Bronchoscopy is a central technique in diagnosing lung cancer, but also in different therapeutic approaches. A lot of techniques are available. The most common indication for bronchoscopy is for tissue sampling and determining the extent of lung cancer. Established diagnostic techniques are forceps biopsy, aspiration or brush cytology sampling, or needle aspiration. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement in patients with advanced stages. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound, autofluorescence bronchoscopy, and electromagnetic navigation. Other technologies, such as magnification, narrow-band imaging and confocal fluorescence microendoscopy, are in development for the use within the airways.

Keywords:
Bronchoscopy, Pulmonary biopsy, Lung cancer, Pulmonary stents, Cancer staging
1.
KilIian G: İber direkte Bronchoscopie. MMW 1898;27:844–847.
2.
Ikeda S, Yanai N, Ishikawa S: Flexible bronchofiberscope. Keio J Med 1968;17:1–16.
3.
Lam S, Kennedy T, Unger M, et al: Localisation of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest 1998;113:696–702.
4.
Herth FJF, Becker HD: Endobronchial ultrasound of the airways and the mediastinum. Monaldi Arch Chest Dis 2000;55:36–45.
5.
Baram D: Palliation of endobronchial disease: flexible and rigid bronchoscopic options. Respir Care Clin N Am 2003;9:237–258.
6.
Laurent F, Montaudon M, Corneloup O: CT and MRI of lung cancer. Respiration 2006;73:133–142.
7.
Savage C, Morrison RJ, Zwischenberger JB: Bronchoscopic diagnosis and staging of lung cancer. Chest Surg Clin N Am 2001;11:701–721.
8.
Poletti V, Chilosi M, Olivieri D: Diagnostic invasive procedures in diffuse infiltrative lung diseases. Respiration 2004;71:107–119.
9.
Gasparini S, Zuccatosta L, De Nictolis M: Transbronchial needle aspiration of mediastinal lesions. Monaldi Arch Chest Dis 2000;55:29–32.
10.
Schreiber G, McCrory DC: Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest 2003;123:115S–128S.
11.
Schieppati E: La puncion mediastinal a traves deI espolon traqueal. Rev Asoc Med Argent 1949;663:497–499.
12.
Wang KP, Marsh BR, Summer WR, Terry PB, Erozan YS, Baker RR: Transbronchial needle aspiration for diagnosis of lung cancer. Chest 1981;80:48–50.
13.
Dasgupta A, Mehta AC, Wang KP: Transbronchial needle aspiration. Semin Respir Crit Care Med 1997;18:571–581.
14.
Harrow EM, Abi-Saleh W, Blum J, Harkin T, Gasparini S, Adrizzo-Harris DJ, Arroliga AC, Wight G, Mehta AC: The utility of transbronchial needle aspiration in the staging of bronchogenic carcinoma. Am J Respir Crit Care Med 2000;161:601–607.
15.
Baselski VM, Wunderkink RD: Bronchoscopic diagnosis of pneumonia. Clin Microbiol Rev 1994;7:533–558.
16.
Van der Drift MA, van der Wilt GJ, Thunnissen FBMJ, Jansen J: A prospective study of the timing and cost-effectiveness of bronchial washing during bronchoscopy for pulmonary malignant tumours. Chest 2005;128;394–400.
17.
Bewig B, Haacke TC, Tiroke A, Bastian A, Bottcher H, Hirt SW, Rautenberg P, Haverich A: Detection of CMV pneumonitis after lung transplantation using PCR of DNA from bronchoalveolar lavage cells. Respiration 2000;67:166–172.
18.
Zochbauer-Muller S, Lam S, Toyooka S, Virmani AK, Toyooka KO, Seidl S, Minna JD, Gazdar AF: Aberrant methylation of multiple genes in the upper aerodigestive tract epithelium of heavy smokers. Int J Cancer 2003;107:612–616.
19.
Bolliger CT: Multimodality treatment of advanced pulmonary malignancies: in Bolliger CT, Mathur PN (eds): Interventional bronchoscopy. Prog Respir Res. Basel, Karger, 2000, pp 187–196.
