Diagnostic Yield of Flexible Bronchoscopy Without Fluoroscopic Guidance in Evaluating Peripheral Lung Lesions

Abstract

Flexible bronchoscopy (FB) is frequently performed in patients with peripheral lung lesions. The aim of this study was to evaluate the diagnostic yield, factors affecting diagnostic yield, complications, and safety of FB without fluoroscopic guidance in patients with peripheral lung lesions. We retrospectively reviewed the medical records of all patients who underwent FB without fluoroscopic guidance for the diagnosis of peripheral lung lesions between 1999 and 2004. Ninety-three patients were enrolled. Among these, 38 lesions were malignant, 46 were benign, and 9 were indeterminate. The overall diagnostic rate was 65%, and the diagnostic sensitivities for malignant and benign lesions were 68% and 74%, respectively. The diagnostic yield was significantly higher for lesions >2 cm (70%) than for lesions ≤2 cm (11%; P <0.001). The diagnostic yield of transbronchial lung biopsy (46%) was higher than that of bronchial washing (29%; P=0.025) or brushing (29%; P=0.022). The yield of transbronchial lung biopsy for malignant disease (70%) was higher than that of benign disease (35%; P=0.003). Pneumothoraces and significant bleeding developed in 4.3% and 2.2% of patients, respectively. This study showed that FB sampling without fluoroscopic guidance was safe with a high rate of accuracy for the diagnosis of lung lesions not visible through a bronchoscope. When we performed a computed tomography scan and determined the exact location of the lesion before FB, the diagnostic yield of FB without fluoroscopic guidance was comparable with that reported earlier using fluoroscopy.