Changes and current state of diagnosis of lung cancer after development of the flexible bronchofiberscope.

The flexible bronchofiberscope developed by Ikeda et al. has brought about revolutionary changes in the diagnosis and treatment of lung cancer. Advances in this device are continuing to emerge and lesions even smaller than those visible to the naked eye can now be visualized. In addition, the use of ultrasound now enables diagnosis of extramural bronchial lesions. Bronchoscopy is also used for the treatment of early hilar lung cancer, and in patients with airway stenosis due to advanced cancer, laser therapy, brachytherapy, and stenting can be performed. The bronchofiberscope is also very useful for tissue sampling from the lung periphery. Further advances in computed tomography imaging have enabled bronchoscopy under computed tomography fluoroscopy, and virtual bronchoscopy images can be generated from computed tomography imaging. Navigation systems have been developed to show the target bronchus where instruments such as forceps should be guided. Computed tomography imaging has made remarkable advances, and computed tomography now plays a central role in chest imaging, including early detection of lesions by low-dose computed tomography, qualitative diagnosis by high-resolution computed tomography and diagnosis of disease progression by contrast computed tomography. Ikeda et al. introduced the concept of personal health data recording system to manage these various images but the technology was not mature enough at that time for implementation. With modern advances in information technology, this is likely to be realized using an electronic health record system.