Advances in Invasive Diagnostics in Lung Cancer

Lung cancer is the leading cause of cancer incidence and mortality worldwide. Pulmonologists play a central role in the timely, guideline-concordant diagnosis and staging of lung cancer. Minimally invasive procedures must also provide sufficient tissue for advanced molecular testing, particularly in light of the evolving landscape of lung cancer treatment. Advanced diagnostic bronchoscopy has developed at an accelerated pace over the last two decades, with a widening array of tools and technologies. Minimally invasive diagnostic sampling is typically guided by the suspected stage of disease. Linear endobronchial ultrasound has an established role in the diagnosis and staging of lung cancer. Novel technologies targeting the lung periphery aim to overcome the challenge of successfully reaching peripheral lung lesions and bridge the diagnostic gap by acquiring adequate samples. Advanced imaging modalities are combined with electromagnetic navigation, ultrathin bronchoscopy, and robotic-assisted bronchoscopy platforms. Herein, we review recent advances in invasive diagnostics in lung cancer, with a focus on interventional pulmonary procedures. The importance of strictly defined diagnostic outcomes in the advanced bronchoscopy literature is highlighted, as is the ongoing need for comparative effectiveness studies.