The role of bronchoscopy in the diagnosis of early lung cancer: a review

Lung cancer is the leading cause of cancer-related mortality worldwide (1). Despite improvements in diagnosis, staging and treatment, the overall 5-year survival for lung cancer is still low (range, 10–20%), due to the very poor prognosis of many patients diagnosed at advanced stage. On the other hand, patients with early stage lung cancer have a 5-year survival of more than 70%, thus screening and detection of early lung cancer is crucial to improve survival (2). Screening with low dose computed tomography (LDCT) have been shown to reduce the mortality by 20% in the high-risk population even if it is not sensitive enough to detect small tumours arising in the central airway (3,4). As shown by Rivera, flexible bronchoscopy became the recommended procedure for all patient suspected of having lung cancer, showing a sensitivity for central airway lesions of 88% and overall sensitivity for all modalities in the diagnosis of peripheral disease of 78% (it varied from 36% to 88%, according to the biopsy method used) (5). Furthermore, it allows the correct surgical planning through the evaluation of the surface, site and extent of the tumour, vocal cord motility and airway lumen (6)