Intraprocedural real-time imaging and tissue sampling in peripheral bronchoscopy.

[PURPOSE OF REVIEW] Peripheral lung lesions remain a prevalent and diagnostically challenging clinical entity. While computed tomography (CT)-guided transthoracic needle aspiration has been the gold-standard for tissue diagnosis, recent advances in technology have led to an increase in the ability of navigational bronchoscopy to successfully reach these lesions.However, despite successful bronchoscopic navigation based on preprocedural CT, diagnostic yield remains low if the proceduralist is unable to identify and correct CT-to-body divergence or confirm tool-in-lesion while sampling the lesion.The use of improved intraprocedural imaging techniques and biopsy tools have provided new techniques to correct positioning and sample lesions with greater diagnostic yield.

[RECENT FINDINGS] Integration of axial imaging in the form of fixed and mobile cone beam CT, digital tomosynthesis, and augmented fluoroscopy into bronchoscopic procedures have led to improved diagnostic accuracy. These advances improve peripheral bronchoscopy through identification and compensation of navigational errors relative to changes in real-time lesion location and confirmation of biopsy instrument location within the lesion.

[SUMMARY] Real-time imaging that is capable of identifying and correcting for CT-to-body divergence is vital to the increased diagnostic accuracy of peripheral bronchoscopic procedures.