Diagnostic yield of fiber optic bronchoscopy in alveolar and/or ground glass opacification in chest computed tomographic scan

Abstract

Background and objectiveTransbronchial lung biopsy (TBLB) can be obtained using forceps and usually represents the centrilobular regions. Therefore, disorders that are centered around terminal and respiratory bronchioles or distributed along the lymphatic routes can be diagnosed. This study investigated the diagnostic yield of flexible bronchoscopy in patients with ground-glass opacity (GGO) or alveolar filling for histopathological diagnosis and found out its complications.Patients and methodsTwenty-six patients with predominant GGO or alveolar opacity in the chest computed tomographic (CT) scan were submitted for TBLB for histopathological confirmation. Patients with respiratory failure, heart failure, coagulopathy, or pathognomonic CT patterns were excluded. All patients were subjected to full history taking, chest CT scan, and TBLB with histopathological examination of the specimens.ResultsThe diagnostic yield of TBLB was 73.1%. Histopathological diagnoses included hypersensitivity pneumonitis (23.1%), sarcoidosis (19.2%), adenocarcinoma (11.5%), small cell lung cancer (7.7%), alveolar proteinosis (3.8%), alveolar hemorrhage (3.8%), organizing pneumonia (3.8%), and chronic nonspecific inflammation (26.9%). There was no significant correlation between age, sex, smoking, and histopathological diagnoses. Regarding the predominant CT finding, 15 (57.7%) patients had GGO, whereas 11 (42.3%) patients had alveolar filling with significant (P=0.008) positive correlation between the CT predominant pattern and histopathological diagnoses. There was a positive significant correlation between lymph node enlargement in CT and histopathological diagnosis (P=0.029). Complications from TBLB included the pneumothorax (15.4%) and bleeding (7.7%).ConclusionsTBLB seems to be a useful and safe procedure. It is of a high diagnostic value. Therefore, it could be considered a routine diagnostic procedure before thoracoscopic or open lung biopsy.