Bronchoscopic Lung Biopsy

The introduction of the flexible bronchoscope in the late 1960s increased the popularity of the bronchoscopic technique and demonstrated that transbronchial biopsy (TBBX) with the flexible instrument could be obtained with minimal mortality and morbidity. The radiographic finding of diffuse lung disease on imaging may be an indication for transbronchial lung biopsy but as with any diagnostic procedure, clinical correlation and consideration of other less invasive diagnostic tests should be made before performing an invasive procedure. There are a few absolute contraindications to TBBX through the flexible bronchoscope, including patient inability to cooperate with the procedure, unstable cardiovascular status, severe hypoxemia despite support, status asthmaticus, and lack of adequately trained personnel and equipment to properly perform the procedure. New techniques and adjuncts designed to enhance the yield and safety of bronchoscopic biopsy include electromagnetic navigation and cone beam computed tomography to improve accuracy, but the technique with the most emerging data is cryobiopsy.