Tearning to perform fiberoptic bronchoscopic examinations requires only modest training. Confident manipulation, recognition, and proper interpretation of pathologic processes, and successful management of complications, require more experience. In order to maximize diagnostic accuracy in different situations encountered in fiberoptic bronchoscopic procedures, at least several other phenomena are important: careful processing of the samples obtained; highly skilled cytology, pathology, and microbiology support; and development of new instrumentation technology. Even these are not enough, however, if efficiency and economy are desired.
In the July issue of Chest (1985; 88:49-51), Shure and Fedullo have helped by identifying a subset of patients with bronchogenic carcinoma who have submucusal and peribronchial abnormalities; in their hands, diagnostic yield was significantly improved by adding transbronchial needle aspiration (TBNA) to other sampling methods. Similar superior diagnostic yield from TBNA in patients with endoscopic features of submucosal tumors have been reported by others.