Chest
Volume 76, Issue 2, August 1979, Pages 176-179
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Diagnostic Accuracy in Peripheral Lung Lesions: Factors Predicting Success with Flexible Fiberoptic Bronchoscopy

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Ninety-seven consecutive peripheral lung lesions were evaluated by biplane fluoroscopically guided flexible fiberoptic bronchoscopy and analyzed to define features that predict diagnostic yield. The overall diagnostic accuracy was 56 percent (63 percent for malignant and 38 percent for benign lesions). The most important characteristic associated with a positive cyto- or histopathologic diagnosis was size of the lesion; the yield was 28 percent when the diameter was < 2.0 cm compared to 64 percent if the diameter was ≥ 2.0 cm (P = 0.0035). The diagnostic yield was similar for lesions located in the outer and middle third of the lung if the diameter was > 2.0 cm; inner one-third lesions were correctly diagnosed more frequently, related in part to the larger size of these lesions. There was no significant difference in diagnostic yield for the following: segmental location, greatest distance from carina on either the posteroanterior or lateral radiograph, or radiographic characteristics of the lesion. We conclude that biplane fluoroscopically guided flexible fiberoptic bronchoscopy is a reasonable diagnostic procedure for peripheral lesions ≥ 2.0 cm in diameter, but that alternative procedures should be used for lesions under 2.0 cm in diameter.

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MATERIALS AND METHODS

All patients with localized peripheral pulmonary infiltrates or nodules which were approached by biplane fluoroscopically guided FFB at Henry Ford Hospital between June, 1974 and July, 1977, form the basis for this report. Details of the bronchoscopic procedure1 and the preparation and collection of cytopathologic specimens were reported previously.2 Mycobacterial and fungal smears and cultures were obtained where appropriate. Bronchial washings were not routinely sent for cytologic

RESULTS

We studied 97 peripheral lung lesions with biplane fluoroscopically guided FFB in 95 patients. There were 66 men and 29 women with a mean age of 64.1 years (range 19–89 years). Fifty-six lesions were located in the right lung, and 41 in the left lung. There were 71 malignant and 26 benign lesions with a range in greatest diameter from 1.1 to 10.7 cm. All data analyses will refer to the diagnostic accuracy in 97 lesions.

The diagnostic accuracy for all lesions was 56 percent. The single best

DISCUSSION

In our series, the most important feature which allowed us to achieve an accurate diagnosis of peripheral lung lesions studied by biplane fluoroscopically guided FFB was the size of the lesion. In a smaller series of malignant lesions, Stringfield et al3 also concluded that the size of the lesion was important. There were, however, too few lesions under 2 cm (three) to separate location from size as the critical factor in diagnosis. Ellis4 analyzed 107 consecutive cases and found a higher

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Manuscript received September 5; revision accepted December 5.

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