Tuberc Respir Dis.  2017 Jul;80(3):284-290. 10.4046/trd.2017.80.3.284.

Factors Related to the Diagnostic Yield of Flexible Bronchoscopy without Guidance in Bronchoscopically Invisible Peripheral Lung Lesions

• Kang HS
• Ha JH
• Kang HH
• Yeo CD
• Rhee CK
• Kim SK
• Moon HS
• Lee SH

• KMID: 2385044
• DOI: http://doi.org/10.4046/trd.2017.80.3.284

Abstract

BACKGROUND
We aimed to analyze the factors predicting the diagnostic performance of flexible bronchoscopy without guidance in peripheral lung lesions that are endoscopically invisible.
METHODS
This was a retrospective study conducted in St. Paul's Hospital, The Catholic University of Korea, between January 2007 and March 2013. We included all patients who received bronchoscopy during this period. The analyzed variables were age, sex, the etiology of the lesion, lesion size, distance from the pleura, and presence of the bronchus sign. We used multiple logistic regression analysis to identify the significant independent factors associated with diagnostic yield.
RESULTS
We included 151 patients in this study. The overall diagnostic yield was 58.3%. The sensitivity was 43.2% for malignant disease and 78.1% for benign disease. The benign lung lesions (p<0.001), lesion size (p=0.015), presence of the exposed type of bronchus sign (p<0.001), and presence of cavitary lung lesions (p=0.005) were factors influencing the yield of flexible bronchoscopy by univariate analysis. In a multivariate logistic regression analysis, the exposed type of bronchus sign and benign lung lesions were independent predicting factors (odds ratio [OR]: 27.95; 95% confidence interval [CI], 7.56-103.32; p<0.001 and OR, 4.91; 95% CI, 1.76-13.72; p=0.002).
CONCLUSION
The presence of the exposed type of bronchus sign and benign lung lesions are determining factors of the diagnostic yield in flexible bronchoscopy in evaluating peripheral lesions that are not endoscopically visible.

Keyword

Bronchoscopy; Lung; Bronchi; Multidetector Computed Tomography

MeSH Terms

Bronchi
Bronchoscopy*
Humans
Korea
Logistic Models
Lung*
Multidetector Computed Tomography
Pleura
Retrospective Studies

Figure

• 

  Figure 1 Study patients. SqCC: squamous cell carcinoma; ADC: lung adenocarcinoma; SCLC: small cell lung cancer.

Reference

1. Asano F, Shinagawa N, Ishida T, Shindoh J, Anzai M, Tsuzuku A, et al. Virtual bronchoscopic navigation combined with ultrathin bronchoscopy: a randomized clinical trial. Am J Respir Crit Care Med. 2013; 188:327–333.

2. Boonsarngsuk V, Raweelert P, Juthakarn S. Endobronchial ultrasound plus fluoroscopy versus fluoroscopy-guided bronchoscopy: a comparison of diagnostic yields in peripheral pulmonary lesions. Lung. 2012; 190:233–237.

3. Bose S, Ghatol A, Eberlein M, Yung RC. Ultrathin bronchoscopy in the diagnosis of peripheral cavitary lung lesions. J Bronchology Interv Pulmonol. 2013; 20:167–170.

4. Chee A, Stather DR, Maceachern P, Martel S, Delage A, Simon M, et al. Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules. Respirology. 2013; 18:784–789.

5. Jain P, Fleming P, Mehta AC. Radiation safety for health care workers in the bronchoscopy suite. Clin Chest Med. 1999; 20:33–38.

6. Rittirak W, Sompradeekul S. Diagnostic yield of fluoroscopy-guided transbronchial lung biopsy in non-endobronchial lung lesion. J Med Assoc Thai. 2007; 90:Suppl 2. 68–73.

7. Gaeta M, Russi EG, La Spada F, Barone M, Casablanca G, Pandolfo I. Small bronchogenic carcinomas presenting as solitary pulmonary nodules. Bioptic approach guided by CT-positive bronchus sign. Chest. 1992; 102:1167–1170.

8. Lee HS, Kwon SY, Kim DK, Yoon HI, Lee SM, Lee JH, et al. Determinants of diagnostic bronchial washing in peripheral lung cancers. Int J Tuberc Lung Dis. 2007; 11:227–232.

9. Rhee CK, Kang HH, Kang JY, Kim JW, Kim YH, Park SA, et al. Diagnostic yield of flexible bronchoscopy without fluoroscopic guidance in evaluating peripheral lung lesions. J Bronchology Interv Pulmonol. 2010; 17:317–322.

