Venkatram Sindhaghatta, Pena Damaris, Bajantri Bharat, Diaz-Fuentes Gilda
Clinical Medicine Division of Pulmonary and Critical Care Medicine BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY.
Medicine (Baltimore). 2019 May;98(19):e15585. doi: 10.1097/MD.0000000000015585.
Bronchoscopy is one of the most common diagnostic procedures in pulmonary practice. Data on the outcome of patients following a non-diagnostic bronchoscopy are sparse. Diagnostic yield depends on indication, the characteristics of patients, and the chest imaging. The aim of this study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy and to compare patients who had a diagnostic with those that had a non-diagnostic bronchoscopy.Retrospective, single-center study of adult patients who underwent bronchoscopy with transbronchial biopsy (TBBX) and/or endobronchial biopsy (EBBX), endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), or brushing. A strict definition for a "diagnostic" bronchoscopy was used. Univariate and multivariate analyses were performed.A total of 684 patients were identified, 350 (51%) had a diagnostic procedure. Of the 334 patients with a non-diagnostic bronchoscopy, 196 (58.6%) were followed, but only 172 (88%) completed 1 year of follow-up. Most of the patients (57.8%) had resolution or stabilization of the condition; in the remaining patients, malignancy was most commonly diagnosed after further investigation followed by diffuse lung diseases and infections. Pulmonary tuberculosis was diagnosed in 8 patients. EBUS-TBNA and EBBX were the procedures associated with a diagnostic bronchoscopy. Presence of bilateral interstitial infiltrates predicted a non-diagnostic bronchoscopy.A significant number of patients with non-diagnostic bronchoscopy may have serious treatable disease that is identified upon further investigation. Close follow up of patients with a non-diagnostic procedure is warranted. Our study found no clear clinical or radiological predictors of diagnostic bronchoscopy.
支气管镜检查是肺部诊疗中最常见的诊断程序之一。关于非诊断性支气管镜检查后患者结局的数据较少。诊断率取决于适应证、患者特征和胸部影像学检查。本研究的目的是评估非诊断性支气管镜检查患者的结局，并比较诊断性支气管镜检查患者与非诊断性支气管镜检查患者的情况。
对接受经支气管活检（TBBX）和/或支气管内活检（EBBX）、支气管内超声引导下经支气管针吸活检（EBUS-TBNA）或刷检的成年患者进行回顾性单中心研究。采用了“诊断性”支气管镜检查的严格定义。进行了单因素和多因素分析。
共确定了684例患者，其中350例（51%）进行了诊断性检查。在334例非诊断性支气管镜检查患者中，196例（58.6%）进行了随访，但只有172例（88%）完成了1年的随访。大多数患者（57.8%）病情缓解或稳定；在其余患者中，最常见的是在进一步检查后诊断为恶性肿瘤，其次是弥漫性肺疾病和感染。8例患者被诊断为肺结核。EBUS-TBNA和EBBX是与诊断性支气管镜检查相关的操作。双侧间质浸润提示为非诊断性支气管镜检查。
相当数量的非诊断性支气管镜检查患者可能患有严重的可治疗疾病，经进一步检查可确诊。对非诊断性检查患者进行密切随访是必要的。我们的研究未发现诊断性支气管镜检查明确的临床或影像学预测因素。