20.
Beamis JF Jr: Interventional pulmonology techniques for treating malignant large airway obstruction: an update. Curr Opin Pulm Med 2005;11:292–295.
21.
Noppen N: Interventional palliative treatment options for lung cancer. Ann Oncol 2002;13 4:247–250.
22.
Chan AL, Yoneda KY, Allen RP, Albertson TE: Advances in the management of endobronchial lung malignancies. Curr Opin Pulm Med 2003;9:301–308.
23.
Spiro A, Ettinger DS: Multidisciplinary management of lung cancer. N Engl J Med 2004;350:379–392.
24.
Mohan A, Guleria R, Mohan C, Sharma R: Laser bronchoscopy – current status. J Assoc Physicians India 2004;52:915–920.
25.
Cavaliere S, Dumon JF: Laser bronchoscopy; in Bolliger CT, Mathur PN (eds): Interventional bronchoscopy. Prog Respir Res. Basel, Karger, 2000, pp 108–119.
26.
Santos RS, Raftopoulos Y, Keenan RJ, Halal A, Maley RH, Landreneau RJ: Bronchoscopic palliation of primary lung cancer: single or multimodality therapy? Surg Endosc 2004;18:931–936.
27.
Lee P, Kupeli E, Mehta AC: Therapeutic bronchoscopy in lung cancer. Laser therapy, electrocautery, brachytherapy, stents, and photodynamic therapy. Clin Chest Med 2002;23:241–256.
28.
Van Boxem T, Muller M, Venmans B, et al: Nd:YAG-laser versus bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study. Chest 1999;116:1108–1112.
29.
Sutedja G, Van Boxem TJ, Schramel FM, et al: Endobronchial electrocautery is an excellent alternative for Nd:YAG-laser to treat airway tumours. J Bronchol 1997;4:101–105.
30.
Noppen M, Meysman M, Van Herreweghe R, et al: Bronchoscopic cryotherapy: preliminary experience. Acta Clin Belg 2001;56:73–77.
31.
Homasson JP: Cryosurgery and electrocautery. Eur Respir Monogr 1998;3:106–123.
32.
Saito Y, Imamura H: Airway stenting. Surg Today 2005;35:265–270.
33.
Walser EM: Stent placement for tracheobronchial disease. Eur J Radiol 2005;55:321–330.
34.
Colt HG, Dumon JF: Lasers and endoprosthesis in bronchopneumology. Rev Pneumol Clin 1991;47:65–73.
35.
Freitag L: Tracheobronchial stents. Eur Respir Monogr 1998;3:79–105.
36.
Mehta AC, Dasgupta A: Airway stents. Clin Chest Med 1999;20:139–151.
37.
Herth FJF, Becker HD, LoCicero J, Thurer R, Ernst A: Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy. Chest 2001;119:1910–1912.
38.
Herth F, Becker HD: New aspects in early detection and local staging of early lung cancer. Lung Cancer 2001;34(suppl 3):S7–S11.
39.
Falcone F, Fois F, Grosso D: Endobronchial ultrasound. Respiration 2003;70:179–194.
40.
Fischer BM, Mortensen J: PET in lung cancer. Respiration 2006;73:267–276.
41.
Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T: Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest 2004;126:122–128.
42.
Yasufuku K, Chhajed PN, Sekine Y, Nakajima T, Chiyo M, Iyoda A, Yoshida S, Otsuji M, Shibuya K, Iizasa T, Saitoh Y, Fujisawa T: Endobronchial ultrasound using a new convex probe: a preliminary study on surgically resected specimens. Oncol Rep 2004;11:293–296.
43.
Krasnik M, Vilmann P, Larsen SS, Jacobsen GK: Preliminary experience with a new method of endoscopic transbronchial real-time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax 2003;58:1083–1086.
44.
Herth FJ, Lunn W, Eberhardt R, Becker HD, Ernst A: Transbronchial vs. transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes. Am J Respir Crit Care Med 2005;171:1164–1167.
