Over the past decade a range of new diagnostic tools has become available to the bronchoscopist, and this range reflects technological advancements such as the development of miniaturized transducers as well as advanced image guidance. Many of these techniques have yet to find an established role in practice and remain research tools. Others, in particular endobronchial ultrasound (EBUS) guidance, have had an immediate clinical impact and are now considered state-of-the-art technologies. The tools discussed below can be broadly grouped together into two categories based on their utility. The first group is used to extend the diagnostic reach of the bronchoscope to direct biopsy of distal lesions or lesions outside the airway and includes EBUS, ultrathin, and electromagnetic navigational bronchoscopy (ENB). The second broad category includes tools such as autofluorescence bronchoscopy (AFB), narrow band imaging (NBI), and high-magnification videobronchoscopy, which primarily aim to improve detection rates for the preinvasive bronchial lesions of dysplasia and carcinoma in situ (CIS). Such lesions, which are only a few cell layers thick, are often missed on regular white light bronchoscopy.

ENDOBRONCHIAL ULTRASOUND

EBUS technology has probably been the greatest advance in diagnostic bronchoscopy since the widespread introduction of the flexible bronchoscope (FB) in the 1960s. It provides the enormous advantage of allowing the endoscopist to look within, as well as outside, the airway wall, is safe and noninvasive for patients, and is relatively straightforward to use.