Lung cancer: CT guided BX-EBUS: How and when?

Histological diagnosis is mandatory for the majority of solid lesions in the lungs in order to characterize the lesions but also to assess the response to treatment. Flexible bronchoscopy has a variable and often poor success rate in sampling pulmonary lesions which are not visible endoscopically. Such focal radiological opacities without endobronchial extension are referred to as peripheral pulmonary lesions and sampling is usually performed under guidance with computed tomography that is a safe and effective technique and became a common procedure representing an essential step for diagnosis and treatment planning. It is usually performed with an 18G or 20G coaxial needle system and several novel guidance and navigation tools may be integrated to clinical practice to offer more accurate lesion targeting. There is however still a percentage of negative sampling a recent study revealed that small lesion size, lower 18 F-FDG uptake or location at the lung bases may lead to inconclusive histology. The diagnostic yield may be increased if PET/CT fusion imaging is used intraprocedurally. CT guided biopsies may also be applied in the same setup with interventions such as ablation of lung lesions offering a "one-stop" approach for such patients.