THE SCOTTISH MULTICENTER PROSPECTIVE-STUDY OF BRONCHOSCOPY FOR BRONCHIAL-CARCINOMA AND SUGGESTED AUDIT STANDARDS

Fibre-optic bronchoscopy is widely used to diagnose bronchial carcinom a. There is considerable variation in techniques for patient sedation, methods of obtaining samples and histopathological yield. We wished t o examine variations in practice in different centres throughout Scotl and and derive realistic audit standards for best clinical practice fr om these results. Diagnostic bronchoscopies from five centres were inc luded. Patient details, grade of individual performing the test, endob ronchial abnormalities, specimens taken and the histocytological yield were recorded. A patient satisfaction questionnaire was completed. On e thousand eight hundred and two bronchoscopies were performed to look for bronchial carcinoma. Sedation and anaesthesia techniques varied c onsiderably between centres. There were marked differences in patient satisfaction between centres. Nearly twice as many females as males wo uld prefer not to have bronchoscopy repeated. Six hundred and fifty-ei ght carcinomas were confirmed by histocytology. Yield was unaffected b y 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 wa shings last). Eighty-seven percent of endoscopically visible tumours w ere confirmed histocytologically, There was a considerable variation i n 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 yiel d and patient satisfaction that can be achieved. Provisional standards of practice for this procedure have been agreed with a view to auditi ng performance against these. It is hoped that centres will adopt the methods that are shown to achieve the highest standards.