PURPOSE: Occassionally, pulmonary nodules are in regions where obtaining a diagnosis with conventional bronchoscopy or CT-guided percutaneous biopsy is difficult. Fifteen prior studies using conventional bronchoscopy for peripheral lesions yielded a sensitivity of 52% for diagnosis of bronchogenic carcinoma. CT-guided bronchoscopy may improve diagnostic accuracy in these difficult to reach lesions, but the literature supporting this is unclear. Our aim is to assess the diagnostic yield of CT-guided bronchoscopy for suspicious nodules unamenable to conventional procedures.
METHODS: Our study encompassed a retrospective chart review of patients who underwent CT-guided bronchoscopy for suspected lung cancer. Patients met inclusion criteria with lesions felt to be too peripheral (beyond the segmental bronchus) for conventional bronchoscopy and too central for percutaneous biopsy; some of these patients had a recent negative bronchoscopy. A successful CT-guided bronchoscopy is defined as a true positive (TP), diagnosed malignancy, or true negative (TN), the absence of malignancy at thoracotomy or decreased mass size on follow-up CT. A false negative (FN) result is defined by the presence of malignancy at thoracotomy or increased mass size on follow-up CT.
RESULTS: Our records identified eighteen patients, eight males and ten females. Sixteen met inclusion criteria; two were excluded due to lack of follow-up. Six TP, four TN, and six FN were measured to yield a sensitivity (50%) and specificity (100%) for the diagnosis of these lesions. Fisher's exact test was used to calculate the two-tailed p value = 0.03.
CONCLUSION: The diagnostic yield of CT-guided bronchoscopy was 50% for lesions unamenable to conventional bronchoscopy or CT-guided percutaneous biopsy. Although our study was underpowered, further studies may exhibit substantial benefit with continued training and implementation.
CLINICAL IMPLICATIONS: CT-guided bronchoscopy is a potentially valuable resource in difficult to reach nodules that would otherwise require a surgical procedure for diagnosis. Additionally, it would allow chemotherapy and or radiation in patients who are not surgical candidates.
DISCLOSURE: Christopher Pastor, No Financial Disclosure Information; No Product/Research Disclosure Information