Abstract
Introduction: The British Thoracic Society guidelines [1] for diagnostic flexible bronchoscopy in adults are currently under review. Present guidelines highlight the importance of needing five endobronchial biopsies (EBs) to optimise diagnostic yield. The aim of our study was to find out whether the availability of a cytopathologist during bronchoscopy has led both to a reduction in the number and need of EBs performed.
Method: The study period was March to October 2010. We reviewed whether the use of immediate analysis of brush biopsies or tumour roll on EBs performed had led to a reduction in number of EBs performed by comparing the number of biopsies performed during this period to numbers performed prior to our in-room cytopathologist set up. We also reviewed 14 consecutive patients who had EBs performed during the study period to look at both how many biopsies tended to be first pass positive and how many biopsies in total were taken per patient.
Results: We found that the availability of a cytopathologist within the bronchoscopy room has led to a significant reduction in the number of EBs performed without detriment to diagnostic rate or further testing like IHC and EGFR status. Of the 14 patients who had EBs 85% of cases were first pass positive with the mean of total biopsies taken being two.
Conclusion: Our retrospective study shows that the availability of an in-room cytopathologist reduces the number of biopsies performed and thus associated complications. Furthermore our small cohort demonstrates that even without a cytopathologist the recommended five EBs is unnecessary.
Reference:
1. The British Thoracic Society Bronchoscopy Guideline Committee - Thorax 2001. 56(Suppl I):i1-i21.
- © 2011 ERS