Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy.
OBJECTIVE
To determine the extent to which on-site cytopathology assessment improves diagnostic yield when sampling lung nodules or masses and/or hilar or mediastinal lymphadenopathy by fiberoptic bronchoscopy (FOB).


METHODS
Prospective cohort study.


METHODS
Two teaching hospitals in Baltimore, MD.


METHODS
Consecutive adult patients (>/= 18 years) undergoing FOB for evaluation of lung nodules or masses and/or hilar or mediastinal lymphadenopathy.


METHODS
Prospective collection of data on patient factors and details of the procedure on standardized report forms.


RESULTS
The primary outcome measure was a new diagnosis obtained by FOB. On-site assessment was used in 81 of 204 cases (40%), and overall diagnostic yield was 62%. Yield was greater when on-site cytopathology assessment was used, in unadjusted analysis (81% vs 50%, p < 0.001) and in a multivariate model (odds ratio, 4.5; 95% confidence interval, 2.1 to 10.0). Other significant predictors of a new diagnosis included older patient age, higher dose of narcotic used during FOB, and shorter procedure time.


CONCLUSIONS
We conclude that diagnostic yield was greater when on-site cytopathology was used to assist FOB evaluation of intrathoracic adenopathy and/or lung nodules or masses. Increasing the use of on-site cytopathology assessment may improve the quality of FOB services.
Diette
G B
GB
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. gdiette@jhmi.edu
White
P
P
Terry
P
P
Jenckes
M
M
Rosenthal
D
D
Rubin
H R
HR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001999:Bronchoscopy / Q000592:standards; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology; D008206:Lymphatic Diseases / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies