Is bronchoscopy still a useful test in patients presenting with haemoptysis, with a normal CT scan?

Abstract

Background: Standard UK practice for investigation of patients presenting with haemoptysis is to perform thoracic CT and bronchoscopy. However, as modern CT scanners become increasingly sensitive more evidence is needed to determine whether bronchoscopy provides useful additional diagnostic information when a patient has had a normal CT scan. Methods: Retrospective analysis of all patients undergoing bronchoscopy for investigation of haemoptysis in a single centre over a six month period (n=52). CTs were performed on helical 64-slice scanners and reported by specialist thoracic radiologists. CT findings were classified as normal, abnormal without evidence of malignancy (e.g. bronchiectasis or emphysema), or probable cancer. Results: CT findings were normal in 19 (37%) patients. 21 (40%) had an abnormal CT without clear malignancy. 12 (23%) had CT findings of probable cancer. No patient with a normal CT had any suspicious bronchoscopic findings. 2 (9%) patients in the abnormal CT group (n=21) had abnormal bronchoscopy and were diagnosed with malignancy. 4 (7.6%) patients undergoing bronchoscopy were referred to ENT due to abnormal bronchoscopic findings in the upper airway. Of these 1 was diagnosed with tonsillar carcinoma. Conclusion: Bronchoscopy remains an important investigation in patients presenting with haemoptysis and an abnormal CT scan. However with modern CT technology combined with specialist reporting, a normal scan may be sufficient to exclude thoracic malignancy, without the need for bronchoscopy. Upper airway abnormalities were seen in patients presenting with haemoptysis; ENT examination should therefore be considered if CT scan is normal.