Review Article

Invasive Procedures in Interventional Pulmonology: A Narrative Review of Educational Evidence-Based Step-By-Step Protocols

DOI:

10.3791/69416

February 10th, 2026

In This Article

Summary

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Procedures in interventional pulmonology are becoming more minimally invasive. This review discusses evidence-based step-by-step approaches in interventional pulmonology to ensure patient safety and diagnostic accuracy.

Abstract

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Lung cancer accounts for the highest number of cancer deaths globally. Accurate diagnosis and staging of lung cancer require invasive procedures, with a trend toward minimally invasive approaches. This narrative review summarizes and discusses standardized, step-wise approaches that aim to improve patient safety, diagnostic accuracy, and procedural consistency across flexible bronchoscopy, endobronchial and endoscopic ultrasound (EBUS and EUS), radial endobronchial ultrasound (rEBUS), electromagnetic navigation bronchoscopy, local anesthetic thoracoscopy, endobronchial cryobiopsy, and transthoracic ultrasound-guided lung biopsy. Traditional apprenticeship models like the Halstedian method: "See one, do one, teach one" are increasingly challenged by studies showing that experience does not ensure expertise. Simulation-based training and structured assessment, guided by frameworks such as Messick's validity framework, are recommended to ensure competency. Emerging technologies such as artificial intelligence (AI) are showing promise in enhancing training, procedural navigation, and performance evaluation, particularly in bronchoscopy and lung ultrasound. As interventional pulmonology evolves, integrating validated training protocols, simulation, and AI will be crucial to standardize education and improve patient care.

Introduction

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Diagnosing and staging lung cancer and lung diseases often necessitate invasive procedures that yield high-quality tissue samples while minimizing risk to the patient. With new minimally invasive techniques emerging1, systematic and step-wise approaches are essential to minimize procedural risk and maximize diagnostic yield. Whether targeting the lung parenchyma, pleural space, or mediastinal lymph nodes, structured procedural strategies reduce variability, standardize training, and enhance patient outcomes2,3,4,5

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Review and Perspective

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Lung cancer accounts for the highest number of cancer deaths globally10, with the patient requiring an invasive pulmonology procedure for tissue sampling and staging.

Flexible bronchoscopy, EBUS, and endoscopic ultrasound (EUS)
Tissue sampling from central tumors can be done using flexible bronchoscopy3, with lymph node sampling using endobronchial ultrasound (EBUS)5 and endoscopic ultrasound (EUS) of the esophagus6. Cold et al.3 present a four-landmarks approach for investigating the 18 bronchial segm....

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Conclusions

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With new techniques emerging in invasive pulmonology, visual articles allow the trainee to "see one" several times. The "do one" should be done through many simulation-based training and assessment sessions. Simulation-based training offers standardized environments to ensure procedural proficiency before exposing patients to procedural risks. AI is an emerging tool, which has already proven its usefulness in bronchoscopy, EBUS, and lung ultrasound. When "teaching one", it should be supported by A.......

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Disclosures

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The author has no conflicts of interest to disclose.

Acknowledgements

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The study did not receive any funding

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References

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  1. Garner, J. L., Shah, P. L., Herth, F., Slebos, D. J. ERJ Advances: interventional bronchoscopy. Eur Respir J. 64 (1), 2301946(2024).
  2. Bodtger, U., et al. Local anesthetic thoracoscopy for undiagnosed pleural effusion. J Vis Exp. (201), e65734(2023).
  3. Cold, K. M., Vamadevan, A., Nielse....

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Tags

Interventional PulmonologyInvasive ProceduresFlexible BronchoscopyEndobronchial UltrasoundElectromagnetic Navigation BronchoscopyLocal Anesthetic ThoracoscopyEndobronchial CryobiopsyLung BiopsySimulation Based TrainingArtificial Intelligence Training

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