Le rôle de l'endoscopie bronchique dans le dépistage et le diagnostic précoce des cancers pulmonaires

With an increasing proportion of peripheral lung tumors, the epidemiology of primary lung cancer has dramatically changed over the last decade. However, recent endoscopic photodetection techniques keep their entire place in the management of roentgenographically occult lung cancers of the proximal bronchial tree. Hence, bronchial carcinoma in-situ are usually treated using endobronchial techniques, and need a careful and extensive endobronchial exploration, where autofluorescence bronchoscopy plays a role of choice. Autofluorescence endoscopy can also be used in selected populations with very high risk of lung cancer, such as active heavy smokers, subjects exposed to asbestos fibers, lung cancer patients, or patients with cured proximal lung cancers. In these indications, endoscopic photodetection should be associated with high resolution CT scan. On the other hand, bronchoscopy has a limited role in CT screening of lung cancer who need a tissue diagnosis. In this situation, navigational bronchoscopy plays an increasing role, with more than 70 % diagnostic yield.