Selection of appropriate bronchoscopic diagnostic procedures

	Brushing	Broncho-alveolar lavage (BAL)	Washing	Endobronchial biopsy (EBB)	Transbronchial biopsy (TBB)	Endobronchial needle aspiration (EBNA)	Transbronchial needle aspiration (TBNA)	Additional guidance
Endoluminal lesion	+	-	+	+++	-	+++	-	AFB or NBI if lesion is not distinct on routine examination
Paratracheal mass, mediastinal or hilar lymphadenopathy	-	-	-	-	-	-	+++	EBUS (radial or linear probe)
Peripheral lung mass or nodule	+/-	+/-	+/-	-	+	-	+	ENB, EBUS (radial probe), XFL
Peripheral pulmonary infiltrate (localized)	+	++	+	-	++	-	+/-	ENB or XFL
Diffuse pulmonary infiltrate	+	+++	-	-	++	-	+

Cytological and microbiological specimens can be collected with all of the above procedures. Histological specimens can only be collected with endobronchial biopsy, transbronchial biopsy, or a needle core. If bronchoscopic procedure is not likely to yield diagnosis or is non-diagnostic, computed tomography (CT)-guided needle aspiration, mediastinoscopy, video-assisted thoracoscopic surgery (VATS), or thoracotomy may be indicated depending upon the location or size of the lesion or mass.

-: unlikely to provide diagnostic information; +/-: uncertain diagnostic value; +: may provide diagnostic information; ++: more likely to provide diagnostic information; +++: most likely to provide diagnostic information; AFB: autofluorescence bronchoscopy; NBI: narrow band imaging; EBUS: endobronchial ultrasound; ENB: electromagnetic navigational bronchoscopy; XFL: x-ray fluoroscopy.

Graphic 50508 Version 3.0

خرید پکیج

Selection of appropriate bronchoscopic diagnostic procedures