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Interventional Bronchoscopy: State-of-the-Art Review.

For approximately the last 50 years, bronchoscopy, especially flexible fiberoptic bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and for therapeutic treatments outside of the aspiration of airway secretions, however, has been limited due to problems with navigation to the lung periphery, locating lesions in the 3-dimensional structure of the lung, the avoidance of lung vasculature structures when performing diagnostic biopsies and the availability of proper tools to access the lesion and simultaneous visualizing the lesion during the biopsy real-time. The last 10-15 years has seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to airway lesions, transparenchymally via virtual avascular pathways, and to visualize the performance of biopsy of the lesion real-time. Additionally, multiple new techniques are either now available, or currently being investigated to treat airway and lung parenchymal diseases, including malignant peripheral lung nodules. These combinations of factors create the potential for bronchoscopy, especially fiberoptic bronchoscopy, to provide the clinician with a new and expanding armamentarium of diagnostic and therapeutic tools to treat a variety of lung diseases. This state-of-the-art review succinctly provides an overview of these techniques and provides the clinician with an organized approach to the role and application of these tools in the diagnosis and therapy of a range of lung diseases.