Bronchoscopic biopsy for diagnosis of lung cancer in the absence of visible endobronchial abnormalities

Abstract

Abstract Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and particularly, malignant diseases. However, endoscopists do not normally perform bronchoscopic biopsy in case lesions are undetected via bronchoscopy. The aim of this study was to evaluate whether performing bronchoscopic biopsy could be established in the diagnosis of lung cancer in case of endobronchial abnormalities undetectable to the naked eye. Methods We retrospectively analyzed 109 cases between January 2008 and December 2012. The inclusion criteria were confirmed lung cancer diagnosis, transbronchial biopsy performed in the absence of visible endobronchial manifestations, brushing, and bronchoalveolar lavage (BAL) according to the images obtained from high-resolution computed tomography (HRCT). Data regarding age, sex, pathology, tumor stage; the method of diagnosis; location of primary lesion (central, peripheral, or intermediate); tumor size, mediastinal lymph node metastasis, and the serum carcinoembryonic antigen (CEA) value were collected. The Pearson chi-square test or Fisher’s exact and McNemar tests were used in the univariate analysis. Results Among the 109 patients, the diagnosis of 37 (33.9%) patients was confirmed through bronchoscopy. Brushing and BAL had higher positive detection rates than biopsy (P = 0.004). There were no differences in the positive detection rates between the sex, pathology, lesion location, tumor size, lymph node metastasis, and the serum CEA value (P > 0.05 for all groups). Conclusion Despite the normal appearance of the endobronchial manifestations, lesions undetectable by bronchoscopy could be indicated. Therefore, we suggest performing bronchoscopic biopsy and that brushing and BAL might increase the positive detection rate of bronchoscopic examination.