Bronchoscopy (EBUS, robotic navigation)

Overview

• What NICE asks for, and what it dropped. NG122 offers endobronchial ultrasound-guided transbronchial needle aspiration for biopsy of paratracheal and peri-bronchial intra-parenchymal lesions, asks every cancer alliance to have at least one centre with endobronchial or oesophageal ultrasound and to audit local test performance, and removed transthoracic needle biopsy, plain bronchoscopy and non-ultrasound-guided needle aspiration from the staging of intrathoracic nodes because they do not reach the sensitivity the British Thoracic Society quality standards require. Flexible bronchoscopy is still offered for central lesions when the nodal stage does not influence treatment.
• Lung cancer: the NHS names CT and bronchoscopy as the two main tests, describing bronchoscopy as a thin flexible tube with a small camera passed down the throat into the lungs. NICE NG122 (1.2.8) says to offer endobronchial ultrasound-guided transbronchial needle aspiration for biopsy of paratracheal and peri-bronchial intra-parenchymal lung lesions, (1.2.9) that every cancer alliance should have at least one centre with endobronchial or endoscopic ultrasound to ensure timely access, and (1.2.11) that samples must be adequate to permit subtyping and assessment of molecular markers.
• Bronchoscopy is also a route to treatment when an airway is blocked: NICE NG122 (1.14.1 to 1.14.3) says to monitor for endobronchial obstruction where there is large airway involvement, to offer external beam radiotherapy and/or endobronchial debulking or stenting for impending obstruction, and that every cancer alliance should ensure rapid access to a team capable of providing interventional endobronchial treatments.