Can HRCT Contribute in Decision-Making on Indication for Flexible Bronchoscopy for Solitary Pulmonary Nodules and Masses?

Abstract

To standardize selection of biopsy procedures for solitary pulmonary nodule and mass (SPNM), we evaluated retrospectively whether high-resolution computed tomography (HRCT) would contribute to decision-making on indication for flexible bronchoscopy (FFB) in 200 SPNM without visible endobronchial abnormalities that underwent HRCT and FFB. A total of 113 SPNM were malignant. For malignancy, the diagnostic yield of FFB was 62.1%. The factors causing low diagnostic yield of FFB are (1) diameter of 25 mm or less (yield 48.9%), (2) distance longer than 40 mm from the inlet of segmental bronchus (yield 50.0%), and (3) no CT bronchus sign (yield 44.9%). If HRCT satisfies two or more of the following conditions—diameter larger than 25 mm, distance from the inlet of segmental bronchus 40 mm or less, positive CT bronchus sign—the likelihood ratios for positive diagnostic FFB range from 1.13 to 4.08; thus, FFB is likely possible to diagnose. The candidate for FFB should be limited to SPNM that satisfies at least two of these three conditions. If SPNM does not satisfy this criterion, likelihood ratios range from 0.18 to 0.64, and another procedure should be considered. On the basis of HRCT, the indication for FFB can be determined.