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PubMedDate not supplied

The use of diagnostic bronchoscopy in lung cancer.

BACKGROUND: The role of fibreoptic bronchoscopy in the diagnosis of bronchogenic carcinoma is well established. However, in developing countries, where the burden of illness is large and diagnostic facilities are limited, only a small number of patients are diagnosed at a stage when they might benefit from operation. We felt it would be desirable to identify subsets of patients suspected of harbouring lung cancers, in whom bronchoscopy would have not only a high diagnostic yield but also provide useful information which might influence treatment, the patient's quality of life and duration of survival. METHOD: We analysed the records of 588 patients, who had been bronchoscoped for suspected lung cancer, over a period of 8 years at a tertiary referral centre in north India. The patients were divided into different clinical subgroups on the basis of their clinical and radiological presentation, and the diagnostic yield from bronchoscopy in each group was calculated. A decision analysis model was constructed and the expected value of clinical information was determined for each group. RESULTS: A tissue diagnosis was established by bronchoscopy in 177 (30%) patients and by additional investigations in 43 (7.3%) patients. A positive tissue diagnosis was obtained most often in patients with clinical and radiological evidence of pulmonary collapse (50%) and mass lesions (38-42%). Only 12% of patients with malignancy underwent resection and 70% of them belonged to the above two groups. The expected value of clinical information was greatest in patients with collapse (0.077) or mass lesions (0.067-0.065). CONCLUSIONS: A diagnostic work-up including fibreoptic bronchoscopy is indicated early in patients with collapse or mass lesions of the lung. Patients with non-resolving pneumonia, pleural effusion, metastatic disease and non-specific lesions on chest X-ray should receive a low priority for bronchoscopy.

Adolescent↗

PubMed2003

Role of multidetector CT virtual bronchoscopy in the evaluation of post-tracheostomy tracheal stenosis--a preliminary study.

AIM: To study the technique and utility of virtual bronchoscopy (virtual reality endobronchial simulation, VRES) as a tool to evaluate post-tracheostomy tracheal stenoses and to correlate the findings of virtual and invasive bronchoscopy and to follow-up treated lesions or those currently under treatment that were initially diagnosed with VRES. METHODOLOGY: This prospective study comprised nine patients in the age group 13 to 65 years presenting with breathlessness and stridor following one or multiple tracheostomies. They underwent plain CT using a multidetector CT (MDCT) scanner (Siemens Volume Zoom) using narrow (1 mm) collimation. These thin slice images were post-processed using an Irix-based workstation with a 'Fly-Through' endoscopy application. These patients also underwent a rigid (three patients) or fiberoptic (six patients) bronchoscopy. RESULTS: Of the nine patients that underwent VRES, five were found to have stenoses, three had obstructing granulation tissue, one had an obstructing membrane and one had synechiae. The invasive bronchoscopic findings supported the VRES diagnosis in all but one case of stenosis, one of granulation tissue and the case with synechiae. Membranes and synechiae were relatively difficult to diagnose without the corresponding axial and multiplanar images. VRES achieved a higher sensitivity, while invasive bronchoscopy a higher specificity. CONCLUSIONS: VRES proved to be comparable to invasive bronchoscopy in the depiction of post-tracheostomy tracheal stenoses, with a notable advantage in critical stenoses in that the airway distal to the stenosis could be assessed with VRES but not with invasive bronchoscopy. A preliminary VRES was found to be of assistance in the selection of patients for the more invasive therapeutic procedures such as laser ablation of granulation tissue and its follow-up.

Adolescent↗

PubMedDate not supplied

Profile of repeat fiberoptic bronchoscopy.

BACKGROUND: Fiberoptic bronchoscopy (FOB) is invaluable in the diagnosis of a variety of pulmonary diseases, but in many instances the procedure has to be repeated because of an inconclusive initial FOB or for reassessment. METHODS: A retrospective analysis of all the fiberoptic bronchoscopic procedures done between September 2000 and February 2003 was performed and details of patients undergoing repeat FOB abstracted. RESULTS: Of the 2,270 bronchoscopies performed on 2114 patients, 132 procedures were repeated, yielding an over all frequency of repeat FOB of 6.34 percent. Bronchoscopy was done twice in 112 patients, thrice in 16 patients and four times in four patients. The commonest diagnosis in patients undergoing repeat bronchoscopy was bronchogenic carcinoma, followed by non-resolving pneumonia or presence of pulmonary infiltrates in immunocompromised host. The major indications for repeating FOB included obtaining specimens for pathological examination, pre and postoperative evaluation of airways, localization of site of bleeding in patients with hemoptysis, and placement of catheters for intraluminal brachytherapy. Of the 88 cases undergoing repeat bronchoscopy for diagnostic purposes, 41 (46.6%) yielded positive results, either in form of positive histology or localisation of source of hemoptysis. CONCLUSIONS: The frequency of repeat bronchoscopy was low. Commonest indication for a repeat procedure was to obtain repeat/additional diagnostic samples. A repeat procedure can yield positive results even when the initial FOB is nondiagnostic.

