McLean A N, Semple P A, Franklin D H, Petrie G, Millar E A, Douglas J G
Department of Respiratory Medicine, Stobhill Hospital, Glasgow, U.K.
Respir Med. 1998 Sep;92(9):1110-5. doi: 10.1016/s0954-6111(98)90403-6.
Fibre-optic bronchoscopy is widely used to diagnose bronchial carcinoma. There is considerable variation in techniques for patient sedation, methods of obtaining samples and histopathological yield. We wished to examine variations in practice in different centres throughout Scotland and derive realistic audit standards for best clinical practice from these results. Diagnostic bronchoscopies from five centres were included. Patient details, grade of individual performing the test, endobronchial abnormalities, specimens taken and the histocytological yield were recorded. A patient satisfaction questionnaire was completed. One thousand eight hundred and two bronchoscopies were performed to look for bronchial carcinoma. Sedation and anaesthesia techniques varied considerably between centres. There were marked differences in patient satisfaction between centres. Nearly twice as many females as males would prefer not to have bronchoscopy repeated. Six hundred and fifty-eight carcinomas were confirmed by histocytology. Yield was unaffected by the grade of doctor performing bronchoscopy. Improving yield may be achieved by increasing the number of sampling techniques employed and changing the order in which specimens are taken (biopsies first and washings last). Eighty-seven percent of endoscopically visible tumours were confirmed histocytologically. There was a considerable variation in histological spectra between centres that may relate to differences in pathological interpretation rather than actual differences in case mix. Suggested audit standards are discussed. This study demonstrates the variety of techniques and also the levels of histocytological yield and patient satisfaction that can be achieved. Provisional standards of practice for this procedure have been agreed with a view to auditing performance against these. It is hoped that centres will adopt the methods that are shown to achieve the highest standards.
纤维支气管镜检查广泛应用于支气管癌的诊断。在患者镇静技术、样本获取方法和组织病理学检出率方面存在相当大的差异。我们希望研究苏格兰各地不同中心的实践差异，并根据这些结果得出最佳临床实践的实际审核标准。纳入了来自五个中心的诊断性支气管镜检查病例。记录了患者详细信息、进行检查的人员级别、支气管内异常情况、采集的样本以及组织细胞学检出率。完成了一份患者满意度调查问卷。共进行了1802例支气管镜检查以查找支气管癌。各中心之间的镇静和麻醉技术差异很大。各中心之间患者满意度存在显著差异。女性表示不愿再次接受支气管镜检查的人数几乎是男性的两倍。通过组织细胞学确诊了658例癌症。支气管镜检查的检出率不受执行检查的医生级别的影响。增加所采用的采样技术数量并改变样本采集顺序（先活检后冲洗）可能会提高检出率。87%的内镜可见肿瘤经组织细胞学确诊。各中心之间的组织学谱存在相当大的差异，这可能与病理解释的差异有关，而非病例组合的实际差异。讨论了建议的审核标准。本研究展示了各种技术以及可实现的组织细胞学检出率和患者满意度水平。已就该程序的临时实践标准达成一致，以便对照这些标准审核操作表现。希望各中心采用已证明能达到最高标准的方法。
