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Bronchoscopy |

Utility of On-Site Cytopathology Assessment for Bronchoscopic Evaluation of Lung Masses and Adenopathy*

Gregory B. Diette, MD; Peter White, Jr, MD; Peter Terry, MD; Mollie Jenckes, MHS; Dorothy Rosenthal, MD; Haya R. Rubin, MD
Author and Funding Information

*From the Departments of Medicine (Drs. Diette, Terry, Jenckes, and Rubin) and Pathology (Dr. Rosenthal), The Johns Hopkins University School of Medicine, Baltimore, MD, and the Department of Medicine (Dr. White), the University of Arkansas for Medical Sciences, Little Rock, AK.

Correspondence to: Gregory B. Diette, MD, MHS, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St., Room 301, Baltimore, MD 21205; e-mail: gdiette@jhmi.edu



Chest. 2000;117(4):1186-1190. doi:10.1378/chest.117.4.1186
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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.

Setting: Two teaching hospitals in Baltimore, MD.

Patients: Consecutive adult patients (≥ 18 years) undergoing FOB for evaluation of lung nodules or masses and/or hilar or mediastinal lymphadenopathy.

Intervention: Prospective collection of data on patient factors and details of the procedure on standardized report forms.

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 procedure time.

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.


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