Role Of Bronchoscopy In Diagnosis Research Articles

Role of fiberoptic bronchoscopy-guided needle aspiration cytology (EBNA) in diagnosing lung cancer in endobronchial lesions: A single-center experience

Objectives: Globally, lung cancer is the leading cause of new cancer diagnosis and deaths. In spite of advancement in diagnostic modalities, lung cancer diagnosis is often delayed due to lack of bronchoscopy facility and techniques. In the present study, we have analyzed role of bronchoscopy in diagnosis of lung cancer with special emphasis on endobronchial needle aspiration (EBNA) cytology in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW) and forcep biopsy (FB). Material and Methods: Prospective and observational study screened 1496 cases with suspected lung malignancy on clinical and radiological basis. Bronchoscopy guided techniques such as EBNA, BW, and FB are used in exophytic endobronchial lesions (EEL) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BW and FB. Rapid on-site evaluation analysis of all EBNA samples done in pathology laboratory allied center. Finally, histopathology proven 893 lung malignancy cases are included in study. Statistical analysis is done using Chi-square test. Results: In the present study, 893 diagnosed lung cancer patients between 29 and 85 age groups; male is 60.02% (536/893) and females are 39.97% (357/893). Commoner radiological presenting features are mass lesion in 48.60% (434/893) cases, Hilar opacity in 33.37% (298/893) cases, and collapse segmental/lobar in 12.54% (112/893) cases. During bronchoscopy, anatomical location is documented on the right side of tracheobronchial in 57.33% (512/893) cases as compared to the left side of tracheobronchial wall 23.96% (214/893) and growth at carina documented in 18.70% cases (167/893) cases. Upper lobe bronchi are commoner site on both the sides as compared to other segmental bronchi. In the present study, yield of FB and FB plus BW in EEL is 84.65% (756/893) and 88.35% (789/893), respectively. Yield of EBNA, EBNA plus BW, and EBNA plus FB in EEL is 70.99% (634/893), 73.48% (656/893), and 99.66% (890/893), respectively. Overall, yield of all bronchoscopy guided techniques (EBNA + FB + BW) in our study in EEL is 100%. Additional yield of EBNA in EEL over other CDTs (CDTs such as FB plus BW) is 11.65%. Sensitivity of FB and EBNA in diagnosing lung malignancy in EEL is 84.65% and 70.99%, respectively. FB is more sensitive technique than EBNA in EEL (P < 0.00001). Sensitivity of FB plus BW in EEL is 88.35% (789/893). Sensitivity of EBNA plus BW in EEL is 73.48% (656/893). Sensitivity of EBNA plus FB in EEL is 99.66% (890/893) (P < 0.00001). Conclusion: EBNA has documented very crucial role in diagnosing lung cancer in comparison to other CDTs. Although FB is more sensitive test then EBNA in EEL in diagnosing disease, we have documented that EBNA has significant additive yield in proportionate number of cases. EBNA is safe, sensitive and cytology samples can give comparable results to histopathology.

Role of endobronchial needle aspiration cytology in diagnosing lung cancer in bronchoscopically visible tumors: A single-center study

Introduction: Bronchoscopy is an important diagnostic tool for the diagnosis of lung cancer, and various techniques have documented increase in diagnostic sensitivity. In this study, we have analyzed the role of bronchoscopy in diagnosis of lung cancer with special emphasis on endobronchial needle aspiration cytology (EBNA) in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW) and forcep biopsy (FB). Materials and Methods: Prospective, observational study screened 1564 cases with suspected lung malignancy on clinical and radiological basis. Bronchoscopy-guided techniques such as EBNA, BW, and FB are used in exophytic endobronchial lesions (EELs) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BW and FB. Rapid onsite evaluation (ROSE) analysis of all EBNA samples done in pathology lab allied center. Finally, histopathology proven 917 lung malignancy cases are included in this study. Statistical analysis is done by using chi-test. Results: In this study, 917 diagnosed lung cancer patients between 29 and 85 age group predominant 61.83% (567/917) and smokers by addiction in 52.12% (478/917) cases. Presented with cough in 80.80% (741/917), clubbing in 55.83% (512/917) cases, and mass lesion in chest radiograph in 53.10% (487/917) cases. Anatomical location is documented on the right side of tracheobronchial in 58.66% (538/917) cases during bronchoscopy. Yield of FB and FB plus BW in EEL is 86.69% (795/917) and 90.94% (834/917), respectively. Yield of EBNA, EBNA plus BW, and EBNA plus FB in EEL is 70.22% (644/917), 75.13% (689/917), and 97.16% (891/917), respectively. Overall yield of all bronchoscopy-guided techniques (EBNA + FB + BW) in our study in EEL is 100%. Additional yield of EBNA in EEL over other CDTs (FB plus BW) is 9.06%. Sensitivity of FB and EBNA in diagnosing lung malignancy in EEL is 86.69% and 70.22%, respectively. FB is more sensitive technique than EBNA in EEL (P < 0.00001). Sensitivity of FB plus BW in EEL is 90.94% (834/917). Sensitivity of EBNA plus BW in EEL is 75.13% (689/917). Sensitivity of EBNA plus FB in EEL is 97.16% (891/917) (P < 0.00001). Conclusion: EBNA is underutilized bronchoscopic technique in visible endobronchial lesions (exophytic endobronchial type) in spite of satisfactory diagnostic yield as compared with other CDTs. Although FB is most commonly preferred technique in bronchoscopically visible tumors, the addition of EBNA has improved overall diagnostic yield of bronchoscopy and decreased need for repeat bronchoscopy procedure.

