In what scenarios should I consider bronchoscopy for patients with suspected lung cancer?

Bronchoscopy should be considered in patients with suspected lung cancer primarily when there is a central lesion identified on CT imaging, especially if nodal staging does not influence the treatment plan. Flexible bronchoscopy is recommended in these cases to obtain tissue samples for diagnosis and tumour subtyping, ensuring adequate pathological material is collected without undue risk to the patient ¹.

Additionally, bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated for biopsy of paratracheal and peri-bronchial intra-parenchymal lung lesions and for sampling enlarged intrathoracic lymph nodes (≥10 mm short axis on CT) when nodal status will affect treatment decisions ¹. This approach allows for minimally invasive mediastinal staging, which is crucial for planning curative-intent treatment.

Bronchoscopy is less commonly used for peripheral lesions, where image-guided biopsy is preferred unless bronchoscopy can provide sufficient diagnostic and staging information ¹. Sputum cytology may be considered only if bronchoscopy is declined or not tolerated, particularly for centrally located tumours ¹.

Recent literature on primary tracheobronchial tumours supports the role of bronchoscopy not only for diagnosis but also for assessing tumour extent within the airways, which can influence management strategies (Shu et al., 2025). This complements guideline recommendations by highlighting bronchoscopy’s value in evaluating airway involvement in suspected lung cancer.