Invasive modalities for the diagnosis of peripheral lung nodules

ABSTRACT

Introduction

Lung nodules are being increasingly discovered either incidentally or through lung cancer screening chest CT scans. Some of these will turn out to be malignant and therefore it is important to obtain an accurate and timely diagnosis of lung cancer when suspected.

Areas covered

This review will cover various invasive diagnostic modalities available to sample lung nodules. Data from key studies, obtained from PubMed searches, will be reviewed. Emerging technologies such as cone-beam CT and robotic-assisted bronchoscopies will be discussed along with ddata available currently to support their use.

Expert opinion

The best approach to diagnosing a lung nodule – whether found incidentally or because of lung cancer screening – is continuously evolving. While CT-guided lung nodule biopsy has a high diagnostic yield, the risk of pneumothorax is often a concern. Bronchoscopy has a better safety profile, but diagnostic ability falls short of CT-guided biopsy. Existing technologies such as electromagnetic navigation have not demonstrated a high diagnostic yield. Factors responsible for this relatively lower low diagnostic yield will be discussed in detail. Emerging technologies such as cone-beam CT scan and robotic bronchoscopy have addressed some of these issues and initial experience has demonstrated better diagnostic yield.

KEYWORDS:

• Lung nodule
• electromagnetic navigation
• robotic bronchoscopy
• conebeam CT

Article highlights

• Several advanced bronchoscopic technologies have emerged for the diagnosing lung cancer..

• There is no single bronchoscopic modality, yet which matches the diagnostic ability of CT guided lung nodule biopsy.

• Compared to CT guided lung biopsy, bronchoscopic modalities for lung nodule diagnosis carry lower pneumothorax rates and possess the ability to stage the mediastinum.

• Emerging bronchoscopic technologies such as Conebeam CT scan and robotic assisted bronchoscopy aim at improving the diagnostic yield for lung nodule diagnosis.

• These newer technologies are expensive and require general anesthesia which may be prohibitive for many centers.

• In the future, it may be possible to bronchoscopically ablate early-stage lung tumors in select patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer of this manuscript discloses undergoing negotiations for a consulting contract with Auris Health and having received prior travel/food compensation from Auris Health and Intuitive Robotics. Peer reviewers in this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.