Bronchoscopy↗

PubMedDate not supplied

Diagnostic value of flexible bronchoscopy in children with persistent and recurrent wheezing.

Episodes of wheezing are very common in infancy. In pediatrics, indications for flexible bronchoscopy include prolonged wheezing, where airway abnormalities such as malacia disorders, tracheobronchial abnormalities, and vascular ring may be found. The study was performed to determine the diagnostic use of flexible bronchoscopy in wheezy patients who were previously administered bronchodilators and steroids for asthma and whose symptoms recurred or were not improved at all. Infants with wheezing were identified and collected over a 3-year period at the pediatric pulmonology unit. Flexible bronchoscopy was performed for diagnostic purposes in 34 (24 boys and 10 girls) patients with wheezing who were previously treated for asthma. The mean age for the onset of the symptoms was 2.5 months (0-12 months), and the mean age of bronchoscopic assessment was 9 months (45 days-48 months). A definitive diagnosis was made by bronchoscopy in 29 (85%) patients. Functional abnormalities in 15 patients (malacia in 9, tracheal dyskinesia in 3, and both in 3 patients), structural abnormalities in 5 patients (bronchial abnormality in 2, subglottic stenosis in 2, and obliterative-like lesion at the orifice of right bronchus in 1), and coexistent structural and functional abnormalities in 9 patients were present. Bronchoscopy revealed normal findings in five patients. Structural and functional airway abnormalities are commonly found in children with wheezing and should be considered in the differential diagnosis of persistent and prolonged wheezing. Bronchoscopy should be performed in patients who remain symptomatic despite treatment for asthma.

Bronchi↗

PubMed1990

[Bronchoscopy in ventilated patients: full narcosis or local anesthesia?].

In a prospective, randomised trial bronchoscopy was performed either in local anaesthesia (LA) or general anaesthesia, each on 15 ventilated patients. LA was carried out with oxybuprocain-hydrochloride 1% in repeated doses injected into the trachea and main bronchi, general anaesthesia with midazolam, piritramide and vecuronium bromide. Measurements were performed before, 3 minutes after induction of anaesthesia, immediately after bronchoscopy and 15 and 60 minutes after bronchoscopy. There was no effect on cardiocirculatory function during bronchoscopy in both groups, but we found a decrease in paO2 from 97 to 80 mmHg (median) after application of LA. Subsequent bronchoscopy did not significantly influence paO2. The present study shows that in ventilation patients undergoing fibreoptic bronchoscopy, the application of LA will usually result in a decline of arterial oxygen tension. This procedure should therefore only be performed if general anaesthesia is undesirable, as e.g. in patients being weaned from ventilation.

Adolescent↗

PubMed1995

[Bronchoscopy in the diagnosis of diffuse pulmonary infiltrates, and corticosteroid treatment in patients with acute respiratory failure].

Forty patients with acute respiratory failure underwent fiberoptic bronchoscopy for evaluation of diffuse pulmonary infiltrates. Immunohematological diseases were the commonest underlying conditions; they were present in 48% of patients. Twenty-five percent of patients had pulmonary disease. Fiberoptic bronchoscopy was done 2.2 days after confirmation of the pulmonary lesion. Seventy-three percent of patients had already received antibiotics and 28% required mechanical ventilation at the time of fiberoptic bronchoscopy. Arterial blood gas analysis done just before fiberoptic bronchoscopy revealed that PaO2 and PaCO2 were 62 Torr and 36 Torr, respectively. A specific diagnosis was made in 29 patients (73%): pneumonia in 13; pulmonary fibrosis in 4; summer-type hypersensitivity pneumonitis in 3; and leukemic cell infiltration in 2. Fifty-two percent of patients were successfully treated with specific therapy. The complications of fiberoptic bronchoscopy were bleeding in 3 patients, pneumothorax in 3 patients, and exacerbation of respiratory failure in one patient. There were no procedure-related deaths, and fiberoptic bronchoscopy was judged to be safe and useful in the diagnosis of pulmonary infiltrates in patients with acute respiratory failure. Twenty-five patients (68%) received high doses of methylprednisolone. The average initial dose was 851 +/- 373 mg, and more than 100 mg was administered for 8 +/- 6 days. Seventeen of these patients recovered from the pulmonary disease. A controlled randomized study is needed to reevaluate the role of corticosteroids in the treatment of acute respiratory distress syndrome.

