Artificial Intelligence in Pulmonary Endoscopy: Current Evidence, Limitations, and Future Directions

Background: Artificial intelligence (AI) is increasingly applied in pulmonary endoscopy, including diagnostic bronchoscopy, interventional pulmonology and endobronchial imaging. Advances in computer vision, machine learning and robotic systems have expanded the potential for automated lesion detection, navigation to peripheral pulmonary lesions, and real-time procedural support. However, the current evidence base remains heterogeneous, and translational challenges persist. Methods: This review summarizes current applications and developments of AI across white-light bronchoscopy (WLB), image-enhanced bronchoscopy (e.g., narrow-band imaging and autofluorescence imaging), endobronchial ultrasound (EBUS), virtual and robotic bronchoscopies, and workflow optimization and training. The authors also examine the methodological limitations, regulatory considerations, and implementation barriers that affect translation into routine practice. Results: Reported developments include deep learning-based models for mucosal abnormality detection, lymph-node characterization during EBUS-guided transbronchial needle aspiration (EBUS-TBNA), improved lesion localization, and reduction in operator-dependent variability. Additionally, AI-assisted simulation platforms and decision-support tools are reshaping training paradigms. Nevertheless, most studies remain retrospective or single-center, with limited external validation, dataset heterogeneity, unclear model explainability, and incomplete integration into clinical workflows. Conclusions: AI has the potential to support lesion detection, navigation, and training in pulmonary endoscopy. However, robust prospective validation, standardized datasets, transparent model reporting, robust data governance, multidisciplinary collaboration, and careful integration into clinical practice are required before widespread adoption.