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Utility of repeated fiberoptic bronchoscopy for suspected malignancy
K G Torrington1, R K Poropatich
1Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC 20307-5000.
Chest
|October 1, 1992
Summary
Repeated fiberoptic bronchoscopy (RFB) use increased significantly. While RFB aided in diagnosing new lesions and guiding therapy in cancer patients, improved initial procedures could reduce its necessity.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Fiberoptic bronchoscopy (FB) is a key diagnostic tool.
- Repeated FB (RFB) use has been increasing.
- Indications for RFB include evaluating new lesions and guiding therapy.
Purpose of the Study:
- To evaluate the diagnostic yield and utility of RFB.
- To identify potential improvements in initial FB procedures to reduce RFB necessity.
- To assess the role of RFB in managing intrathoracic malignant neoplasms.
Main Methods:
- Retrospective analysis of 1598 FBs performed on 1391 patients from 1986-1990.
- Review of indications for RFB, particularly in patients with known or suspected intrathoracic malignant neoplasms.
- Analysis of RFB specimen results (positive, false-negative, true-negative).
Main Results:
- RFB use increased from 11% to 20% during the study period.
- Of 254 RFBs, 151 were for intrathoracic malignant neoplasms, guiding therapy or evaluating new lesions.
- RFB had a significant diagnostic yield in cases where initial FB was nondiagnostic, avoiding surgical staging.
Conclusions:
- RFB is valuable for diagnosing new lesions and guiding therapy in cancer patients.
- Optimizing initial FB techniques (fluoroscopy-guided biopsies, needle aspiration, bronchial biopsies) could potentially decrease the need for RFB.
- RFB provides a significant diagnostic yield and can obviate more invasive procedures when initial bronchoscopies are inconclusive.