Acute Disease↗

PubMed1995

[Capnography for bronchoscopy with rigid technique using high frequency jet ventilation (HFJV)].

OBJECTIVES AND METHODS: Rapid bronchoscopy in general anaesthesia still has its precise indications, where the high frequency jet ventilation technique offers several advantages. The monitoring of ventilation, however, has been rather unsatisfactory up to date. We therefore studied capnography in 60 bronchoscopies during HFJV (rate: 100/min; I:E = 0.33; driving pressure: 0.08-0.14 MPa) using a rigid bronchoscope with a distally located sampling port. Continuous capnograms were recorded. End-tidal partial pressures of carbon dioxide (petCO2), however, were obtained from 2-3 single breaths by intermittently reducing the jet-frequency to 10-12/min. After 6 min (MP1: whole group; n = 60) and 18 min of HFJV (MP2: n = 34 of this group) petCO2 values were regularly obtained and compared to pCO2 in synchronously drawn capillary blood samples (pcCO2). The jet driving pressure initially adjusted to body weight, however, was only corrected according to petCO2, aiming at 34 mmHg. RESULTS: During HFJV, sinusoidal capnograms permitted the identification of every single jet impulse. With instruments being passed through the bronchoscope, however, these curves were substantially distorted. Mean pcCO2 at MP1 (37.8 +/- 6.7 mmHg) and MP2 (37.2 +/- 6.7 mmHg) demonstrated normal ventilation to light hyperventilation. Differences from mean petCO2 obtained during low frequency breathing were 3.3 mmHg at MP1 and 4.4 mmHg at MP2 (p < 0.05). There were strong correlations between the individual pairs of pcCO2 and petCO2 from MP1 (r = 0.80) and MP2 (r = 0.75) as well as between the pairs of dpcCO2 and dpetCO2 from both MPs (r = 0.77). The accuracy of the ventilator setting according to petCO2 with reference to pcCO2 was 73% for MP1 and 74% for MP2 (sensitivity: 75%/79%; specificity: 72%/67%). CONCLUSIONS: Capnography in rigid bronchoscopy during HFJV proved a clinically applicable addition to monitoring. Its routine use is strongly recommended in interventional bronchoscopy. The true petCO2 values obtained by intermittent single low frequency jet breathing permit estimates of gas exchange sufficiently exact for clinical purposes and for adjustment of the ventilator setting. Wave forms of the continuously recorded capnogram during HFJV are a warning of impeded ventilation or airway obstruction and, thus, of the danger of barotrauma or hypoventilation. Besides contributing to patient safety, this monitoring method might improve the acceptance of HFJV for bronchoscopy. Furthermore, it can also be applied to rigid bronchoscopy with common ventilation.

Adult↗

PubMed1991

Hemoptysis. Indications for bronchoscopy.

Indications for bronchoscopy in patients with hemoptysis and a normal or nonlocalizing chest roentgenogram continue to be controversial. We reviewed the records for 119 bronchoscopies performed for hemoptysis in patients with a normal (n = 75) or nonlocalizing (n = 44) chest roentgenogram. Bronchogenic carcinoma was identified in 2.5% of the bronchoscopies. Additional neoplasms were found in another 2.5%. The presence of nonlocalizing abnormalities was not associated with an increase in either the rate of bronchogenic carcinoma or in the diagnostic yield (specific anatomic diagnosis or bleeding site identified) at bronchoscopy when compared with patients with normal chest roentgenograms. The factors of male sex, age more than 40 years, and a more than 40 pack-year smoking history appear useful in identifying patients in whom the yield of bronchoscopy is likely to be high.

Adolescent↗

PubMed1997

Geographic variation in the utilization of esophagoscopy and bronchoscopy in head and neck cancer.

