Background: Flexible bronchoscopy is essential in diagnosing many pathologic conditions, and tools such as lavage and biopsies using brushes, forceps, and needles are paramount to success.
Introduction: Bronchoscopists worldwide are routinely confronted with questions about such tools regarding the type, size, utility, costs, safety, anticipated yield, and others. Does the underlying suspected condition matter to the choice of instruments used? What is the anticipated outcome for benign versus malignant diseases? These and other questions are raised daily by bronchoscopists.
Methods: Pubmed was reviewed for research in the English language pertaining to diagnostic bronchoscopy. The literature is conflicting on the benefits of the types of tools available. The success of brush biopsies, forceps, and transbronchial needle aspiration is only partially dependent on the size of the instrument used or its other characteristics. Multiple biopsies are needed, and different approaches may be complementary in some circumstances.
Results: By understanding the factors that involve in a biopsy, the bronchoscopist is more likely to be successful when a crucial diagnosis is mandatory.
Conclusion: This review aims to be a reference to bronchoscopists everywhere as they contemplate their approach to flexible diagnostic bronchoscopy.
Keywords: Flexible bronchoscopy, endobronchial biopsies, transbronchial biopsies, endobronchial ultrasound (EBUS TBNA), bronchoscopic biopsy, bronchial wash.