(Denver, Colo.—July 14, 2025) -- A multidisciplinary guideline panel convened by the American Association of Bronchology and Interventional Pulmonology (AABIP) and the Early Detection & Screening Committee of the International Association for the Study of Lung Cancer (IASLC) has determined that guided-bronchoscopy sampling provides tissue of comparable adequacy for comprehensive biomarker testing to percutaneous (CT-guided) biopsy, while delivering a superior safety profile—especially when contemporary navigational technologies are employed.
The guidelines have been published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer. The study is available here: https://www.jto.org/article/S1556-0864(25)00722-1/pdf .
Linear endobronchial guided sampling of accessible mediastinal lesions is well established as a first-choice modality for lung cancer mediastinal staging. Parenchymal lung lesions, however, are routinely accessed by either a percutaneous (CT-guided) or a bronchoscopic approach. Direct comparisons between the percutaneous approach and bronchoscopy or endobronchial ultrasound (EBUS) and mediastinoscopy are sparse in regard to diagnostic accuracy, and it remains unknown which sampling technique is the safest and offers the most adequate material for comprehensive biomarker testing.
This clinical practice guideline developed by AABIP and IASLC provides evidence on the safety and sampling adequacy for comprehensive biomarker testing of bronchoscopy-guided lung parenchymal biopsies as compared to percutaneous biopsies, and endobronchial ultrasound-guided lymph node sampling as compared to mediastinoscopy.
The available evidence suggests that guided-bronchoscopy sampling is of similar adequacy for comprehensive biomarker testing compared to percutaneous biopsy, while consistently demonstrating a better safety profile with fewer complications, especially with the use of contemporary advanced navigational bronchoscopic technologies
Key Findings
- Sampling adequacy: Across the analyzed studies, bronchoscopy-guided parenchymal biopsies yielded molecular-testing specimens equivalent in quality and quantity to those obtained via percutaneous biopsy.
- Safety: Guided bronchoscopy consistently produced fewer serious complications—such as pneumothorax and significant bleeding—than percutaneous approaches.
