Any patient presenting to a respiratory physician with a possible diagnosis of lung cancer requires a rapid and accurate histological diagnosis, together with enough staging information to enable a correct management plan to be arranged. Standards for these processes have been suggested.¹ In practice it is incumbent upon physicians to assess each case and to determine the optimum combination of sampling and imaging tests that will be likely to achieve a firm diagnosis and staging at the minimum inconvenience to his or her patients, and with a minimum of delay which is known to be very distressing to them.²

Since the advent of fibreoptic bronchoscopy (FOB) in 1974, and with its current very wide availability, most physicians would consider this as their first investigation after a clinical assessment and plain radiology. Selection would be influenced by the latter, so that lesions clearly falling into the category of small solitary pulmonary nodules . . . [Full text of this article]