Transbronchial biopsy and needle aspiration.

Transbronchial biopsy and transbronchial needle aspiration greatly increase the utility of bronchoscopy in the diagnosis of a variety of disease processes. Transbronchial needle aspiration has brought into focus the importance of good cytopathologic support. The addition of histologic specimens (for light and electron microscopy) with the newer large-bore needles may further increase the utility of transbronchial needle aspiration. Both techniques are limited, in part, by the lack of distal tip deflection of the sampling instrument for steering accurately to peripheral masses. Tip deflection may have been partly responsible for the good yields reported for the double-hinged curet on small nodules, although the bronchographic map was also a factor. A steerable brush was described several years ago, but it was somewhat difficult to accurately maneuver, and long-term results were never reported. As yet, no easy answer is available for this problem. In the future, new generations of ultrathin bronchoscopes may permit much more accurate placement of sampling devices in the periphery of the lung and will represent an exciting diagnostic advance.