Study objectives: To determine the extent to which
on-site cytopathology assessment improves diagnostic yield when
sampling lung nodules or masses and/or hilar or mediastinal
lymphadenopathy by fiberoptic bronchoscopy (FOB).
Design: Prospective cohort study.
Two teaching hospitals in Baltimore, MD.
Consecutive adult patients (≥ 18 years) undergoing FOB for evaluation
of lung nodules or masses and/or hilar or mediastinal
Intervention: Prospective collection
of data on patient factors and details of the procedure on standardized
Measurements and results: The primary
outcome measure was a new diagnosis obtained by FOB. On-site assessment
was used in 81 of 204 cases (40%), and overall diagnostic yield was
62%. Yield was greater when on-site cytopathology assessment was used,
in unadjusted analysis (81% vs 50%, p < 0.001) and in a
multivariate model (odds ratio, 4.5; 95% confidence interval, 2.1 to
10.0). Other significant predictors of a new diagnosis included older
patient age, higher dose of narcotic used during FOB, and shorter
Conclusions: We conclude that
diagnostic yield was greater when on-site cytopathology was used to
assist FOB evaluation of intrathoracic adenopathy and/or lung nodules
or masses. Increasing the use of on-site cytopathology assessment may
improve the quality of FOB services.