Pulmonary Procedures |

The Diagnostic Value and Economic Impact of Cytologic Brushing During Fiberoptic Bronchoscopy FREE TO VIEW

Manaf Zaizafoun, MD; Rene Franco, MD; Michel Fernandez, MD; Shirley Jones, MD; Carl Boethel, MD
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Baylor Scott & White, Temple, TX

Chest. 2015;148(4_MeetingAbstracts):796A. doi:10.1378/chest.2277761
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SESSION TITLE: Interventional Pulmonary

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 25, 2015 at 04:30 PM - 05:30 PM

PURPOSE: Previous studies have found the sensitivity of fiberoptic cytologic brushing (FCB) to be approximately 50%-80%. The aim of this study is to evaluate the diagnostic value of FCB when done in combination with other modalities (Trans-bronchial biopsy (TBB), Endo-bronchial Biopsy (EBB), and/or Bronchoalveloar lavage (BAL)) and assess its economic impact. It is our view that when used in concert with other bronchoscopic diagnostic modalities, FCB adds little if any value to the work up of the pulmonary patient.

METHODS: We perfomed a retrospective chart analysis of patients who underwent fiberoptic bronchoscopy in our institution during the period from January 1, 2013 through June 30, 2014. We included only patients who had FCB done independently or in combination with other bronchoscopic sampling procedures. Means and frequencies were calculated for patient characteristics and brushing measures. Incremental costs associated with the use of brushing were also calculated. The study protocol was approved by our local IRB and consent was waived due to the retrospective nature of the study.

RESULTS: 900 total charts were analyzed. 560 charts were excluded due to absence of FCB. Out of the 340 patients included in our study, FCB in combination with TBB, EBB, and/or BAL provided two cases (1.2%) where FCB was the sole positive and diagnostic modality. 293 patients had FCB performed with TBB and BAL; FCB provided an exclusive diagnosis where TBB and BAL were negative in one patient: an added diagnostic utility of 0.7% in this cohort. FCB did not add any additional diagnostic value in 31 patients in which 16 had a positive diagnosis. In 1 of 14 cases where BAL was the only additional modality utilized, FCB was able to provide a diagnosis. The economic impact of FCB resulted in procedural and pathological cost of $1,567.77 per case. Out of 340 cases where brushing was utilized, the added healthcare cost was $533,041.80. Given the yield of only two additional positive cases, the diagnostic value is minimal and the economic impact is significant.

CONCLUSIONS: FCB had diagnostic impact in only 1.2% of our patient population and led to a significant increase in cost. Based on our data, the clinical benefit is minimal, and we recommend the judicious use of FCB as it appears to add little in diagnostic value with profound economic burden.

CLINICAL IMPLICATIONS: Based on our data, the clinical benefit is minimal, and we recommend the judicious use of FCB as it appears to add little in diagnostic value with profound economic burden.

DISCLOSURE: The following authors have nothing to disclose: Manaf Zaizafoun, Rene Franco, Michel Fernandez, Shirley Jones, Carl Boethel

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