P76 Is a normal CT thorax sufficient to exclude thoracic malignancy in patients referred to fast-track clinic with haemoptysis? – Data from eight years of referrals to a large NHS teaching hospital

Quinn, James; Chia, WL; Raju, RS; Callister, Mej; Kennedy, Mpt

doi:10.1136/thorax-2019-btsabstracts2019.219

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“…In this study, 258 out of 275 CT scans (94%) showed normal anatomy or benign changes. We defined a benign diagnosis as pathology which could not be associated with cancer and is consistent with criteria used in other published case series 8–22 …”

Section: Discussionmentioning

confidence: 99%

“…The value of performing FOB in patients with non‐massive haemoptysis and clear or benign CT findings is unclear. Several retrospective case series 8–22 suggest that the rates of identifying lung malignancies using FOB in patients with non‐massive haemoptysis and a clear or benign CT scan is negligible. Perhaps the CT scan should be reviewed before proceeding to FOB, and FOB only indicated if there are abnormalities on CT which suggest a potential lung malignancy.…”

Section: Introductionmentioning

confidence: 99%

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The value of bronchoscopy in patients with non‐massive haemoptysis and a clear or benign computer tomogram scan

Murphy

Jackson

Johnston

et al. 2020

Clinical Respiratory J

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Introduction The preferred diagnostic pathway for patients presenting with non‐massive haemoptysis and normal or benign computer tomography (CT) radiological findings is unclear. The common approach is to investigate with both CT and bronchoscopy, irrespective of patient‐specific factors. The value of performing fibreoptic bronchoscopy (FOB) in patients with non‐massive haemoptysis and clear or benign CT findings remains undetermined. We aimed to investigate its value using a large retrospective case series. Material and Methods A retrospective review of 4376 FOBs performed in Northumbria Healthcare NHS Foundation Trust from January 2012 to December 2019 for patients presenting with haemoptysis and clear or benign CT findings. Statistical analysis was performed to describe patient‐specific variables, clinical characteristics, pathological findings and subsequent management decisions. Results A total of 4376 FOBs were performed during the study period, 275 were indicated to investigate non‐massive haemoptysis. Two hundred and fifty‐nine patients underwent a CT scan (158 before and 101 after FOB); 16 never had a CT because the treating physician did not feel it was necessary. About 258 CT scans showed normal anatomy. All patients underwent FOB; 192 showed normal findings. Bronchoscopic findings did not alter clinical management in 274 patients. One patient was referred to the ear, nose and throat department following the identification of polypoid vocal cord lesion which, following thorough investigation, was confirmed as benign. Conclusion FOB provides minimal value for identifying lung malignancies in patients with non‐massive haemoptysis and a clear or benign CT scan irrespective of patient‐specific risk factors. Cost savings would be associated if physicians altered practice accordingly.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%