Study objectives: To evaluate factors affecting the
diagnostic yield of flexible fiberoptic bronchoscopy in evaluating
solitary pulmonary nodules (SPNs).
Retrospective analysis of bronchoscopies performed over a 4-year
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.
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
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