Advanced Diagnostic Bronchoscopy
If your child has a hard-to-diagnose pulmonary condition, traditional methods — such as a clinical exam, an X-ray or even standard flexible bronchoscopy (viewing the lungs by inserting a tube with a camera into the airway) — often can't get to the root of the problem. Patients with pulmonary lesions, pulmonary nodules, mediastinal masses or enlarged lymph nodes (lymphadenopathy), or those who are immunocompromised, can be especially challenging to diagnose.
The Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center at Children's Hospital of Philadelphia (CHOP) offers an alternative in the form of advanced diagnostic bronchoscopy. These minimally invasive techniques can help us find answers for your child's hard-to-diagnose pulmonary problems without needing more invasive surgical lung biopsies.
- Transbronchial biopsy (fluoroscopic)
- Forceps
- Needle aspiration
- Endobronchial ultrasound (EBUS)
- Radial EBUS
- Linear EBUS
- Navigational bronchoscopy using CT navigation
Our pediatric experts have adapted these nonsurgical methods traditionally used in adults and made them safe and available for children.
Children usually recover in fewer than 24 hours, without major complications. These procedures can often be performed without the need for your child to be hospitalized.
Transbronchial biopsy
Using a bronchoscope (a flexible tube inserted into the windpipe and lungs) and X-rays, physicians on the pulmonary advanced diagnostics team gather samples of lung tissue using small forceps or a needle, potentially avoiding the need for open surgery.
Endobronchial ultrasound (EBUS)
Similar to basic transbronchial biopsy techniques, newer technology using endobronchial ultrasound (EBUS) or computerized tomography (CT) improves accuracy and precision when guiding physicians to gather samples of lung and lymph node tissue without relying on open surgery.
If your child is undergoing an EBUS, a flexible tube will be inserted in their mouth and into their windpipe and lungs. The EBUS scope has a video camera with an ultrasound probe attached to the end. It sends images of the lungs and nearby lymph nodes to a screen so your pulmonologist can examine and evaluate those areas.
This technique allows the center's experts to more accurately diagnose tumors/masses in the lung or chest, pulmonary nodules, difficult-to-diagnose infections, and autoimmune, genetic and inflammatory disorders in children.
CHOP began performing EBUS-guided transbronchial lung and lymph node biopsies in 2015. There are two forms of EBUS advanced techniques:
Linear EBUS
Linear EBUS is used to biopsy lymph nodes or lesions in the part of the chest that lies between the sternum and the spinal column, and between the lungs (mediastinum), the trachea and two main branches going into the lungs (bronchi).
This technique can be helpful in diagnosing conditions such as sarcoidosis, sarcoma, lymphoma, carcinoma, inflammatory myofibroblastic tumor (IMT), histoplasmosis and tuberculosis. Children with lymphoma, solid tumors and sarcoidosis have been successfully and safely diagnosed with EBUS-guided transbronchial lymph node tissue sampling (aspiration) techniques at CHOP. Mediastinal lymphadenopathy (abnormal lymph nodes located between the lungs and nestled among the great vessels coming off the heart) can also be effectively sampled with EBUS-guided transbronchial lymph node aspiration techniques.
Radial EBUS
Radial EBUS is helpful in identifying the cause of pulmonary nodules, especially those on the edge of the lungs. The radial EBUS probe allows us to locate the peripheral lesions and obtain biopsies with greater accuracy. Radial EBUS is often combined with virtual navigation to guide the bronchoscope to the exact location of the peripheral lesion.
Immunocompromised children with pneumonia may benefit from EBUS-guided transbronchial lung biopsy, which can identify the specific infection so treatment can be targeted.
Virtual navigational bronchoscopy
Virtual navigational bronchoscopy using CT imaging is also used at the same time as EBUS. This technique improves our ability to more precisely locate pulmonary lesions that need to be biopsied.
A lesion (growth), shown in green, is visible in a CT scan image on the left. On the right, a virtual navigation pathway for bronchoscopy is shown in as a blue line.
A bronchoscopic image (left) alongside a bronchoscopic image from the CT navigation software. The target lesion is the green sphere and the virtual pathway is the blue line.