Diagnostic yield of bronchoscopy in hemoptysis without radiological abnormalities: A retrospective cohort study

Bronchoscopy is widely used to evaluate the source and cause of hemoptysis. Its diagnostic value is well established in patients with abnormal radiological findings; however, its utility in patients without such findings remains uncertain.

We retrospectively included adults with hemoptysis who underwent bronchoscopy between January 2019 and June 2023 and were followed up clinically and radiologically for at least 1 year. Computed tomography (CT) scans were reviewed and categorized as pathological or nonpathological; cases with pathological findings were further classified according to malignancy suspicion. The diagnostic yield of bronchoscopy was compared between groups. Receiver operating characteristic (ROC) analysis was used to derive an age cutoff; multivariable logistic regression identified independent predictors.

A total of 380 patients were included (mean age 58.3 ± 14.6 years; 78.9% males). Bronchoscopy was diagnostic in 37.6% of cases. Diagnostic yield was significantly higher in patients over 50 years of age, in males, and in those with abnormal CT findings. In contrast, bronchoscopy was rarely diagnostic in patients younger than 50 years with normal CT. Logistic regression showed a 3.5-fold increase in diagnostic yield with age (odds ratio [OR]: 3.48, 95% confidence interval [CI] 1.27-9.53, P = 0.015) and 15.8-fold with CT findings suggestive of malignancy (OR: 15.81, 95% CI: 7.35-33.95, P < 0.001).

Bronchoscopy provides meaningful diagnostic information in patients aged ≥50 years and/or with CT findings suspicious for malignancy, whereas its yield is limited in younger patients with normal CT. A selective approach may be appropriate in low-risk cases.