OBJECTIVE: To determine the extent to which esophagoscopy and bronchoscopy are being used in various regions of the United States in the initial examination of patients with head and neck cancer. DESIGN: Population-based study derived from Medicare claims data and information from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. SETTING: Five SEER areas (San Francisco, Calif; Connecticut; Seattle, Wash; Iowa; and Detroit, Mich). PARTICIPANTS: The cohort included 1410 Medicare patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx diagnosed between March 1, 1991, and December 31, 1993, in the 5 SEER areas. MAIN OUTCOME MEASURE: Rates of esophagoscopy and bronchoscopy according to SEER area. RESULTS: The proportion of patients who underwent esophagoscopy ranged from 12.9% (San Francisco) to 39.8% (Detroit) for patients with local cancer and from 22.2% (San Francisco) to 59.7% (Detroit) for patients with regional cancer. The proportion of patients who underwent bronchoscopy ranged from 6.9% (San Francisco) to 32.6% (Detroit) for patients with local cancer and from 12.8% (San Francisco) to 50.7% (Detroit) for patients with regional cancer. After controlling for differences in age, sex, race, tumor site, tumor grade, comorbidity, and socioeconomic status, SEER area remained independently associated with esophagoscopy and bronchoscopy (both P < .001). CONCLUSIONS: There is substantial geographic variation in the use of esophagoscopy and bronchoscopy as part of the initial examination of patients diagnosed as having head and neck cancer that cannot be explained by differences in patient or tumor characteristics. This variation likely underscores uncertainty and disagreement about the value of endoscopic screening for synchronous tumors. Additional research is required to determine whether routine endoscopic screening increases survival rates or improves quality of life.

Aged↗

PubMed1997

Yield from flexible bronchoscopy in children.

Flexible fiberoptic (FO) bronchoscopy can now be undertaken readily in children using topical anesthesia and light sedation and has largely supplanted rigid open tube (OT) bronchoscopy for diagnostic purposes. The present study examined the contribution of the FO bronchoscope to clinical management in children presenting with specific types of problems. We examined the first 200 consecutive flexible bronchoscopies performed in 1995 in children under 18 years of age (median age, 2.27 years). Indications for bronchoscopy were noisy breathing (26.5%), recurrent pneumonia (21.0%), suspected pneumonia in an immunocompromised patient (10.5%), atelectasis or bronchial toilet (12.5%), possible foreign body aspiration (13.0%), and miscellaneous other reasons (16.5%). Inspection of the airway was abnormal in 67.0% of all investigations and made a clinically meaningful contribution to management in 67.5%, especially in those with noisy breathing (98.1%), possible foreign body aspiration (100%), and atelectasis (76.0%). Bronchoalveolar lavage (BAL) cytology was abnormal in 80.4% of the 107 lavages, but contributed little to management except in those with recurrent pneumonia (73.8%). Bacteria were isolated in 26.6% of the 109 specimens cultured, but this finding rarely affected management. Fungi were isolated in 47.4% of the 19 lavages in the immunocomprised group. Together, inspection, BAL and microbiology contributed to management in a mean of 90.5% (range, 76.2-100%) of patients in the various groups. We concluded that a high yield of clinically meaningful information can be expected from FO bronchoscopy in children when coupled with BAL and microbiological studies of lavage fluid.

Bronchoalveolar Lavage Fluid↗

PubMed2001

Pediatric bronchoscopy.

Diagnostic flexible endoscopy for pediatric respiratory diseases is performed in many centers. Technical advances have resulted in performance of interventional bronchoscopies, and new diagnostic indications are being explored. Indications with documented clinical benefit include congenital or acquired progressive or unexplained airway obstruction. Pulmonary infections in immunodeficient children who do not respond to empirical antibiotic treatment may be diagnosed by bronchoscopy and bronchoalveolar lavage (BAL). The potential usefulness of bronchoscopy and BAL for managing chronic cough, wheeze, or selected cases with asthma or cystic fibrosis requires further study. The use of transbronchial biopsies (TBB) is established in pediatric lung transplantation. The role of TBB in the diagnosis of chronic interstitial lung disease in children remains to be determined. For a number of interventional applications, rigid endoscopy is required, and pediatric bronchoscopists should be trained in its use. Complications in pediatric bronchoscopy are rare, but severe nosocomial infection or overdosing with local anesthetics has occurred. The issues of quality control, video documentation, interobserver variability of findings, and educational standards will have to be addressed in the future as bronchoscopy use becomes less restricted to only large pediatric pulmonary units.

Airway Obstruction↗

PubMed1994

Ipratropium bromide protects against bronchoconstriction during bronchoscopy.

