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Routine Pathology Testing Prior to Bronchoscopy has Limited Clinical Impact With Significant Economic and

Christine Lu1, Alistair Miller1,2, Ben Dunne3,4

  • 1Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia.

Journal of Bronchology & Interventional Pulmonology
|January 19, 2026
PubMed
Summary
This summary is machine-generated.

Routine pathology testing before bronchoscopy provides minimal clinical benefit and incurs significant costs. A targeted approach focusing on patients with risk factors is recommended for efficient resource use and improved sustainability.

Keywords:
bronchoscopyenvironmental impactpreprocedural testingquality

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Area of Science:

  • Medical diagnostics
  • Pulmonology
  • Health economics

Background:

  • Current guidelines de-emphasize routine preprocedural pathology testing for low-risk procedures.
  • British Thoracic Society recommends specific tests only for patients with bleeding risk factors.
  • Pre-bronchoscopy pathology testing is often ordered without clear clinical necessity, leading to waste.

Purpose of the Study:

  • To evaluate the clinical utility of routine preprocedural pathology testing before bronchoscopy.
  • To assess the financial and environmental impact of these tests.
  • To determine if routine testing influences patient management or complication rates.

Main Methods:

  • Retrospective review of 436 outpatient bronchoscopic procedures over 12 months.
  • Definition of preprocedural testing included tests ordered at referral or repeated within 6 weeks.
  • Analysis of clinical management impact, complication rates, financial costs (MBS prices), and carbon footprint (CO2e).

Main Results:

  • All 436 procedures included preprocedural testing; 8.3% had abnormal results, but only 4.0% led to intervention (all in high-risk patients).
  • No interventions were needed for patients without risk factors; no procedures were delayed or cancelled.
  • Routine testing cost AUD 30,441.20 and generated 103.2 kg CO2e, with no correlation to adverse outcomes.

Conclusions:

  • Routine pathology testing before bronchoscopy offers limited clinical value and rarely impacts management.
  • Clinically significant findings are confined to patients with pre-existing risk factors, supporting a selective testing strategy.
  • Transitioning to evidence-based, targeted testing is crucial for optimizing resource allocation and environmental sustainability.