Ground-glass nodule in lung with bronchoscope approaching a question mark

Lung Nodules: Is a Bronchoscopy Always Necessary?

Rhea Morgan in Health & Wellness August 2025 • 4 min read.

"New research sheds light on when a preoperative bronchoscopy might not be beneficial for persistent ground-glass nodules."

The detection of pulmonary nodules, small spots on the lungs, is a common and often worrying clinical issue. As a result of more frequent and advanced imaging techniques, particularly low-dose chest computed tomography (CT) scans, more of these nodules are being discovered. While many are benign, some can indicate early-stage lung cancer, making their evaluation crucial.

Persistent ground-glass nodules (GGNs) are a specific type of pulmonary nodule characterized by their hazy appearance on CT scans. These nodules can represent various conditions, including focal fibrosis (scarring), premalignant lesions, or subtypes of adenocarcinoma, a common type of lung cancer. Unlike solid nodules, GGNs can be challenging to diagnose without invasive procedures, often requiring long-term monitoring to determine their nature.

Traditionally, before surgical removal of lung nodules, a procedure called flexible bronchoscopy (FB) is performed to examine the airways and collect tissue samples. However, the utility of FB in the preoperative assessment of GGNs has been a topic of debate. This article examines the findings of a recent study investigating whether routine preoperative FB is always necessary for patients with persistent GGNs, potentially reducing the need for invasive procedures in select cases.

Bronchoscopy and Ground-Glass Nodules: What the Research Shows

Ground-glass nodule in lung with bronchoscope approaching a question mark

A recent study published in PLOS One investigated the diagnostic value of preoperative flexible bronchoscopy (FB) in patients with persistent ground-glass nodules (GGNs) who were suspected of having lung cancer. The researchers retrospectively analyzed data from 264 patients with 296 GGNs who underwent both preoperative FB and surgical resection.

Here's a breakdown of the key findings:

Limited Diagnostic Value: Preoperative FB identified malignancy in only 3 of 208 GGNs (1%) examined via bronchial washing cytology, and all three were part-solid GGNs. No other etiology was identified through FB.
No Change in Surgical Strategy: Routine preoperative FB did not change the planned surgical approach for any patient in the study.
High Malignancy Rate: Surgical resection subsequently confirmed that 271 of the GGNs (91%) were malignant. The resected malignancies included invasive adenocarcinoma(58%), minimally invasive adenocarcinoma (10%) and adenocarcinoma in situ (23%).
Benign Cases: The remaining 25 GGNs (9%) were confirmed as benign at surgical resection.

These results suggest that, for small, persistent pure GGNs, routine preoperative FB may not significantly contribute to diagnosis or treatment planning. The procedure demonstrated low sensitivity and negative predictive value in this specific patient population.

The Future of GGN Management

The study's findings indicate that routine preoperative FB may not be necessary for all patients with persistent GGNs, particularly those with small, pure GGNs. The decision to perform FB should be individualized based on the nodule's characteristics, patient risk factors, and clinical context.

Shared decision-making between physicians and patients is crucial in determining the best course of action. Patients should be informed about the potential benefits and risks of FB, as well as alternative diagnostic and management strategies, such as CT surveillance.

Further research is needed to refine the criteria for selecting patients who may benefit from preoperative FB. Prospective studies using advanced bronchoscopic techniques, such as navigational bronchoscopy, could help improve the diagnostic yield and guide treatment decisions.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1371/journal.pone.0121250, Alternate LINK

Title: Preoperative Flexible Bronchoscopy In Patients With Persistent Ground-Glass Nodule

Subject: Multidisciplinary

Journal: PLOS ONE

Publisher: Public Library of Science (PLoS)

Authors: Byung Woo Jhun, Sang-Won Um, Gee Young Suh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Kyung Soo Lee, Joungho Han, Jhingook Kim

Published: 2015-03-24

Everything You Need To Know

What are pulmonary nodules?

Pulmonary nodules are small spots found on the lungs, often discovered during imaging like low-dose chest CT scans. While some pulmonary nodules are harmless, others may indicate early-stage lung cancer, emphasizing the importance of careful evaluation. These nodules are a common finding, and their detection has increased with advancements in imaging techniques. Persistent ground-glass nodules (GGNs) are a specific type of pulmonary nodule with a hazy appearance on CT scans, which requires thorough investigation to determine their nature.

What is a ground-glass nodule (GGN)?

A persistent ground-glass nodule (GGN) appears hazy on a CT scan. These GGNs can signify various conditions, including focal fibrosis (scarring), premalignant lesions, or different forms of lung cancer like adenocarcinoma. The diagnostic complexity arises because unlike solid nodules, GGNs may be hard to diagnose without more invasive procedures. This hazy appearance distinguishes them from solid nodules, influencing the need for long-term monitoring or other diagnostic methods to determine their nature and guide treatment strategies.

What is a flexible bronchoscopy (FB)?

Flexible bronchoscopy (FB) is a procedure where a doctor examines the airways and collects tissue samples. Traditionally, it has been used before surgery to remove lung nodules. However, studies have investigated its necessity for persistent ground-glass nodules (GGNs). Findings suggest that for specific cases, particularly those with small, pure GGNs, the routine use of FB might not significantly aid in diagnosis or alter treatment plans. The research highlights the need to evaluate the usefulness of FB based on the characteristics of each nodule and the patient's overall health.

What did the research reveal about flexible bronchoscopy (FB) and ground-glass nodules (GGNs)?

According to a recent study, preoperative flexible bronchoscopy (FB) demonstrated limited diagnostic value for persistent ground-glass nodules (GGNs). It identified malignancy in only a small percentage of cases, primarily in part-solid GGNs. The study revealed that FB did not change the surgical approach in any patient. Surgical resection later confirmed that a large majority of the GGNs were malignant, including cases of invasive adenocarcinoma, minimally invasive adenocarcinoma, and adenocarcinoma in situ. This data suggests that routine FB may not be beneficial for all patients, especially those with small, pure GGNs.

How should doctors decide whether to use flexible bronchoscopy (FB) for a ground-glass nodule (GGN)?

The research suggests that the decision to perform flexible bronchoscopy (FB) should be individualized, considering the specific characteristics of the ground-glass nodule (GGN), the patient's risk factors, and the broader clinical context. For patients with small, pure GGNs, the study findings indicate that routine preoperative FB may not be necessary. This approach aims to reduce the use of invasive procedures when they do not significantly improve diagnosis or treatment planning. Individualized assessment of each case, considering factors like nodule size, appearance, and patient health, is crucial in deciding the best course of action.