Chest
Volume 117, Issue 4, April 2000, Pages 1049-1054
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Clinical Investigations
BRONCHOSCOPY
Diagnostic Yield of Fiberoptic Bronchoscopy in Evaluating Solitary Pulmonary Nodules

https://doi.org/10.1378/chest.117.4.1049Get rights and content

Study objectives

To evaluate factors affecting the diagnostic yield of flexible fiberoptic bronchoscopy in evaluating solitary pulmonary nodules (SPNs).

Design

Retrospective analysis of bronchoscopies performed over a 4-year period.

Setting

A tertiary teaching hospital.

Patients

One hundred seventy-seven patients with pulmonary nodules without endobronchial lesions who underwent bronchoscopy with brushing, washing, and transbronchial biopsy.

Results

There were 151 malignant and 26 benign lesions. The diagnostic accuracy of bronchoscopy in malignant and benign lesions were 64% (97 of 151) and 35% (9 of 26), respectively. The yield of bronchoscopy was directly related to lesion size (p < 0.001, χ2). When lesions were grouped according to distance from the hilum, yields of bronchoscopy in central, intermediate, and peripherally located lesions were 82, 61, and 53%, respectively (p = 0.05, χ2). When we stratified distance from the hilum by lesion size, the difference in yield was not significant. However, lesions ≤ 2 cm had a diagnostic yield of 14% (2 of 14) when located in the peripheral third vs 31% (5 of 16) when located in the inner two thirds of the lung. There was a trend toward higher combined diagnostic yield in right middle and lingular lobes when compared to all other segments (p = 0.09, χ2). Transbronchial biopsy, washing, and brushing were complementary in improving the yield of bronchoscopy.

Conclusions

Size is the strongest determinant of diagnostic yield in bronchoscopy when evaluating SPNs. The yield of bronchoscopy is particularly low in lesions ≤ 2 cm that are located in the outer third of the lung. Thus, alternative diagnostic approaches may be preferable in this situation.

Section snippets

Materials and Methods

We retrospectively reviewed the medical records of all patients who underwent bronchoscopy at the Houston Veterans Affairs Medical Center (HVAMC) between January 1992 and August 1996. One hundred seventy-seven patients met the following criteria for inclusion in the study: (1) presence of a single circumscribed lung mass completely surrounded by aerated lung without associated abnormalities (including atelectasis, pneumonitis, satellite lesions, or cavity); (2) lesions that were not visible

Results

One hundred seventy-seven patients fulfilled the inclusion criteria and were enrolled in the study. They were all men (mean age, 65 ± 8 years; range, 41 to 83 years), and were all active or ex-smokers (mean, 59 ± 23 pack-years; range, 24 to 126 pack-years).

One hundred fifty-one lesions were malignant (80 adenocarcinoma, 58 squamous cell carcinoma, 3 undifferentiated nonsmall cell carcinomas, 6 small-cell carcinomas, and 4 carcinoid tumors). Twenty-six lesions were benign (12 noncaseating

Discussion

Although multiple studies have investigated factors affecting diagnostic yield in FFB, only seven English-language studies have addressed SPNs (Table 1). Diagnostic yields in SPN studies ranged from 18 to 62%. In the study by Torrington and Kern,2 SPNs were poorly characterized and were defined only as meeting criteria for stage I carcinomas (T1N0M0 or T2N0M0). Thus, there was no upper limit for the size of lesions, and it is uncertain whether lesions that were pleural based or had associated

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