Chest
Clinical Investigations: OncologyCost-effectiveness of Collecting Routine Cytologic Specimens During Fiberoptic Bronchoscopy for Endoscopically Visible Lung Tumor
Section snippets
Patients
The records of all fiberoptic bronchoscopies at Duke University Medical Center from July 1, 1990, to March 1, 1995 are recorded prospectively and maintained in a computerized database. This database includes demographic characteristics, indications for the bronchoscopy, bronchoscopic findings during the procedure, type, location, and results of histologic and cytologic specimens taken during the bronchoscopy. There were 2,498 records contained in the database. We reviewed all bronchoscopies
RESULTS
Sensitivity of Bronchoscopy
We analyzed the bronchoscopies from 201 patients with visible endobronchial lesions. Table 2 lists these patients' diagnoses. Endobronchial biopsy specimens were positive for cancer in 143 patients. Endobronchial brushings were positive for cancer in 85 patients and endobronchial washings were positive for cancer in 76. Bronchoscopy yielded a diagnosis of cancer in 151 of the 201 patients. In addition, bronchoscopy revealed benign diagnoses in nine patients. The
DISCUSSION
Our data confirm the findings of previous studies that the adding of brushing and washing cytology to biopsy of endobronchial tumors modestly increases the overall sensitivity of the procedure (85.3% vs 80.8%, McNemar's p=0.01). Adding either washings or brushings to forceps biopsy has a remarkably similar impact, increasing the sensitivity from 80.8 to 84.8% (McNemar's p=0.03). These results document a somewhat smaller increase in sensitivity than previously reported by most investigators.6, 7
APPENDIX
Equations used to calculate costs and effects for bronchoscopy strategies:
REFERENCES (16)
- et al.
The role of bronchoscopy in lung cancer
Clin Chest Med
(1993) - et al.
Fiberoptic bronchoscopy: comparison of procedures used in the diagnosis of lung cancer
J Thorac Cardiovasc Surg
(1978) - et al.
Diagnostic accuracy in lung cancer: comparison of techniques used in association with flexible fiberoptic bronchoscopy
Chest
(1976) Transthoracic needle aspiration
Clin Chest Med
(1992)Transthoracic percutaneous lung biopsy
Radiol Clin North Am
(1990)- et al.
Thoacoscopy for the diagnosis of the indeterminate solitary pulmonary nodule
Ann Thorac Surg
(1993) - et al.
Comparison of transbronchial needle aspiration biopsy, aspiration of bronchial secretion, bronchial washing, brush biopsy and forceps biopsy in the diagnosis of lung cancer
Eur J Respir Dis
(1983) - et al.
Fiberoptic bronchoscopy in the diagnosis of bronchial cancer: comparison of washings brushings and biopsies in central and peripheral tumors
Clin Oncol
(1983)
Cited by (72)
Usefulness of Routine Bronchial Aspirate of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration
2023, Archivos de BronconeumologiaFlexible Bronchoscopy
2018, Clinics in Chest MedicineEstablishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines
2013, ChestCitation Excerpt :A central lesion can present as an exophytic endobronchial mass, submucosal spread, or a peribronchial tumor causing extrinsic compression. Thirty-five studies of patients with central disease were identified (Fig 3).5,70–75,77,88–109,123–127 Among a total of 4,507 patients, the overall sensitivity of FB was 88%.
revision accepted September 11.