Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques

Kjetil Roth, Jon A Hardie, Alf H Andreassen, Friedemann Leh, Tomas Ml Eagan, Kjetil Roth, Jon A Hardie, Alf H Andreassen, Friedemann Leh, Tomas Ml Eagan

Abstract

Background: The reported diagnostic yield from bronchoscopies in patients with lung cancer varies greatly. The optimal combination of sampling techniques has not been finally established. The objectives of this study were to find the predictors of diagnostic yield in bronchoscopy and to evaluate different combinations of sampling techniques.

Methods: All bronchoscopies performed on suspicion of lung malignancy in 2003 and 2004 were reviewed, and 363 patients with proven malignant lung disease were included in the study. Sampling techniques performed were biopsy, transbronchial needle aspiration (TBNA), brushing, small volume lavage (SVL), and aspiration of fluid from the entire procedure. Logistic regression analyses were adjusted for sex, age, endobronchial visibility, localization (lobe), distance from carina, and tumor size.

Results: The adjusted odds ratios (OR) with 95% confidence intervals (CI) for a positive diagnostic yield through all procedures were 17.0 (8.5-34.0) for endobronchial lesions, and 2.6 (1.3-5.2) for constriction/compression, compared to non-visible lesions; 3.8 (1.3-10.7) for lesions > 4 cm, 6.7 (2.1-21.8) for lesions 3-4 cm, and 2.5 (0.8-7.9) for lesions 2-3 cm compared with lesions <= 2 cm. The combined diagnostic yield of biopsy and TBNA was 83.7% for endobronchial lesions and 54.2% for the combined group without visible lesions. This was superior to either technique alone, whereas additional brushing, SVL, and aspiration did not significantly increase the diagnostic yield.

Conclusion: In patients with malignant lung disease, visible lesions and larger tumor size were significant predictors of higher diagnostic yield, after adjustment for sex, age, distance from carina, side and lobe. The combined diagnostic yield of biopsy and TBNA was significant higher than with either technique alone.

