling PPLs by r‐EBUS bronchoscopy is how to find the road to the lesion. Various bronchoscopic navigation devices have been developed to reach PPLs, such as virtual bronchoscopic navigation (VBN), electromagnetic navigational bronchoscopy (ENB), and even robotic‐assisted bronchoscopy 6 . They indeed bring increased diagnostic yields, while they are expensive, time‐consuming, and impossible to be available in all bronchoscopy centers.…”