CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses

Abstract

CT bronchus sign (BS) designates a bronchus leading directly to a peripheral pulmonary lesion. The objective of this investigation is to determine the contribution of BS-guided bronchoscopic multiple diagnostic procedures (BMDPs) to the diagnostic yield of solitary nodules or masses (SPNMs) suspected of pulmonary carcinoma (PC). A prospective study was carried out in 92 patients with a 2–5 cm diameter SPNM at the level of third to fifth bronchial branching and without endobronchial tumors. Within 10 days after 2-mm CT scans were done, in each of 92, bronchial washing (BW), brushing (BR), transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBB) were performed respectively, via fiberoptic bronchoscopy (FB) under fluoroscopic guidance. In 40 (82%) of 49 with BS and in 19 (44%) of 43 without BS, FB established the diagnosis (p < 0.01). In 84 cases of PC, BW, BR, TBNA and TBB provided the diagnostic yields of 4% (3), 26% (22), 57% (48) and 49% (41), respectively; the combined yield reached 68% (57). A metastasis and a tuberculoma were diagnosed exclusively by TBB, and TBNA, respectively. All differences of diagnostic yield except that between TBNA and TBB (p > 0.05) were determined to be significant (p < 0.05). Thoracotomy verified diagnosis in 48 of 59 cases diagnosed and 19 of 33 undiagnosed by FB, and various tissue biopsies or clinical follow-up in 11 diagnosed and 14 undiagnosed by FB. The above data suggest that in the diagnosis of PC as a SPNM at the level of third–fifth bronchial branching, combining the guidance of CT BS, and BMDPs under fluoroscopic guidance can increase the yield considerably.

Factors Related to Diagnostic Yield of Flexible Bronchoscopy Without Guidance in Bronchoscopically Invisible Peripheral Lung Lesions

“…In a study of the determinants of diagnostic BW in peripheral lung cancers, the exposed type of bronchus sign was the most important factor 8 . Our results correspond with these earlier studies 8,25 . A revealing fact is that the unexposed type of bronchus sign was not different from the absence of the bronchus sign in affecting the diagnostic yield of bronchoscopy for peripheral lung lesions.…”

“…The bronchus sign is grouped into two categories according to the presence or absence of exposure of the tumor mass to the bronchial lumen 10 . In a previous prospective study, there was no difference in the diagnostic yield between TBLB and TTNA in lesions with the exposed type of CT bronchus sign 25 . In a study of the determinants of diagnostic BW in peripheral lung cancers, the exposed type of bronchus sign was the most important factor 8 .…”

Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis

“…It suggests that diagnostic yield of EBUS-TBLB may be influenced by the probability of malignancy for a given patient. The incidence of malignancy in nodules detected by low-dose CT in lung cancer screening trials is much lower than observed in studies included in this meta-analysis, varying from 13% [46] [62] or even clinical models, predicting the probability of malignancy in PPLs [43], may be helpful in determining optimal investigation approaches for individual patients. Future studies are required to inform construction of such a clinical algorithm.…”

Ultrathin Bronchoscopy as an Adjunct to Standard Bronchoscopy in the Diagnosis of Peripheral Lung Lesions

“…One factor that potentially limits the use of the standard bronchoscope as a diagnostic tool is the size of the lesion, as lesions less than 2 cm have a very low yields ranging from 21 to 54% [3, 4, 5, 6]. Other factors associated with lower diagnostic return include increasing distance of the lesion from hilum, the presence of a benign lesion and absence of a bronchus sign on chest CT [3, 6, 7, 8, 9]. …”