Yiliang Zhang1, Yang Zhang1, Sufeng Chen1, Yuan Li2, Yongfu Yu3, Yihua Sun4, Haiquan Chen5. 1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. 2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China. 3. Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark. 4. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. Electronic address: sun_yihua76@hotmail.com. 5. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. Electronic address: hqchen1@yahoo.com.
Abstract
OBJECTIVE: This study evaluated the role of conventional bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules (SPNs). METHODS: Patients with SPNs of unknown origin were enrolled for preoperative bronchoscopy at our institution. Bronchoscopic findings were prospectively collected, and their impact on planned therapy was analyzed. RESULTS: A total of 1026 patients were included. Bronchoscopy identified unsuspected findings in 80 (7.8%) of them, with a total of 826 (80.5%) malignant nodules. Referent values for bronchoscopic detection of malignant SPNs were: accuracy, 24.3% (95% confidence interval [CI]: 21.7%-27.0%); sensitivity, 5.9% (95% CI: 4.5%-7.4%); specificity, 100%; and negative predictive value, 20.5% (95% CI: 18.0%-22.9%). Malignant bronchoscopic findings were more common in male patients (odds ratio [OR] = 2.1, 95% CI: 1.1-3.9, P = .021) and large nodules (OR = 2.3, 95% CI: 1.6-3.3, P < .001). Surgery was cancelled in 2 (0.2%) patients and modified in 36 (3.5%) patients because of bronchoscopic findings. In all, for 268 (26.1%) SPNs that presented with ground-glass opacity, the bronchoscopy was unrevealing. CONCLUSIONS: In the preoperative evaluation of SPN, bronchoscopy is most likely to reveal malignancy in larger SPNs and in male patients. Bronchoscopy is not indicated in SPNs that present with ground-glass opacity on computed tomography scan.
OBJECTIVE: This study evaluated the role of conventional bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules (SPNs). METHODS:Patients with SPNs of unknown origin were enrolled for preoperative bronchoscopy at our institution. Bronchoscopic findings were prospectively collected, and their impact on planned therapy was analyzed. RESULTS: A total of 1026 patients were included. Bronchoscopy identified unsuspected findings in 80 (7.8%) of them, with a total of 826 (80.5%) malignant nodules. Referent values for bronchoscopic detection of malignant SPNs were: accuracy, 24.3% (95% confidence interval [CI]: 21.7%-27.0%); sensitivity, 5.9% (95% CI: 4.5%-7.4%); specificity, 100%; and negative predictive value, 20.5% (95% CI: 18.0%-22.9%). Malignant bronchoscopic findings were more common in male patients (odds ratio [OR] = 2.1, 95% CI: 1.1-3.9, P = .021) and large nodules (OR = 2.3, 95% CI: 1.6-3.3, P < .001). Surgery was cancelled in 2 (0.2%) patients and modified in 36 (3.5%) patients because of bronchoscopic findings. In all, for 268 (26.1%) SPNs that presented with ground-glass opacity, the bronchoscopy was unrevealing. CONCLUSIONS: In the preoperative evaluation of SPN, bronchoscopy is most likely to reveal malignancy in larger SPNs and in male patients. Bronchoscopy is not indicated in SPNs that present with ground-glass opacity on computed tomography scan.