The Question of Performing or Not Performing Diagnostic or Therapeutic Bronchoscopy

The indications for diagnostic and therapeutic bronchoscopy continue to expand rapidly as the field of bronchoscopy has been revolutionized by advanced technologies. Because of its high accessibility and popularity, there has been high enthusiasm and incentive for performing this procedure even when its value is limited diagnostically, its expected clinical success is low therapeutically, or its risk of complications is high. Bronchoscopy is a relatively safe procedure; however, being able to perform bronchoscopy does not mean and should not lead to the necessity to perform it. This approach can be considered in cases in which a high diagnostic yield or therapeutic clinical success is anticipated, and the benefits of the procedure outweigh the risks. Alternative diagnostic or therapeutic modalities should be used when the pretest probability of diagnostic yield or therapeutic clinical success is low and the risks outweigh the benefits for the patient. The bronchoscopist should be well acquainted with the indications, diagnostic and therapeutic limitations, alternatives, contraindications, risk-benefit ratio, complications, technical and clinical success, and cost of the procedure. Before, during, and after any diagnostic or therapeutic bronchoscopy, a patient-centered practical approach should be exercised by meticulously considering the initial evaluation of the patient, procedural strategies and planning, procedural techniques and results, and long-term management plan.