Does AQuIRE challenge the role of navigational bronchoscopy for peripheral pulmonary lesions?

The rise of navigational or guided bronchoscopic techniques over the last 15 years has changed our approach to the diagnosis of suspicious peripheral pulmonary lesions (PPL). PPL are described as focal radiographic lesions ≤3 cm diameter surrounded by normal lung parenchyma that are not visible beyond segmental bronchi and are without evidence of endobronchial abnormalities (1-5). Diagnostic yields for these lesions with standard flexible bronchoscopy are generally lower than those achieved with central lesions (5,6). The use of computer tomography guided transthoracic needle/core biopsy (CT-TTNA) has frequently been the method of choice and has higher diagnostic yields than standard bronchoscopy. However, it is associated with significant risks of bleeding and pneumothorax with ~5–7% of all biopsies requiring chest tube insertion (5-7). Bronchoscopy has the advantage that staging can be performed at the same time and is the lower risk procedure.