Updates in diagnostic bronchoscopy for lung cancer

Yang, Seok Chul

Abstract

Despite therapeutic advances with minimally invasive surgical techniques, improved radiotherapy dosing with 3-dimensional planning, new chemotherapy agents and targeted therapies including epidermal growth factor receptor tyrosine kinase inhibitor, monoclonal antibody and anti-angiogenesis agents, the 5-year overall survival for lung cancer has remained relatively poor, mainly because by the time a diagnosis is made, lung cancer is often well advanced and treatment options are limited. The majority of lung cancer cases are diagnosed in a late stage, when nonspecific symptoms such as cough, dyspnea, and hemoptysis are present. Advances in early diagnostic and treatment options have the potential to manage lung cancer. The diagnostic approach to lung cancer may be divided into two problems; first, establishing the diagnosis and second, accuracy of staging. Bronchoscopy is now being used increasingly in the investigation and management of a wide spectrum of malignant, infectious, inflammatory, and other diseases or pathology of the lungs. There have been recently advances in bronchoscopic diagnosis of lung cancer; autofluorescence bronchoscopy, endobronchial ultrasound, and electromagnetic navigation bronchoscopy. Autofluorescene bronchoscopy exploits the inherent fluorescence property of cancerous tissue and improves detection of premalignant lesions not seen with white light bronchoscopy. Endobronchial ultrasound utilizes a flexible ultrasound probe to image and biopsy lesions and lymph nodes beyond the wall of the bronchus. Electromagnetic navigation bronchoscopy combines virtual bronchoscopy, three-demensional CT images, and a steerable probe to help navigate a bronchoscope to a particular peripheral lung lesion or lymph node. The purpose of this review is to describe current bronchoscopic advances in diagnosis and staging of lung cancer.