title: Bronchoscopic pursuit of the peripheral pulmonary lesion: navigational bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy.
abstract: OBJECTIVE
  Peripheral pulmonary lesions (PPL) are being diagnosed with increasing frequency, especially with the increased use of chest computed tomography (CT). Depending on the location and size, these lesions often present a diagnostic challenge in terms of the low yield of traditional bronchoscopic biopsy techniques or the risks of a percutaneous biopsy approach.
  
  
  RESULTS
  Over the last several years, several different image-guided bronchoscopy techniques have emerged, including virtual bronchoscopic navigation, electromagnetic navigation bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy. These technologies seek to improve both access and the diagnostic yield of PPL compared with traditional bronchoscopy and to perform with a lower complication rate than percutaneous techniques such as CT-guided trans-thoracic needle aspiration.
  
  
  CONCLUSIONS
  These advanced bronchoscopic techniques play an increasingly common role in the evaluation and biopsy of PPL. Electromagnetic navigation bronchoscopy and radial endobronchial ultrasound are the most commonly used guided techniques either in isolation or in combination and have the most published data regarding clinical experience and diagnostic yield; however, none of the techniques have consistently matched the yield of CT-guided trans-thoracic needle biopsy for PPL. Overall the complication rate of image-guided bronchoscopy techniques is low with pneumothorax being the most common adverse event.
authors.affiliation: Virginia Commonwealth University Health System, Richmond, Virginia, USA.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shepherd
mesh_terms: D001707:Biopsy, Needle; D001999:Bronchoscopy / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography