The value of flexible bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules_West China Medical Journal

Authors：

LIU Dan , ZHU Yingying , ZHU Hui , YANG Sai , SHI Jingyu , LUO Yongxiao , HAN Qingbing ,  LI Weimin

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Weimin, Email: weimi003@yahoo.com

Keywords：

Flexible bronchoscopy; Lung cancer; Pre-operation evaluation; Solitary pulmonary nodule

DOI：

10.7507/1002-0179.201710028

Video：

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Objective To evaluate the diagnostic value and utility of flexible bronchoscopy in the preoperative assessment in patients with solitary pulmonary nodules (SPNs). Methods A total of 111 patients with SPNs of unknown origin treated between January and June 2016 were retrospectively enrolled. The clinical characteristics, bronchoscopy findings and surgical strategies were collected. Results In the total 111 cases, malignant and benign SPNs were 79 and 32 cases, respectively. The mean diameter of malignant SPNs was larger than that of benign SPNs [(2.04±0.58) vs. (1.70±0.75) cm, P<0.05]. Bronchoscopy identified 9 cases (8.1%) unsuspected findings. Surgeries were modified or cancelled in 3 patients (2.7%) because of bronchoscopy findings. Transbronchoscopy biopsies were performed in 26 patients, 9 of whom were diagnosed lung cancer preoperatively, with a sensitivity of 45% (9/20) and a specificity of 100% (6/6). Conclusions Flexible bronchoscopy can be contributed to diagnosis of SPN before surgery and determination of surgical strategies. It is suggested that flexible bronchoscopy could be included in the routine preoperative work-up of SPN.

Citation： LIU Dan, ZHU Yingying, ZHU Hui, YANG Sai, SHI Jingyu, LUO Yongxiao, HAN Qingbing, LI Weimin. The value of flexible bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules. West China Medical Journal, 2018, 33(1): 32-35. doi: 10.7507/1002-0179.201710028 Copy

1.	Baaklini WA, Reinoso MA, Gorin AB, et al. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest, 2000, 117(4): 1049-1054.
2.	Reichenberger F, Weber J, Tamm M, et al. The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. Chest, 1999, 116(3): 704-708.
3.	Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 94S-107S.
4.	Lederle FA, Niewoehner DE. Lung cancer surgery. A critical review of the evidence. Arch Intern Med, 1994, 154(21): 2397-2400.
5.	Torrington KG, Kern JD. The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule. Chest, 1993, 104(4): 1021-1024.
6.	Goldberg SK, Walkenstein MD, Steinbach A, et al. The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule. Chest, 1993, 104(1): 94-97.
7.	Becker GL, Whitlock WL, Schaefer PS, et al. The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions. Arch Intern Med, 1990, 150(3): 557-559.
8.	Seely JM, Mayo JR, Miller RR, et al. T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology, 1993, 186(1): 129-132.
9.	Chen C, Zheng H, Gao W, et al. Prognosis and staging of superficial endobronchial lung cancer: the impact of invasion depth, tumor diameter, and coexistent pneumonitis or atelectasis. Chin Med J (Engl), 2010, 123(12): 1505-1509.
10.	International Early Lung Cancer Action Program I, Henschke CI, Yankelevitz DF, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med, 2006, 355(17): 1763-1771.
11.	National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
12.	Zhang YL, Zhang Y, Chen SF, et al. Is bronchoscopy necessary in the preoperative workup of a solitary pulmonary nodule?. J Thorac Cardiovasc Surg, 2015, 150(1): 36-40.
13.	Schwarz C, Schoenfeld N, Bittner RC, et al. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules. Eur Respir J, 2013, 41(1): 177-182.
14.	Zhang GM, Zhu Y, Luo L, et al. Preoperative lymphocyte-monocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy. Tumour Biol, 2015, 36(11): 8537-8543.
15.	van’t Westeinde SC, Horeweg N, Vernhout RM, et al. The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules. Chest, 2012, 142(2): 377-384.
16.	Chhajed PN, Bernasconi M, Gambazzi F, et al. Combining bronchoscopy and positron emission tomography for the diagnosis of the small pulmonary nodule < or = 3 cm. Chest, 2005, 128(5): 3558-3564.

1. Baaklini WA, Reinoso MA, Gorin AB, et al. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest, 2000, 117(4): 1049-1054.
2. Reichenberger F, Weber J, Tamm M, et al. The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. Chest, 1999, 116(3): 704-708.
3. Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 94S-107S.
4. Lederle FA, Niewoehner DE. Lung cancer surgery. A critical review of the evidence. Arch Intern Med, 1994, 154(21): 2397-2400.
5. Torrington KG, Kern JD. The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule. Chest, 1993, 104(4): 1021-1024.
6. Goldberg SK, Walkenstein MD, Steinbach A, et al. The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule. Chest, 1993, 104(1): 94-97.
7. Becker GL, Whitlock WL, Schaefer PS, et al. The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions. Arch Intern Med, 1990, 150(3): 557-559.
8. Seely JM, Mayo JR, Miller RR, et al. T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology, 1993, 186(1): 129-132.
9. Chen C, Zheng H, Gao W, et al. Prognosis and staging of superficial endobronchial lung cancer: the impact of invasion depth, tumor diameter, and coexistent pneumonitis or atelectasis. Chin Med J (Engl), 2010, 123(12): 1505-1509.
10. International Early Lung Cancer Action Program I, Henschke CI, Yankelevitz DF, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med, 2006, 355(17): 1763-1771.
11. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
12. Zhang YL, Zhang Y, Chen SF, et al. Is bronchoscopy necessary in the preoperative workup of a solitary pulmonary nodule?. J Thorac Cardiovasc Surg, 2015, 150(1): 36-40.
13. Schwarz C, Schoenfeld N, Bittner RC, et al. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules. Eur Respir J, 2013, 41(1): 177-182.
14. Zhang GM, Zhu Y, Luo L, et al. Preoperative lymphocyte-monocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy. Tumour Biol, 2015, 36(11): 8537-8543.
15. van’t Westeinde SC, Horeweg N, Vernhout RM, et al. The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules. Chest, 2012, 142(2): 377-384.
16. Chhajed PN, Bernasconi M, Gambazzi F, et al. Combining bronchoscopy and positron emission tomography for the diagnosis of the small pulmonary nodule < or = 3 cm. Chest, 2005, 128(5): 3558-3564.

West China Medical Journal

The value of flexible bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules

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