Pulmonary function is reportedly impaired by fiberoptic bronchoscopy. We investigated the effect of two anticholinergic agents, intramuscular atropine and inhaled ipratropium bromide, on bronchoconstriction in 29 patients who were undergoing diagnostic bronchoscopy. The patients were divided into three groups; the first received 0.5 mg of atropine intramuscularly; the second took four puffs of 0.02 mg ipratropium bromide aerosolized by a metered-dose inhaler, and the third inhaled four puffs of a placebo. Fifteen minutes later a standardized topical anesthetic, lidocaine, was administered, and a bronchoscopic examination was performed. Pulmonary function was measured before and 15 minutes after each step. Pulmonary function was not affected by the treatment with anticholinergics or the placebo. In the placebo and the atropine groups, the topical anesthesia produced significant reductions in forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR); further reductions in these values were observed after bronchoscopy. In the group treated with ipratropium bromide there were no significant changes in FEV1 and PEFR after topical anesthesia. Bronchoscopy induced significant reductions in FEV1 and PEFR, but the changes were significantly smaller than those seen in the placebo and atropine groups. The results suggest that the deleterious effect of bronchoscopy on pulmonary function is due to topical lidocaine anesthesia and to the bronchoscopic examination itself. Inhaled ipratropium bromide protects against these deleterious effects, whereas intramuscular atropine does not.

Administration, Inhalation↗

PubMed1995

The role of ECG monitoring during bronchoscopy in lung cancer patients.

Bronchoscopy, as an endoscopic technique, is associated with respiratory and circulatory disorders. Cardiac rhythm disorders are the most common cardiovascular complications of bronchoscopy. In order to study ECG changes during bronchological procedures, ECG monitoring was undertaken (30 min before, during and 30 min after bronchoscopy) in 100 patients, 76 with bronchial carcinoma and 24 suffering from some other pulmonary disease. Within the same intervals PaO2, PaCO2 and pH were recorded. All recorded arrhythmias were classified as minor and major. According to arrythmia noted during bronchoscopy, patients were divided into two groups: group 1 comprised 70 patients without arrythmia or with minor arrythmia (70%) and group 2, 30 patients with major arrythmia (30%). No significant difference was noted in associated cardiac disease, cardiological medication, blood pressure, pulse rat, PaO2, PaCO2 and pH (P < 0.05). The only statistically significant difference between the two groups of patients was related to localization of tumour in the lungs. We could not correlate the occurrence of major arrythmia during bronchoscopy in patients with lung carcinoma with any underlying cardiopulmonary condition. Significant differences were noted in effects of tumour localization, i.e. major arrhythmias are more common and more dangerous in cases of tumours of the left bronchial trunk (possible bronchoscopic stimulation of the left stellate ganglion), and we therefore believe that ECG monitoring is desirable in these cases for the early detection and appropriate management of haemodynamically dangerous arrhythmias.

Adolescent↗

PubMed2006

Virtual positron emission tomography/computed tomography-bronchoscopy: possibilities, advantages and limitations of clinical application.

The aim of this study was to demonstrate the possibilities, advantages and limitations of virtual bronchoscopy using data sets from positron emission tomography (PET) and computed tomography (CT). Twelve consecutive patients with lung cancer underwent PET/CT. PET was performed with F-18-labelled 2-[fluorine-18]-fluoro-2-deoxy-D: -glucose ((18)F-FDG). The tracheobronchial system was segmented with a volume-growing algorithm, using the CT data sets, and visualized with a shaded-surface rendering method. The primary tumours and the lymph node metastases were segmented for virtual CT-bronchoscopy using the CT data set and for virtual PET/CT-bronchoscopy using the PET/CT data set. Virtual CT-bronchoscopy using the low-dose or diagnostic CT facilitates the detection of anatomical/morphological structure changes of the tracheobronchial system. Virtual PET/CT-bronchoscopy was superior to virtual CT-bronchoscopy in the detection of lymph node metastases (P=0.001), because it uses the CT information and the molecular/metabolic information from PET. Virtual PET/CT-bronchoscopy with a transparent colour-coded shaded-surface rendering model is expected to improve the diagnostic accuracy of identification and characterization of malignancies, assessment of tumour staging, differentiation of viable tumour tissue from atelectases and scars, verification of infections, evaluation of therapeutic response and detection of an early stage of recurrence that is not detectable or is misjudged in comparison with virtual CT-bronchoscopy.

