COST-EFFECTIVENESS OF COLLECTING ROUTINE CYTOLOGIC SPECIMENS DURING FIBEROPTIC BRONCHOSCOPY FOR ENDOSCOPICALLY VISIBLE LUNG-TUMOR

Study objective: Fiberoptic bronchoscopy is the most common modality u sed to diagnose endobronchial carcinoma, Collection of brushing and wa shing specimens for cytology is common during bronchoscopy for endobro nchial abnormality, but it is unknown if collection of these specimens is cost-effective. Design: Retrospective review of a computerized dat abase with cost-effectiveness analysis. Setting: Tertiary care medical center. Patients: Two hundred one patients undergoing bronchoscopy fo r endobronchial lung tumor. Interventions: All patients in the study u nderwent fiberoptic bronchoscopy that included forceps biopsies, washi ngs, and brushings. In addition to analyzing the sensitivity of forcep s biopsy, washings, and brushings at diagnosing malignancy, we analyze d the cost-effectiveness of three potential specimen collection strate gies. These strategies were (1) collection of both washings and brushi ngs in addition to forceps biopsy specimen, (2) collection of either w ashings or brushings in addition to forceps biopsy specimen, and (3) c ollection of forceps biopsy specimen only. Measurements and results: T he sensitivity of bronchoscopy, including biopsy, washing, and brushin g is 85.3% (95% confidence interval [CI], 80.1 to 90.5%). The sensitiv ity of forceps biopsy is 80.8% (95% CI, 75.0 to 86.6%). The addition o f washings and brushings increases the sensitivity of bronchoscopy fro m 80.8 to 85.3% (McNemar's p = 0.01). Cost-effectiveness analysis reve als that forceps biopsy plus washing or brushing has a marginal cost-e ffectiveness ratio of $308 per reduced-quality day avoided compared wi th forceps alone. Adding an additional cytology specimen has a margina l cost-effectiveness ratio of $5,500 per reduced-quality day avoided. Conclusions: There is a modest but definite increase in the sensitivit y of bronchoscopy in diagnosing endobronchial cancer with the addition of washings and brushings for cytology. Cost-effectiveness analysis r eveals that collection of either washings or brushings is probably the best strategy.