OUTCOMES OF PATIENTS WITH A NON-DIAGNOSTIC INITIAL BRONCHOSCOPY FOR SUSPECTED THORACIC MALIGNANCY

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Flexible fiberoptic bronchoscopy plays an important role in the diagnosis of thoracic malignancies. The rate of lung cancer detection on bronchoscopy ranges between 30-75%. There is sparse data regarding the outcome of patients suspected of thoracic malignancies and an initial negative bronchoscopy. The goal of this study was to evaluate the outcomes of patients with an initial non-diagnostic bronchoscopy. In addition, we compared them with the diagnostic group to identify variables predictive of a diagnostic bronchoscopy. METHODS: This was a retrospective review of medical records of patients who underwent bronchoscopy with biopsy and/or needle aspiration for suspected thoracic malignancy. The study period was from January 2012 to December 2017. The study was approved by the institutional review board. RESULTS: 225 patients were included in the study. There were 116 (51.56%) males and the mean age of the cohort was 62 years. 115 (51.11%) bronchoscopies were non-diagnostic. Of the 115 patients with a non-diagnostic bronchoscopy, 57 (49.57%) were lost to follow-up. Of the remaining 58 patients, 41 (70.69%) had resolution or stabilization of radiological abnormalities. Additional tissue biopsy revealed 15 (25.86%) patients with thoracic malignancies of which 11 were primary lung cancers. 4 other malignancies included lymphoma, metastatic squamous cell carcinoma, pharyngeal small cell carcinoma, and thymoma. 2 were identified to be granulomas. In univariate analysis, HIV infection was the only comorbidity found more frequently in the non-diagnostic group and weight loss was the only symptom associated with a diagnostic bronchoscopy. Presence of lung mass and mediastinal adenopathy was predictive of a diagnostic procedure, while solitary nodule predicted a non-diagnostic bronchoscopy. Performance of endobronchial biopsy and transbronchial needle aspiration was predictive of a diagnostic bronchoscopy while transbronchial biopsy was predictive of a non-diagnostic bronchoscopy. CONCLUSIONS: Our diagnostic bronchoscopic yield of 48.89% in suspected thoracic malignancy was similar to other studies. Close follow up of patients with non-diagnostic procedures identified malignancies in about 26% of them. CLINICAL IMPLICATIONS: Follow up of patients with initial non-diagnostic bronchoscopies is of paramount importance, as up to 26% of those patients have been found to have malignancy upon further investigation. In our inner-city community, post-procedure follow up is a challenge due to various factors and physicians need to consider them in patients with initial non-diagnostic procedures. DISCLOSURES: No relevant relationships by Gilda Diaz-Fuentes, source=Web Response No relevant relationships by Maneesh Gaddam, source=Web Response No relevant relationships by Sindhaghatta Venkatram, source=Web Response