The Scottish multi-centre prospective study of bronchoscopy for bronchial carcinoma and suggested audit standards

Abstract

Fibre-optic bronchoscopy is widely used to diagnose bronchial carcinoma. There is considerable variation in techniques for patient sedation, methods of obtaining samples and histopathological yield. We wished to examine variations in practice in different centres throughout Scotland and derive realistic audit standards for best clinical practice from these results. Diagnostic bronchoscopies from five centres were included. Patient details, grade of individual performing the test, endobronchial abnormalities, specimens taken and the histocytological yield were recorded. A patient satisfaction questionnaire was completed. One thousand eight hundred and two bronchoscopies were performed to look for bronchial carcinoma. Sedation and anaesthesia techniques varied considerably between centres. There were marked differences in patient satisfaction between centres. Nearly twice as many females as males would prefer not to have bronchoscopy repeated. Six hundred and fifty-eight carcinomas were confirmed by histocytology. Yield was unaffected by the grade of doctor performing bronchoscopy. Improving yield may be achieved by increasing the number of sampling techniques employed and changing the order in which specimens are taken (biopsies first and washings last). Eighty-seven percent of endoscopically visible tumours were confirmed histocytologically. There was a considerable variation in histological spectra between centres that may relate to differences in pathological interpretation rather than actual differences in case mix. Suggested audit standards are discussed. This study demonstrates the variety of techniques and also the levels of histocytological yield and patient satisfaction that can be achieved. Provisional standards of practice for this procedure have been agreed with a view to auditing performance against these. It is hoped that centres will adopt the methods that are shown to achieve the highest standards.

Is preparation for bronchoscopy optimal?

“…A high level of variability in current bronchoscopy practices was shown [7][8][9], confirming previous reports. The response rate of 76% achieved by the present study compares favourably to previous reports of 53% and 60% [8,9].…”

“…One study suggests patients find the transcricoid route more pleasant than the "spray as you go" method and, as a result, less lignocaine is required [1], thereby reducing the likelihood of exceeding the recommended dose, which has been shown to be a common occurrence [8,9]. The present results for topical anaesthesia are similar to those of other reports [7][8][9].…”

“…The median number of consultants per hospital unit was three (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The median population served per consultant was 116,667 people with an interquartile (IQR) range of 90,000-150,000 people.…”

Improving standards in flexible bronchoscopy for lung cancer

“…There are three comparable published series [13][14][15]. We believe our study is the first to assess prospectively the change in detection rate over time, with all FB procedures recorded in exact sequential order.…”

Monitoring, Sedation, and Anesthesia for Flexible Fiberoptic Bronchoscopy

“…Despite this, debate has continued regarding the necessity of sedation during FFB. Surveys have revealed increased physician comfort and use of sedation during bronchoscopy (McLean et al, 1998;Prakash et al, 1991). Patient satisfaction and willingness to pursue repeat FFB procedures if required has been shown to be higher in those receiving sedative and systemic analgesic agents (Gonzales et al, 2003;Hirose et al, 2008;Putinati et al, 1999;Steinfort & Irvin, 2010).…”