Affiliation: Sentara Princess Anne Hospital, 1975 Glenn Mitchell Drive, Suite 202, Virginia Beach, VA 23456, USA.
Peripheral pulmonary nodules can present diagnostic challenges, especially in high risk patients. Surgical biopsy is the gold standard for establishing a diagnosis and can often serve as definitive treatment; however, there are associated risks, morbidities, and costs, which may be too high, especially if the result is a benign lesion. Bronchoscopy (with or without fluoroscopy) or imaging guided transthoracic needle aspiration can often determine the diagnosis in appropriate patients; navigational aids can often improve the yield of bronchoscopic biopsy. Navigational bronchoscopy guides the user to the lesion(s) of interest using computer software integrated with computed tomography images and an electromagnetic field generated around the patient. While this is a relatively new technology, several studies have demonstrated the efficacy and safety of the procedure. Navigational bronchoscopy is best used, along with transthoracic needle aspiration, endobronchial ultrasound (including radial probe), and surgical interventions, as part of a step-wise diagnostic approach to the evaluation of a peripheral pulmonary nodule.