The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules.
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.


CONCLUSIONS
Conventional white-light bronchoscopy should not be routinely recommended for patients with positive test results in a lung cancer screening program.
Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: s.vantwesteinde@erasmusmc.nl.
Susan C
SC
van 't Westeinde
Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Nanda
N
Horeweg
Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
René M
RM
Vernhout
Department of Pulmonary Medicine, University Medical Center Groningen, Groningen, The Netherlands.
Harry J M
HJM
Groen
Department of Pulmonary Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Jan-Willem J
JJ
Lammers
Department of Pulmonary Medicine, Kennemer Gasthuis Haarlem, Haarlem, The Netherlands.
Carla
C
Weenink
Department of Pulmonary Medicine, UZ Gasthuisberg, Leuven, Belgium.
Kristiaan
K
Nackaerts
Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands.
Matthijs
M
Oudkerk
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Willem
W
Mali
Department of Pathology, VU Medical Center Amsterdam, Amsterdam, The Netherlands.
Frederik B
FB
Thunnissen
Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Harry J
HJ
de Koning
Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Rob J
RJ
van Klaveren
D000368:Aged; D001999:Bronchoscopy; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed