Advanced bronchoscopic techniques for diagnosing interstitial lung disease

This thesis investigates how bronchoscopic techniques can improve the diagnosis and assessment of interstitial lung diseases (ILD) while reducing patient burden through less invasive strategies. It focuses on three complementary approaches: optimizing tissue sampling, adding microscopic in vivo imaging, and using rapid ex vivo microscopy to improve biopsy workflow.
In suspected sarcoidosis, endobronchial and esophageal ultrasound using the EBUS scope achieved comparable granuloma detection, supporting selection based on patient tolerance and local expertise. For ILD patients requiring lung tissue, a step-up strategy starting with transbronchial cryobiopsy and reserving surgical biopsy for inconclusive cases proved as effective as immediate surgery, but with fewer complications, less pain, shorter hospital stay, and greater cost-effectiveness.
Bronchoscopic imaging was explored to provide microscopic information in vivo. Polarization-sensitive endobronchial optical coherence tomography detected and quantified fibrosis, while confocal laser endomicroscopy was feasible and safe in mechanically ventilated ICU patients, enabling visualization of alveolar abnormalities without biopsy.
Higher harmonic generation microscopy was introduced as a rapid, label-free method to assess fresh lung biopsies within minutes. This approach allows immediate evaluation of biopsy adequacy and improves procedural workflow. Overall, the results support a stepwise, patient-centered diagnostic approach: HRCT, clinical data, and multidisciplinary discussion remain the basis. When additional certainty is needed, the data support a least-invasive-first strategy for tissue sampling. At the same time, the imaging chapters show that innovative bronchoscopic imaging and rapid ex vivo microscopy may contribute to ILD diagnostics and may improve workflow when tissue is obtained.