PURPOSE: We tried to improve the yeld of FiberOpticBronchoscopy (FOB) in the diagnosis of peripheral lung nodules combining FOB with the technique of the modern digital x-ray to drive Transbronchial Biopsy (TBx).
METHODS: In patients with peripheral lung nodules, we perform FOB on the digital x-ray table of the angiographic room. After we approach the segmental bronchus driving to the nodule, we push out the forcep toward the nodule and the image is frozen on a monitor, then the objective is rotated of 90° and the lateral vision of the chest is offered us to verify the position. If it is satisfactory, we proceed to the biopsy which is usually repeated many times. We revised the case records of all patients who underwent TBx in our hospital from November 2000 up to April 2006. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated.
RESULTS: Onehundredtwentyeight patients underwent TBx for peripheral lung nodules and 112 for diffuse parenchimal diseases. All FOBs were performed by the same pulmonologist and all biopsies read by the same pathologist. We did not registered deaths in the 48 hours following the procedure or however as consequence of it. We did not observe pneumothorax in our 240 patients, and only two had significant hemorragies. Fourtyone biopsies out of 128 gave a diagnosis of malignancy, 62 a negative answer, and 26 samples resulted to be unsufficient or unreadable matherial for the pathologist. All but one positive biopsies received a surgical and/or clinical confirmation. Twentythree out of 62 negative biopsies resulted to be true-negative, 19 false-negative, and in 20 cases we did not find confirmation of the negativity, so that we did not take them into account. Sensitivity resulted to be 67.8%, Specificity 95.8%, PPV 97,6%, and NPV 54,8%.
CONCLUSION: In our experience TBx showed to be a safe procedure with a diagnostic power equivalent to CT-guided Needle biopsy (CTNx).
CLINICAL IMPLICATIONS: TBx should be considered in the diagnostic pathway of peripheral lung lesions before CTNx.
DISCLOSURE: Giuseppe Anzalone, None.