The Role of Bronchoscopy in Diagnosis of Chronic Cough in Adults: A Retrospective Single-Center Study

Cough is one of the most frequent symptoms reported to pulmonologists. The role of bronchoscopy in the diagnostic work-up of chronic cough is not clearly defined. The aim of this study was to evaluate the utility of fiberoptic bronchoscopy (FOB) and additional testing of samples collected during FOB in the differential diagnosis of chronic cough in adults. This was a single-center retrospective study. Out of 7115 conventional white light FOB examinations, we finally selected 198 with cough as the only indication. In 40.9% of bronchoscopic examinations, no visible cause of cough was found. Visual signs of chronic bronchitis (CB) were detected in 57.6% of reports. Only in 3 cases (1.5%) bronchoscopy revealed a potential cause of chronic cough other than CB. Mycobacterium tuberculosis or other mycobacteria were spotted in none of the samples. In 91.1% of bronchoalveolar lavage (BAL) cytologic examinations, at least one cell count abnormality was detected, but only in case of increased percentage of eosinophils, it might be considered clinically relevant. In 53% of bacteriological culture results, at least one potentially pathogenic bacterium was isolated. The present study results strengthen the evidence that FOB combined with additional testing of airway specimens obtained during FOB is not a powerful tool in the differential diagnosis of chronic cough, and FOB as a diagnostic tool may be overused. The appropriate timing and decision regarding referral for FOB and additional testing of achieved material requires careful clinical consideration.

Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 – August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.

Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis.

Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children. The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB. A retrospective, descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014. The median age of the enrolled patients was 3.4 years, with 73.2% of patients under five years old. The most common subtype was tumorous type (145/157, 92.4%). If only involved bronchus were considered, the common affected sites were right middle lobe bronchus (49/228, 21.5%), left upper lobe bronchus (41/228, 18.0%), right upper lobe bronchus (41/228, 18.0%), right main bronchus (35/228, 15.4%), respectively. Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044), with an odds ratio of 2.313 (95% confidence interval: 1.009-5.299). Before the bronchoscopy, only 16 (10.2%) patients were highly suspected of EBTB, while the others were diagnosed as PTB without EBTB (69.4%), or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission. The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions. The most frequent subtype of EBTB in children is tumorous type. The lesions are seen in the right bronchial system more frequently. FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management.

Central airway obstructive infections (CAOI) are challenging medical conditions that may represent an advanced and complicated process of ongoing infections. The epidemiology of CAOI is unknown as well as the pathophysiology and the mechanism of development. This is due to sparse data in the literature that consists mainly of case reports and retrospective case series. CAOI can be caused by fungal, bacterial, parasitic and viral infections. Most patients with CAOI can be diagnosed clinically and with chest imaging, which demonstrate obstruction of the central airways. However, bronchoscopy is commonly used to confirm and obtain a specific diagnosis to guide specific therapy. In recent years, interventional pulmonology (IP) is becoming widely available and offer a minimally invasive approach for the management of central airway diseases such as cancers, benign strictures, and other conditions. Various bronchoscopic modalities are used to treat central airway obstruction (CAO), such as mechanical debulking, endobronchial laser therapy, electrocautery, argon plasma coagulation, cryotherapy, and airway stenting. In patients with CAOI, the role of therapeutic bronchoscopy is not clearly defined, but many isolated reports in the literature described bronchoscopic intervention in combination with medical therapy as the initial management approach. In this paper, we present cases of CAOI that underwent bronchoscopic intervention as part of their management. We described the infectious etiology, locations, bronchoscopic findings and bronchoscopic modalities for airway management.

The Role of Bronchoscopy in Diagnosis of Sarcoidosis

The Role of Bronchoscopy in Diagnosis of Sarcoidosis

A broncofibroscopia no diagnóstico etiológico de afecções pulmonares em pacientes com síndrome da imunodeficiência adquirida

To evaluate the role of bronchoscopy in diagnosis of pulmonary disease in acquired immunodeficiency syndrome. This study analyses a group of 49 patients with AIDS diagnosis admitted at Nereu Ramos Hospital-Florianópolis-SC. It was selected patients with respiratory symptoms and radiologic signs of pulmonary disease, without etiological diagnosis by sputum analysis. These patients were submitted to bronchoscopy with bronchoalveolar lavage, bronchial brush and transbronchial biopsy. The samples were analyzed by BAAR, cytomegalovirus, P. carinii, other fungus and bacterioscopy by Gram. The bronchoscopy was effective on the realization of etiological diagnosis of 71.43% of the cases. The transbronchial biopsy was the most positive technique which confirmed the diagnosis of 59.18% of the cases. The technique with the least positivity was the bronchial brush, with a diagnosis of 4.08% of the cases. The most frequent etiological agent was P. carinii (42.8%), followed by M. tuberculosis (22.86%). No complication was observed in the procedures making. The conclusion of this present study was that the bronchoscopy is a secure procedure, with good diagnosis performance for pulmonary disease in this group of patients.

Acute life-threatening intraoperative atelectasis

A case is presented of acute intraoperative atelectasis causing profound hypoxaemia in a patient undergoing a combined epidural-general anaesthetic for hip surgery in the lateral position. The pathophysiology of the resultant ventilation-perfusion mismatch and the effects of applied positive end-expiratory pressure in the lateral position are explored. The emergency management is assessed, with emphasis on the role of bronchoscopy in diagnosis and treatment of this rare cause of life-threatening hypoxaemia in the operating room. This patient with risk factors for respiratory complications may have benefited from preoperative bronchoscopy to assist in lung expansion.