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Chest. 2012 Aug;142(2):377-384. doi: 10.1378/chest.11-2030.

The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules.

Author information

1
Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: s.vantwesteinde@erasmusmc.nl.
2
Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
3
Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
4
Department of Pulmonary Medicine, University Medical Center Groningen, Groningen, The Netherlands.
5
Department of Pulmonary Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
6
Department of Pulmonary Medicine, Kennemer Gasthuis Haarlem, Haarlem, The Netherlands.
7
Department of Pulmonary Medicine, UZ Gasthuisberg, Leuven, Belgium.
8
Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands.
9
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
10
Department of Pathology, VU Medical Center Amsterdam, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Up to 50% of the participants in CT scan lung cancer screening trials have at least one pulmonary nodule. To date, the role of conventional bronchoscopy in the workup of suspicious screen-detected pulmonary nodules is unknown. If a bronchoscopic evaluation could be eliminated, the cost-effectiveness of a screening program could be enhanced and the potential harms of bronchoscopy avoided.

METHODS:

All consecutive participants with a positive result on a CT scan lung cancer screening between April 2004 and December 2008 were enrolled. The diagnostic sensitivity and negative predictive value were calculated at the level of the suspicious nodules. In 95% of the nodules, the gold standard for the outcome of the bronchoscopy was based on surgical resection specimens.

RESULTS:

A total of 318 suspicious lesions were evaluated by bronchoscopy in 308 participants. The mean ± SD diameter of the nodules was 14.6 ± 8.7 mm, whereas only 2.8% of nodules were > 30 mm in diameter. The sensitivity of bronchoscopy was 13.5% (95% CI, 9.0%-19.6%); the specificity, 100%; the positive predictive value, 100%; and the negative predictive value, 47.6% (95% CI, 41.8%-53.5%). Of all cancers detected, 1% were detected by bronchoscopy only and were retrospectively invisible on both low-dose CT scan and CT scan with IV contrast.

CONCLUSION:

Conventional white-light bronchoscopy should not be routinely recommended for patients with positive test results in a lung cancer screening program.

PMID:
22302298
DOI:
10.1378/chest.11-2030
[Indexed for MEDLINE]

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