45.
Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P: Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy 2005;37:833–839.
46.
Pastorino U: Early detection with low-dose spiral computed tomography is one of the most promising development of clinical research. Respiration 2006;73:5–13.
47.
Lam S, MacAulay C, LeRiche JC, et al: Detection and localization of early lung cancer by fluorescence bronchoscopy. Cancer 2000;89:2468–2473.
48.
Kennedy TC, Franklin WA, Prindiville SA, Cook R, Dempsey EC, Keith RL, Hirsch FR, Merrick TA, Shroyer KR, Petty TL, Byers T, Bunn PA Jr, Miller YE: High prevalence of occult endobronchial malignancy in high risk patients with moderate sputum atypia. Lung Cancer 2005;49:187–191.
49.
Haussinger K, Becker H, Stanzel F, Kreuzer A, Schmidt B, Strausz J, Cavaliere S, Herth FJF, Kohlhaufl M, Muller KM, Huber RM, Pichlmeier U, Bolliger CT: Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions: a European randomised controlled multicentre trial. Thorax 2005;60:496–503.
50.
Feller-Kopman D, Lunn W, Ernst A: Autofluorescence bronchoscopy and endobronchial ultrasound: a practical review. Ann Thorac Surg 2005;80:2395–2401.
51.
Shibuya K, Fujisawa T, Hoshino H, Baba M, Saitoh Y, Iizasa T, Suzuki M, Otsuji M, Hiroshima K, Ohwada H: Fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy. Lung Cancer 2001;32:19–25.
52.
Herth FJF, Ernst A, Becker HD: Autofluorescence-bronchoscopy – a comparison of two methods (life and D-light systems). Respiration 2003;70:395–398.
53.
Hirsch FR, Franklin WA, Gazdar AF, et al: Early detection of lung cancer: clinical perspectives of recent advances in biology and radiology. Clin Cancer Res 2001;7:5–22.
54.
Moro-Sibilot D, Jeanmart M, Lantuejoul S, Arbib F, Laverriere MH, Brambilla E, Brambilla C: Cigarette smoking, preinvasive bronchial lesions, and autofluorescence bronchoscopy. Chest 2002;122:1902–1908.
55.
Schwarz Y, Mehta AC, Ernst A, Herth F, Enge H, Besser D, Becker HD: Electromagnetic navigation during flexible bronchoscopy. Respiration 2003;70:516–522.
56.
Becker HD, Herth FJF, Ernst A, Schwarz Y: Bronchoscopic biopsy of peripheral lung lesions under electromagnetic guidance: a pilot study. J Bronchol 2005;12:9–14.
57.
Shibuya K, Hoshino H, Chiyo M, et al: Subepithelial vascular patterns in bronchial dysplasias using a high magnification bronchovideoscope. Thorax 2002;57:902–907.
58.
Shibuya K, Hoshino H, Chiyo M, Iyoda A, Yoshida S, Sekine Y, Iizasa T, Saitoh Y, Baba M, Hiroshima K, Ohwada H, Fujisawa T: High magnification bronchovideoscopy combined with narrow band imaging could detect capillary loops of angiogenic squamous dysplasia in heavy smokers at high risk for lung cancer. Thorax 2003;58;989–995.
59.
Herth FJF, Eberhardt R, Ernst A: Narrow-band imaging bronchoscopy – a new technique for early lung cancer detection. Respiration (submitted).
60.
Kiesslich R, Goetz M, Vieth M, Galle PR, Neurath MF: Confocal laser endomicroscopy. Gastrointest Endosc Clin N Am 2005;15:715–731.
61.
Kiesslich R, Neurath MF: Magnifying chromoendoscopy for the detection of premalignant gastrointestinal lesions. Best Pract Res Clin Gastroenterol 2006;20:59–78.
62.
Kiesslich R, Neurath MF: Endoscopic detection of early lower gastrointestinal cancer. Best Pract Res Clin Gastroenterol 2005;19:941–961.
© 2006 S. Karger AG, Basel
2006
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.