References

    1. Cancer registry of Norway (Nov 2006).
    1. Honeybourne D, Babb J, Bowie P, Brewin A, Fraise A, Garrard C, Harvey J, Lewis R, Neumann C, Wathen CG, Williams T. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56:I1–I21. doi: 10.1136/thorax.56.suppl_1.i1.
    1. Schreiber G, McCrory DC. Performance characteristics of different modalities for diagnosis of suspected lung cancer: Summary of published evidence. Chest. 2003;123:115S–128S. doi: 10.1378/chest.123.1_suppl.115S.
    1. Charig MJ, Phillips AJ. CT-guided cutting needle biopsy of lung lesions – Safety and efficacy of an out-patient service. Clinical Radiology. 2000;55:964–969. doi: 10.1053/crad.2000.0964.
    1. Gasparini S, Ferretti M, Secchi EB, Baldelli S, Zuccatosta L, Gusella P. Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses. Experience with 1,027 consecutive cases. Chest. 1995;108:131–137. doi: 10.1378/chest.108.1.131.
    1. Hattori S, Matsuda M, NISHIHAR H, Horai T. Early diagnosis of small peripheral lung cancer – Cytologic diagnosis of very fresh cancer cells obtained by TV-brushing technique. Acta Cytologica. 1971;15:460–467.
    1. Lam WK, So SY, Hsu C. Fiberoptic bronchoscopy in the diagnosis of bronchial cancer: Comparison of washings, brushings and biopsies in central and peripheral tumors. Clinical Oncology. 1983;9:35–42.
    1. Torrington KG, Kern JD. The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule. Chest. 1993;104:1021–1024. doi: 10.1378/chest.104.4.1021.
    1. Wallace JM, Deutsch AL. Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule. Chest. 1982;81:665–671. doi: 10.1378/chest.81.6.665.
    1. Baaklini WA, Reinoso MA, Gorin AB, Sharafkanch A, Manian P. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest. 2000;117:1049–1054. doi: 10.1378/chest.117.4.1049.
    1. Chechani V. Bronchoscopic diagnosis of solitary pulmonary nodules and lung masses in the absence of endobronchial abnormality. Chest. 1996;109:620–625. doi: 10.1378/chest.109.3.620.
    1. Estarriol MH, Goday MR, Sanchez MV, Padro XB, Sot MTC, Quetglas FS. Bronchoscopic lung biopsy with fluoroscopy to study 164 localized pulmonary lesions. Archivos de Bronconeumologia. 2004;40:483–488. doi: 10.1157/13067568.
    1. Naidich DP, Sussman R, Kutcher WL, Aranda CP, Garay SM, Ettenger NA. Solitary pulmonary nodules. CT -bronchoscopic correlation. Chest. 1988;93:595–598. doi: 10.1378/chest.93.3.595.
    1. Radke JR, Conway WA, Eyler WR, Kvale PA. Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible bronchoscopy. Chest. 1979;76:176–179. doi: 10.1378/chest.76.2.176.
    1. Reichenberger F, Weber J, Tamm M, Bolliger CT, Dalquen P, Perruchoud AP, Soler M. The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. Chest. 1999;116:704–708. doi: 10.1378/chest.116.3.704.
    1. Stringfield JT, Markowitz DJ, Bentz RR, Welch MH, Weg JG. Effect of tumor size and location on diagnosis by fiberoptic bronchoscopy. Chest. 1977;72:474–476. doi: 10.1378/chest.72.4.474.
    1. Aristizabal JF, Young KR, Nath H. Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma? Chest. 1998;113:1244–1249. doi: 10.1378/chest.113.5.1244.
    1. Castella J, Buj J, Puzo C, Anton PA, Burgues C. Diagnosis and staging of bronchogenic carcinoma by transtracheal and transbronchial needle aspiration. Annals of Oncology. 1995;6:s21–s24.
    1. Pilotti S, Rilke F, Gribaudi G, Spinelli P. Cytologic diagnosis of pulmonary carcinoma on bronchoscopic brushing material. Acta Cytologica. 1982;26:655–660.
    1. Bilaceroglu S, Kumcuoglu Z, Alper H, Osma E, Cagirici U, Gunel O, Bayol U, Celikten E, Perim K, Kose T. CT bronchus sign-guided bronchoscopic multiple diagnostic: Procedures in carcinomatous solitary pulmonary nodules and masses. Respiration. 1998;65:49–55. doi: 10.1159/000029237.
    1. Kvale PA, Bode FR, Kini S. Diagnostic accuracy in lung cancer; Comparison of techniques used in association with flexible fiberoptic bronchoscopy. Chest. 1976;69:752–757. doi: 10.1378/chest.69.6.752.
    1. Debeljak A, Mermolja M, Sorli J, Zupancic M, Zorman M, Remskar J. Bronchoalveolar lavage in the diagnosis of peripheral primary and secondary malignant lung tumors. Respiration. 1994;61:226–230.
    1. de Gracia J, Bravo C, Miravitlles M, Tallada N, Orriols R, Bellmunt J, Vendrell M, Morell F. Diagnostic value of bronchoalveolar lavage in peripheral lung cancer. American Review of Respiratory Disease. 1993;147:649–652.
    1. Gay PC, Brutinel WM. Transbronchial needle aspiration in the practice of bronchoscopy. Mayo Clinic Proceedings. 1989;64:158–162.
    1. Mak VHF, Johnston IDA, Hetzel MR, Grubb C. Value of washings and brushings at fiberoptic bronchoscopy in the diagnosis of lung cancer. Thorax. 1990;45:373–376.
    1. Mori K, Yanase N, Kaneko M, Ono R, Ikeda S. Diagnosis of peripheral lung cancer in cases of tumors 2 cm or less in size. Chest. 1989;95:304–308. doi: 10.1378/chest.95.2.304.
    1. Pirozynski M. Bronchoalveolar lavage in the diagnosis of peripheral, primary lung cancer. Chest. 1992;102:372–374. doi: 10.1378/chest.102.2.372.
    1. Popp W, Rauscher H, Ritschka L, Redtenbacher S, Zwick H, Dutz W. Diagnostic sensitivity of different techniques in the diagnosis of lung tumors with flexible fiberoptic bronchoscope. Comparison of brush biopsy, imprint cytology of forceps biopsy, and histology of forceps biopsy. Cancer. 1991;67:72–75. doi: 10.1002/1097-0142(19910101)67:1<72::AID-CNCR2820670114>;2-L.
    1. Zavala DC. Diagnostic fiberoptic bronchoscopy: Techniques and results of biopsy in 600 patients. Chest. 1975;68:12–19. doi: 10.1378/chest.68.1.12.
    1. Mclean AN, Semple PD, Franklin DH, Petrie G, Millar EA, Douglas JG. The Scottish multi-centre prospective study of bronchoscopy for bronchial carcinoma and suggested audit standards. Respiratory Medicine. 1998;92:1110–1115. doi: 10.1016/S0954-6111(98)90403-6.
    1. Kacar N, Tuksavul F, Edipoglu O, Ermete S, Guclu SZ. Effectiveness of transbronchial needle aspiration in the diagnosis of exophytic endobronchial lesions and submucosal/peribronchial diseases of the lung. Lung Cancer. 2005;50:221–226. doi: 10.1016/j.lungcan.2005.05.018.
    1. Govert JA, Kopita JM, Matchar D, Kussin PS, Samuelson WM. Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor. Chest. 1996;109:451–456. doi: 10.1378/chest.109.2.451.
    1. van der Drift MA, van der Wilt GJ, Thunnissen FBJM, Janssen JP. A prospective study of the timing and cost-effectiveness of bronchial washing during bronchoscopy for pulmonary malignant tumors. Chest. 2005;128:394–400. doi: 10.1378/chest.128.1.394.
    1. Karahalli E, Yilmaz A, Turker H, Ozvaran K. Usefulness of various diagnostic techniques during fiberoptic bronchoscopy for endoscopically visible lung cancer: Should cytologic examinations be performed routinely? Respiration. 2001;68:611–614. doi: 10.1159/000050581.

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