The Role of Conventional Bronchoscopy in the Workup of Suspicious CT Scan Screen-Detected Pulmonary Nodules

Susan C. van't Westeinde*, Nanda Horeweg, Rene M. Vernhout, Harry J. M. Groen, Jan-Willem J. Lammers, Carla Weenink, Kristiaan Nackaerts, Matthijs Oudkerk, Willem Mali, Frederik B. Thunnissen, Harry J. de Koning, Rob J. van Klaveren

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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.

Trial registration: Nederlands Trial Register; No.: ISRCTN63545820; URL: www.trialregister.nl. CHEST 2012; 142(2):377-384

Original languageEnglish
Pages (from-to)377-384
Number of pages8
JournalChest
Volume142
Issue number2
DOIs
Publication statusPublished - Aug-2012

Keywords

  • PERIPHERAL LUNG LESIONS
  • NAVIGATION DIAGNOSTIC BRONCHOSCOPY
  • GUIDELINES 2ND EDITION
  • ENDOBRONCHIAL ULTRASONOGRAPHY
  • COMPUTED-TOMOGRAPHY
  • CANCER
  • TRIAL
  • MANAGEMENT
  • NELSON
  • BIOPSY

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