The Factors Affecting the Diagnostic Yield of Fiberoptic Bronchoscopy in Evaluating Peripheral Solitary Pulmonary Nodules or Masses

Abstract

Objective: To evaluate the factors affecting the diagnostic yield of fiberoptic bronchoscopy (FOB) in evaluating peripheral solitary pulmonary nodules (SPNs) or masses. Materials and Methods: Bronchoscopies were performed prospectively over a 1-year period in a tertiary teaching hospital. Sixty nine patients who had pulmonary nodules or masses with no bronchoscopically visible lesions underwent transbronchial biopsy (TBB) and bronchial brushing (BB) under fluoroscopy. Interaction of the factors was analyzed by univariate and multivariate analyses. Results: There were 52 malignant and 17 benign lesions. A combination of both diagnostic methods improved the yield of FOB compared to that of each method alone (p＜0.001). The yield of FOB was related to the approachability of the lesions (p＜0.001). Lesions which were smaller than 2.3 cm, were located in the right upper lobe, and had a negative CT bronchus sign were more difficult to approach (p=0.034, 0.008, and 0.012, respectively). The approachability was not associated with the distance from the tip of the bronchoscope to the lesion (p=0.275). Conclusions: The approachability of the lesions is the determinant for the diagnostic yield of FOB. The approachability is easier with larger lesions, locations with no sharp angulation of the bronchus with a forceps approach and a positive CT bronchus sign. Alternative diagnostic tools may be suggested for lesions with difficult approaches.