J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text HTML] [Full Text PDF] （in Japanese / 2068KB） [Members Only]

J.Jpn. Surg. Soc.. 127(1): 19-27, 2026

Feature topic

BRONCHOSCOPIC DIAGNOSIS OF SMALL-SIZED LUNG CANCERS: DEVELOPMENT AND FUTURE PERSPECTIVES OF CONE-BEAM CT-GUIDED BIOPSY

1) Department of Thoracic and Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
2) Department of Oncological Medical Services, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan

Naoya Kawakita1), Shiori Matsui1), Ayaka Tsuji1), Emi Takehara1), Keisuke Fujimoto1), Taihei Takeuchi1), Naoki Miyamoto1), Atushi Morishita1), Hiroaki Toba2), Hiromitsu Takizawa1)

With advances in imaging technologies, an increasing number of small peripheral pulmonary lesions (≤3 cm) are being detected, necessitating the development of accurate, minimally invasive diagnostic strategies. Although CT-guided transthoracic needle aspiration offers a high diagnostic yield, it carries risks such as pneumothorax and tumor seeding. In contrast, transbronchial biopsy is considered safer but has traditionally shown limited diagnostic performance for peripheral lesions. Recent innovations in navigation-assisted bronchoscopy, including virtual bronchoscopic navigation, radial endobronchial ultrasound, electromagnetic navigation, and cone-beam CT, have significantly improved diagnostic capabilities. We have demonstrated that a combined approach utilizing a 1.7-mm channel ultrathin bronchoscope, radial ultrasound, and cone-beam CT yields significantly higher diagnostic accuracy compared with conventional methods. This article reviews the procedural steps and advantages of cone-beam CT-assisted, ultrasound-guided transbronchial biopsy and outlines future directions in clinical applications and technical innovation. Cone-beam CT-guided bronchoscopy, with its ability to provide precise three-dimensional localization and real-time tool adjustment, may become a standard method for the diagnosis of small peripheral lung cancers due to its balance of safety and diagnostic performance.

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