10. Tsuboi E, Ikeda S, Tajima M, Shimosato Y, Ishikawa S. Transbronchial biopsy smear for diagnosis of peripheral pulmonary carcinomas. Cancer. 1967; 20:687–698.

11. Hsia DW, Jensen KW, Curran-Everett D, Musani AI. Diagnosis of lung nodules with peripheral/radial endobronchial ultrasound-guided transbronchial biopsy. J Bronchology Interv Pulmonol. 2012; 19:5–11.

12. Yeow KM, Su IH, Pan KT, Tsay PK, Lui KW, Cheung YC, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest. 2004; 126:748–754.

13. Hergott CA, Tremblay A. Role of bronchoscopy in the evaluation of solitary pulmonary nodules. Clin Chest Med. 2010; 31:49–63.

14. Joos L, Patuto N, Chhajed PN, Tamm M. Diagnostic yield of flexible bronchoscopy in current clinical practice. Swiss Med Wkly. 2006; 136:155–159.

15. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143:5 Suppl. e142S–e165S.

16. Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest. 2000; 117:1049–1054.

17. Botana-Rial M, Nunez-Delgado M, Pallares-Sanmartin A, Leiro-Fernandez V, Torres-Duran M, Represas-Represas C, et al. Multivariate study of predictive factors for clearly defined lung lesions without visible endobronchial lesions in transbronchial biopsy. Surg Endosc. 2010; 24:3031–3036.

18. Gaeta M, Pandolfo I, Volta S, Russi EG, Bartiromo G, Girone G, et al. Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy. AJR Am J Roentgenol. 1991; 157:1181–1185.

19. Naidich DP, Sussman R, Kutcher WL, Aranda CP, Garay SM, Ettenger NA. Solitary pulmonary nodules: CT-bronchoscopic correlation. Chest. 1988; 93:595–598.

20. Schreiber G, McCrory DC. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest. 2003; 123:1 Suppl. 115S–128S.

21. Labbe C, Beaudoin S, Martel S, Delage A, Joubert P, Drapeau C, et al. Diagnostic yield of non-guided flexible bronchoscopy for peripheral pulmonary neoplasia. Thorac Cancer. 2015; 6:517–523.

22. Boonsarngsuk V, Raweelert P, Sukprapruet A, Chaiprasithikul R, Kiatboonsri S. Factors affecting the diagnostic yield of flexible bronchoscopy without guidance in pulmonary nodules or masses. Singapore Med J. 2010; 51:660–665.

23. Sing A, Freudenberg N, Kortsik C, Wertzel H, Klosa B, Hasse J. Comparison of the sensitivity of sputum and brush cytology in the diagnosis of lung carcinomas. Acta Cytol. 1997; 41:399–408.

24. Roth K, Hardie JA, Andreassen AH, Leh F, Eagan TM. Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques. BMC Pulm Med. 2008; 8:2.

25. Bilaceroglu S, Kumcuoglu Z, Alper H, Osma E, Cagirici U, Gunel O, et al. CT bronchus sign-guided bronchoscopic multiple diagnostic procedures in carcinomatous solitary pulmonary nodules and masses. Respiration. 1998; 65:49–55.

26. Chechani V. Bronchoscopic diagnosis of solitary pulmonary nodules and lung masses in the absence of endobronchial abnormality. Chest. 1996; 109:620–625.

27. Tamiya M, Sasada S, Kobayashi M, Uehara N, Okamoto N, Morishita N, et al. Diagnostic factors of standard bronchoscopy for small (≤15 mm) peripheral pulmonary lesions: a multivariate analysis. Intern Med. 2011; 50:557–561.

28. Fraire AE, Cooper SP, Greenberg SD, Rowland LP, Langston C. Transbronchial lung biopsy. Histopathologic and morphometric assessment of diagnostic utility. Chest. 1992; 102:748–752.

29. Descombes E, Gardiol D, Leuenberger P. Transbronchial lung biopsy: an analysis of 530 cases with reference to the number of samples. Monaldi Arch Chest Dis. 1997; 52:324–329.

30. Cox ID, Bagg LR, Russell NJ, Turner MJ. Relationship of radiologic position to the diagnostic yield of fiberoptic bronchoscopy in bronchial carcinoma. Chest. 1984; 85:519–522.

31. Ost DE, Ernst A, Lei X, Kovitz KL, Benzaquen S, Diaz-Mendoza J, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions: results of the AQuIRE Registry. Am J Respir Crit Care Med. 2016; 193:68–77.

32. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol. 1996; 167:105–109.