To determine the current diagnostic yield of fibreoptic bronchoscopy (FOB) in the investigation of lung cancer.
This is a retrospective analysis of FOB performed between January 1998 and December 2003 for possible lung cancer at Apollo Hospitals, a tertiary care referral centre in Hyderabad, South India.
One thousand four hundred and fourteen (1414) patients underwent FOB for possible lung cancer during the study period. There were 1081 males (76.4%) and 333 females (23.6%); mean age was 46.9 yrs + 2.84 SD. Out of 1414 patients, 1131 received a diagnosis of lung cancer (80%; 95% CI: 78-82). Amongst the 1131 diagnosed patients endobronchial tumour was seen in 724 patients (64%). Bronchoscopic appearances suspicious of malignancy was observed in 169 patients (15%) no endobronchial growth was seen in 226 patients (20%). Positive sampling rate when tumour was seen endobronchially was 90%; the yield was 80% by biopsy & 5% each by bronchoalveolar lavage, cytology, transbronchial needle aspiration & brushings. In patients without any endobronchial growth, BAL cytology was positive in 11 patients(5%) The diagnostic yield with transbronchial lung biopsy was 75%(n=170) & with transbronchial needle aspiration was 20% (n=45). Symptomatically, 792 patients (70%) presented with history of haemoptysis. Three hundred & thirty nine patients (30%) were referred because of abnormal Chest X Ray. Clinical correlation of patient’s history & bronchoscopic diagnosis showed a sensitivity of 88.7% and specificity of 66%. Radiological correlationship with diagnosis of lung cancer had a sensitivity of 86.6%; specificity of 51%; positive predictive value of 24.4% and negative predictive value of 93.1% with accuracy of 56%.
Fibreoptic Bronchoscopy when performed for suspected lung cancer had a high overall diagnostic yield. Broncho alveolar lavage, transbronchial lung biopsy & transbronchial needle aspiration can further improve the diagnostic yield.
Bronchoscopy performed for suspected lung cancer can yield high diagnostic rate provided it is combined with various modalities.
A. Vigg, None.