Advanced Imaging Techniques to Facilitate Bronchoscopic Sampling of Peripheral Pulmonary Lesions

Purpose of Review This review describes real-time imaging modalities recently introduced into bronchoscopic sampling of peripheral pulmonary nodules and appraises the data available on these technologies. Recent Findings In the last 5 years, four different types of imaging modalities have been introduced into bronchoscopic sampling of peripheral pulmonary nodules: digital tomosynthesis, augmented fluoroscopy, hybrid 2-dimensional/3-dimensional mobile C-arm fluoroscopy, and cone-beam computed tomography. Various single-center studies have reported modest to significant increases in diagnostic yield with the addition of these imaging modalities. Summary Advanced imaging techniques provide real-time imaging confirmation of sampling of a peripheral pulmonary lesion during bronchoscopy. Initial data shows promise with improving yields. Further studies are needed to determine the performance characteristics of the different imaging modalities when combined with peripheral bronchoscopic methods to reach the lesion.