Integrating Artificial Intelligence in Bronchoscopy and Endobronchial Ultrasound (EBUS) for Lung Cancer Diagnosis and Staging: A Comprehensive Review

Artificial intelligence (AI) is increasingly investigated as a potential adjunct in the diagnosis and staging of lung cancer, particularly through integration with bronchoscopy and endobronchial ultrasound (EBUS). Deep learning models have been applied to modalities such as white-light imaging, autofluorescence bronchoscopy, and spectroscopy, with the aim of assisting lesion detection, standardizing interpretation, and reducing interobserver variability. AI has also been explored in EBUS for lymph node assessment and guidance of transbronchial needle aspiration (EBUS-TBNA), with preliminary studies suggesting possible improvements in diagnostic yield. However, current evidence remains largely confined to small, retrospective, single-center datasets, often reporting performance under idealized conditions. External validation is rare, reproducibility is undermined by a lack of data and code availability, and workflow integration into real-world bronchoscopy practice has not been demonstrated. As such, most systems should still be regarded as experimental. Translating AI into routine thoracic oncology will require large-scale, prospective, multicenter validation studies, greater data transparency, and careful evaluation of cost-effectiveness, regulatory approval, and clinical utility.