Respiratory and sleep medicine
Bronchoscopy, EBUS and thoracic tissue biopsy
What flexible bronchoscopy, BAL, EBUS-TBNA, CT-guided biopsy, cryobiopsy and pleural biopsy each reach, how to choose the test that diagnoses and stages at once, reading BAL and EBUS results, and safety (anticoagulants, lidocaine, pneumothorax).
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The aim is one procedure that diagnoses and stages, and that gets enough tissue for PD-L1 and a gene panel. Pick the highest-stage, safest site first.
- Flexible bronchoscopy sees central airways and samples by washings, brushings, endobronchial biopsy, BAL and transbronchial biopsy.
- EBUS-TBNA samples mediastinal and hilar nodes under ultrasound. It has replaced mediastinoscopy as the first staging test (ESGE/ERS/ESTS 2015).
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Sources
- Du Rand IA et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax 2013;68(Suppl 1):i1-i44British Thoracic Society (Thorax), 2013 (current BTS guideline)
- Vilmann P et al. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer: ESGE guideline in cooperation with ERS and ESTS. Eur Respir J 2015;46:40-60European Society of Gastrointestinal Endoscopy, European Respiratory Society, European Society of Thoracic Surgeons, 2015
- Silvestri GA et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: ACCP evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e211S-e250SAmerican College of Chest Physicians, 2013
- Annema JT et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer (ASTER). JAMA 2010;304:2245-52JAMA, 2010
- Bousema JE et al. Endosonography with or without confirmatory mediastinoscopy for resectable lung cancer: a randomized clinical trial (MEDIASTrial). J Clin Oncol 2023;41(22):3805-15Journal of Clinical Oncology, 2023
- Raghu G et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2022;205:e18-e47American Thoracic Society, 2022
- Maskell NA et al. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions. Lancet 2003;361:1326-30The Lancet, 2003
- von Bartheld MB et al. Endosonography vs conventional bronchoscopy for the diagnosis of sarcoidosis (GRANULOMA). JAMA 2013;309:2457-64JAMA, 2013
- Last updated
- 14 November 2026
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