Fiberoptic bronchoscopy allows direct visualization of the bronchial tree. It is useful for diagnosing conditions that require culture of a lower respiratory tract infection by bronchoalveolar lavage (BAL), or conditions such as bronchogenic carcinoma, that require tissue diagnosis by transbronchial biopsy. Sometimes these techniques are combined, as in the diagnosis of Pneumocystis jiroveci (carinii) pneumonia (PCP), for which the sensitivity of bronchoscopy with BAL is approximately 86% and with transbronchial biopsy is 87% (Broaddus et al., 1985). A comparative assessment of different bronchoscopic techniques in obtaining culture specimens in cases of ventilator-associated pneumonia found no significant difference between blind bronchial brushings and bronchoscope-assisted lavage, bronchoscope-directed brushings, or even blind endotracheal aspirates (Wood et al., 2003). Rates of complications (including hemoptysis and pneumothorax) with traditional bronchoscopy are in the range of 0.5% to 1.0% without biopsy and up to 6.8% with transbronchial biopsy (Pue and Pacht, 1995). In a pulmonary fellowship program, the rate of complications for all bronchoscopies performed (with and without biopsy) was 2.06% (Ouel-lette, 2006). Therapeutic interventions using bronchoscopy are also increasing, and lesions are treated through the bronchoscope with laser, cryotherapy, electrocautery, and stents (Rafanan and Mehta, 2000).

Newer diagnostic techniques include fluorescent bron-choscopy, which can be more sensitive for detecting early endobronchial tumors (Gilbert et al., 2004; Moghissi et al., 2008), and virtual bronchoscopy, which uses sophisticated software to reconstruct images from HRCT scan, to create three-dimensional imagery without invasive testing. This technique has been found useful in planning partial lung resection surgery, for example, but it cannot provide bronchoscopy's direct visualization of color, texture, or friability of the bronchial mucosa (Finklestein et al., 2004).

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