(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.
- Lymph-node staging: Endobronchial ultrasound (EBUS) continues to rival mediastinoscopy in diagnostic accuracy while offering lower morbidity for mediastinal assessment.
“These recommendations are immediately actionable for clinicians deciding how best to obtain tissue for biomarker analysis in suspected or confirmed lung cancer,” said Abhinav Agrawal, MD, Director of Interventional Pulmonology and Associate Professor of Medicine & Cardiovascular/Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. “They should also inform the design of future clinical trials by highlighting both sample adequacy and the safety advantages of minimally invasive bronchoscopic techniques.”
About the IASLC
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 11,000 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis and treatment of all thoracic malignancies. Visit www.iaslc.org for more information.
About the American Association of Bronchology and Interventional Pulmonology[GU1]
The American Association of Bronchology and Interventional Pulmonology (AABIP) is dedicated to advancing the art and science of bronchology and interventional pulmonology through education, research, and advocacy.
About the JTO
Journal of Thoracic Oncology (JTO), the official journal of the International Association for the Study of Lung Cancer, is the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. JTO emphasizes a multidisciplinary approach and includes original research reviews and opinion pieces. The audience includes epidemiologists, medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, radiologists, pathologists, nuclear medicine physicians, and research scientists with a special interest in thoracic oncology.
[GU1]Do you want to make this the acronym to match the IASLC header above and the JTO header below?
Journal
Journal of Thoracic Oncology