Kim Deok Hyong, Kang Bo Hyoung, Um Soo-Jung, Kim Insu
Department of Internal Medicine, Dong-A University Hospital, Busan 49201, Republic of Korea.
Department of Internal Medicine, Dong-A University College of Medicine, Busan 49021, Republic of Korea.
Medicina (Kaunas). 2025 Sep 7;61(9):1617. doi: 10.3390/medicina61091617.
: Flexible bronchoscopy is widely used for evaluating intrathoracic airway and pulmonary diseases. However, its diagnostic value in upper airway abnormalities, including those involving the larynx, pharynx, and proximal trachea, remains underexplored. We evaluated the diagnostic significance and effectiveness of bronchoscopy in assessing upper airway diseases, including those involving the larynx, based on real-world data. : We conducted a retrospective observational study involving 2229 patients who underwent bronchoscopy between March 2019 and December 2023. Patients with abnormal upper airway findings during bronchoscopy were referred for further otolaryngological evaluation. Patients were categorized according to the experience of their bronchoscopist (with ≥100 procedures defining experienced). Abnormal findings were analyzed according to anatomical region (oral cavity, larynx, and vocal cords), disease status (benign vs. malignant), and patient demographics. Multivariate logistic regression was used to identify predictors of abnormal findings. : Among 2229 patients (mean age 65.4 years), 72 (3.2%) exhibited visible upper airway abnormalities. No significant differences were observed in the abnormality detection rates between experienced and inexperienced operators across all anatomical regions. However, the presence of malignant disease was significantly associated with a higher likelihood of detecting abnormalities (5.4% vs. 1.9%, < 0.001). Multivariate analysis revealed that male sex (odds ratio [OR] 2.069, = 0.017), age < 74 years (OR 2.404, = 0.009), and malignancy (OR 3.030, < 0.001) were independent predictors of abnormal findings. : Flexible bronchoscopy can incidentally detect upper airway abnormalities, particularly in patients with malignancy, male sex, or younger age. These findings suggest that systematic inspection of the upper airway during bronchoscopy may offer additional diagnostic value, regardless of the operator's experience. The integration of upper airway assessment into routine bronchoscopic practice may enhance the early detection of clinically significant lesions and improve comprehensive patient care.
可弯曲支气管镜检查广泛用于评估胸内气道和肺部疾病。然而，其在上气道异常（包括涉及喉、咽和气管近端的异常）中的诊断价值仍未得到充分探索。我们基于真实世界数据评估了支气管镜检查在评估包括涉及喉部的上气道疾病中的诊断意义和有效性。
我们进行了一项回顾性观察研究，纳入了2019年3月至2023年12月期间接受支气管镜检查的2229例患者。支气管镜检查期间上气道发现异常的患者被转诊进行进一步的耳鼻喉科评估。患者根据其支气管镜检查医生的经验进行分类（≥100例操作定义为有经验）。根据解剖区域（口腔、喉和声带）、疾病状态（良性与恶性）和患者人口统计学分析异常发现。采用多因素逻辑回归来确定异常发现的预测因素。
在2229例患者（平均年龄65.4岁）中，72例（3.2%）出现可见的上气道异常。在所有解剖区域，有经验和无经验的操作者之间的异常检出率没有显著差异。然而，恶性疾病的存在与更高的异常检出可能性显著相关（5.4%对1.9%，P<0.001）。多因素分析显示，男性（比值比[OR]2.069，P=0.017）、年龄<74岁（OR 2.404，P=0.009）和恶性肿瘤（OR 3.030，P<0.001）是异常发现的独立预测因素。
可弯曲支气管镜检查可偶然发现上气道异常，特别是在患有恶性肿瘤、男性或年龄较轻的患者中。这些发现表明支气管镜检查期间对上气道进行系统检查可能具有额外的诊断价值，无论操作者的经验如何。将上气道评估纳入常规支气管镜检查实践可能会提高对具有临床意义病变的早期检测，并改善患者的综合护理。
