The Value of Fiberoptic Bronchoscopy in the Diagnosis of Central and Peripheral Lung Cancer

Abstract

Background: Flexible fiberoptic bronchoscopy combined with bronchial brushing (BB), bronchial washing (BW) and endobronchial biopsies (EBB) has been widely performed to achieve diagnoses of lung cancer. Our study was designed to evaluate the diagnostic yield of BB, BW and EBB in central and peripheral lung cancers. Methods: A total of 295 patients who presented with a central or peripheral lung mass in the chest radiography were proven to have a malignancy, based on the final cytology and histology reports, and the clinical evidence. Each patient received a bronchoscopy with BB, BW, or EBB, or a combination of these procedures. In all, 191 patients with a central type of lung cancer had a visible endobronchial lesion, and 104 patients had a peripheral type which was not visible to bronchoscopy. The tumor size of the peripheral lung cancer was recorded. Results: The overall diagnostic yield in the central lung cancer group (81.7%) was significantly higher than that of the peripheral lung cancer group (29.8%, p＜0.0001). Each EBB and BB procedure significantly increased the diagnostic accuracy of central lung cancer compared to that of peripheral lung cancer. The BW diagnostic rate showed no difference between central and peripheral lung cancer. The diagnostic rate of the combined procedures was significantly increased in central lung cancer, but not in peripheral lung cancer. The conventional EBB, BW, or BB procedures achieved a higher diagnostic yield for peripheral lung cancer with a tumor size＞3 cm (39.7%) than for a tumor size less than 3cm (19.6%, p=0.005). Conclusions: In conclusion, the combination of BB and EBB has a satisfactory diagnostic yield in central lung cancer. In peripheral types of lung cancer, conventional procedures alone cannot achieve a good result. Bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration with or without endobronchial ultrasonography will provide more accurate diagnostic sensitivity.