Peripheral bronchoscopy: back to basics

PURPOSE OF REVIEW: Peripheral bronchoscopy is increasingly practiced to gain access to peripheral pulmonary lesions (PPLs). Lung cancer screening with low-dose computed tomography (CT) is fuelling the need for superior navigational tools such as robot-assisted bronchoscopy to target screen-detected pulmonary nodules which may be as small as 6 mm. RECENT FINDINGS: It is an opportune moment to return to the basics of performing peripheral bronchoscopy through revising airway mapping with CT imaging. Virtual bronchoscopy, electromagnetic navigation bronchoscopy (ENB) and robot-assisted bronchoscopy (RAB) have yet to supplant the accuracy of manual airway mapping achieved simply by CT reading. The technique of airway mapping should be consistently utilised for airway navigation as it is complementary to technologies such as virtual bronchoscopy, ENB or RAB. In this review, we share the technique of performing airway mapping with a case illustration, and our approach to peripheral bronchoscopy. SUMMARY: Airway mapping is a foundational skill that must be preserved, practiced and perfected in our bronchoscopic approach to a PPL. In the absence of advanced navigational tools, peripheral bronchoscopy can be performed in combination with readily available tools to obtain a high diagnostic yield.