Factors affecting the diagnostic yield of flexible bronchoscopy without guidance in pulmonary nodules or masses

Boonsarngsuk V, Raweelert P, Sukprapruet A, Chaiprasithikul R, Kiatboonsri S
Correspondence: Dr Viboon Boonsarngsuk, bss-vb@hotmail.com

ABSTRACT
Introduction In day-to-day bronchoscopic practice, no guidance is available to pinpoint the precise location of pulmonary nodules or masses, especially in developing countries. This results in a large number of non-diagnostic testings. The present study aimed to determine the predictors of diagnostic yield in bronchoscopy without guidance and develop a model to predict the decision to perform this procedure.
Methods A retrospective study was conducted on 330 patients with pulmonary nodules or masses without any sign of atelectasis on chest radiographs, who underwent diagnostic bronchoscopy without guidance between June 2004 and May 2008. The patient characteristics, as well as radiological and bronchoscopic findings were included in the analysis of factors affecting the diagnostic yield.
Results The overall diagnostic yield of bronchoscopy was 55.8 percent. The tumour size, endobronchial visibility and the characteristics of endobronchial abnormalities were predictors of higher diagnostic yield. The prediction model was developed from the data that can be recognised before bronchoscopy. Bronchoscopy provided the diagnosis in 66.4 percent of the patients who had a tumour size of 4 cm or larger.
Conclusion The diagnostic yield of bronchoscopy without guidance was influenced by the size of the lesion, the endobronchial visibility and the characteristics of endobronchial abnormalities. Computed tomography (CT) of the chest should be performed to evaluate airway involvement. If the lesion is less than 4 cm in diameter and there is a negative CT illustration of airway involvement, flexible bronchoscopy with guidance should be considered.

Keywords: diagnostic yield, flexible bronchoscopy, guidance, pulmonary nodule
Singapore Med J 2010; 51(8): 660-665