Endoscopic Ablation for Malignant Lung Lesions: Current Techniques, Unmet Needs and Future Directions

Endoscopic ablation represents an emerging, lung-sparing treatment modality for patients with malignant pulmonary lesions, particularly those who are medically inoperable or unsuitable for conventional therapies. Currently, techniques such as radiofrequency ablation, microwave ablation, cryoablation, and pulsed electric field are being rigorously studied to assess their feasibility, safety, and oncologic potential. While preliminary outcomes have shown feasibility and short-term safety, several challenges persist, including difficulties in accessing peripheral lesions, variability in ablation margins, and the lack of long-term efficacy data. Despite these limitations, ongoing advances in device design, navigation, and imaging, such as robotic-assisted bronchoscopy and cone-beam computed tomography, are enhancing the precision and utility of endoscopic ablation. This review aims to synthesize the current evidence on endoscopic ablation techniques, with a focus on emerging technologies, clinical applications, and key research gaps.