Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy

Chest. 2000 Apr;117(4):1186-90. doi: 10.1378/chest.117.4.1186.

Abstract

Study objectives: To determine the extent to which on-site cytopathology assessment improves diagnostic yield when sampling lung nodules or masses and/or hilar or mediastinal lymphadenopathy by fiberoptic bronchoscopy (FOB).

Design: Prospective cohort study.

Setting: Two teaching hospitals in Baltimore, MD.

Patients: Consecutive adult patients (>/= 18 years) undergoing FOB for evaluation of lung nodules or masses and/or hilar or mediastinal lymphadenopathy.

Intervention: Prospective collection of data on patient factors and details of the procedure on standardized report forms.

Measurements and results: The primary outcome measure was a new diagnosis obtained by FOB. On-site assessment was used in 81 of 204 cases (40%), and overall diagnostic yield was 62%. Yield was greater when on-site cytopathology assessment was used, in unadjusted analysis (81% vs 50%, p < 0.001) and in a multivariate model (odds ratio, 4.5; 95% confidence interval, 2.1 to 10.0). Other significant predictors of a new diagnosis included older patient age, higher dose of narcotic used during FOB, and shorter procedure time.

Conclusions: We conclude that diagnostic yield was greater when on-site cytopathology was used to assist FOB evaluation of intrathoracic adenopathy and/or lung nodules or masses. Increasing the use of on-site cytopathology assessment may improve the quality of FOB services.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy, Needle
  • Bronchoscopy* / standards
  • Confidence Intervals
  • Diagnosis, Differential
  • Female
  • Fiber Optic Technology
  • Humans
  • Lung Diseases / pathology*
  • Lung Neoplasms / pathology
  • Lymphatic Diseases / pathology*
  • Male
  • Mediastinum
  • Middle Aged
  • Odds Ratio
  • Predictive Value of Tests
  • Prospective Studies