Bronchoscopy↗

PubMed1997

Central airway stenoses: preliminary results of spiral-CT-generated virtual bronchoscopy simulations in 29 patients.

The purpose of this study was to determine the feasibility of using virtual bronchoscopy simulations to depict stenoses of the tracheobronchial tree. Virtual bronchoscopy simulations, based on ray casting, were applied to spiral-CT data sets of 29 patients presenting 41 stenoses of the central airways, proved with fiberoptic bronchoscopy. Simulations of the inner walls of the airways were of good quality in 27 of 29 patients. Airway stenoses were depicted in 39 of 41 cases. Evaluation of the length of stenoses and surrounding tissues required simultaneous display of multiplanar reformations. Virtual bronchoscopy provides a valuable road map for bronchoscopy, in an image format familiar to bronchoscopists.

Adult↗

PubMed1984

Role of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia.

The utility and safety of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia have not been examined. The results of 21 bronchoscopic procedures in 19 patients with invasive pulmonary aspergillosis and acute leukemia were reviewed. Analysis was confined to the 16 patients who had histopathologically documented infection on biopsy or at autopsy. Fiberoptic bronchoscopy established or suggested the diagnosis of invasive pulmonary aspergillosis in eight of 16 (50 percent) patients. Transbronchial or bronchial biopsy added only one diagnosis to those obtained by bronchial washing and brushing. Although fiberoptic bronchoscopy was a safe and well-tolerated procedure in our patients with invasive pulmonary aspergillosis and acute leukemia, its success rate was only 50 percent overall, and it appeared to be even less successful when performed early in the course of the disease. Fiberoptic bronchoscopy is a useful first procedure for the evaluation of patients with acute leukemia and possible invasive pulmonary aspergillosis, but a negative result does not exclude aspergillosis. Further diagnostic procedures, including repeated bronchoscopy, or institution of empiric antifungal therapy may be warranted if the clinical suspicion of invasive pulmonary aspergillosis is high.

Acute Disease↗

PubMed1992

Early diagnosis of tuberculosis by fibreoptic bronchoscopy.

We carried out a retrospective study of the methods used to achieve an early diagnosis of 67 patients with pulmonary tuberculosis treated at our institute between 1984 and 1989. Sputum bacteriology was positive in 56 of the 67 patients, 22 were positive on microscopical examination of smears and on culture and 34 on culture alone. The 11 patients with negative sputum bacteriology were all diagnosed by fibreoptic bronchoscopy. In addition, 21 of the 34 smear-negative/culture-positive patients were examined by fibreoptic bronchoscopy and the initial diagnosis was made in 7 of these. Thus the initial diagnosis was made by sputum bacteriology in 49 cases and by fibreoptic bronchoscopy in 18 cases. The median number of days between obtaining a specimen and starting therapy was 7 days for sputum microscopy, 41 days for sputum culture, 7 days for microscopic examination of bronchoscopy specimens, 51 days for culture of the same and 19 days for biopsy. Fibreoptic bronchoscopy is therefore useful for the diagnosis of cases of tuberculosis in which tubercle bacilli are not detected in sputum and, in some instances, for an earlier diagnosis of smear-negative/culture-positive patients.

Adult↗

PubMed2005

Is virtual bronchoscopy an efficient diagnostic tool for the thoracic surgeon?

Virtual bronchoscopy has emerged over the past decade as a potentially complementary investigation to conventional bronchoscopy in the diagnosis, grading, and monitoring of pulmonary disease. A meta-analysis reporting on the use of virtual bronchoscopy has not yet been performed. The primary aim of this study is to evaluate its diagnostic accuracy compared to the gold standard investigation of conventional bronchoscopy (fiberoptic or rigid). Quantitative data synthesis included the calculation of independent sensitivity and specificity, construction of summary receiver operating characteristic curves, pooled analysis, and sensitivity analysis. Seventeen studies were identified comprising 459 patients. The calculated pooled sensitivity was 84% (95% CI, 78% to 89%), specificity 75% (95% CI, 62% to 85%) and area under the curve was 0.92, which shows good diagnostic performance. Meta-analysis confirms virtual bronchoscopy is very discriminating in the evaluation of patients with significant airway stenosis that is due to a wide spectrum of pathologic conditions. It can potentially have a beneficial role in selected thoracic patients (with bronchoesophageal fistulas, postlung transplantation, anastomoses, and suspected foreign body aspiration).

Area Under Curve↗