Hk. Bungay et al., An evaluation of computed tomography as an aid to diagnosis in patients undergoing bronchoscopy for suspected bronchial carcinoma, CLIN RADIOL, 55(7), 2000, pp. 554-560
AIM: To determine whether computed tomography (CT) can predict the likeliho
od of obtaining a positive tissue diagnosis at fibreoptic bronchoscopy (FOB
), or demonstrate an alternative means of achieving a tissue diagnosis, in
patients presenting with a high clinical suspicion of primary bronchogenic
carcinoma and an abnormal chest radiograph (CXR).
MATERIALS AND METHODS: Sixty-two patients presenting with a high clinical s
uspicion of carcinoma and an abnormal CXR had chest and liver CT and FOE pe
rformed, All patients subsequently had histocytological confirmation of mal
ignancy. Features recorded from the CTs included: the site and characterist
ics of a mass if present, and its relationship to adjacent airways; the pre
sence of presumed metastatic disease; and a CT prediction of the likelihood
of positive FOE was made,
RESULTS: Of the patients, 41/62 (66%) had inoperable stage IIIb/IV disease.
Fibreoptic biopsy yielded positive tissue diagnoses in 38/62 (61%), Comput
ed tomography features predicting a positive FOE in this group included: il
l-definition of the mass (12/15, 80%); a mass <4cm from the origin of the n
earest lobar bronchus (36/53, 68%); an endobronchial component of mass (22/
24, 92%); a segmental or larger airway leading to the mass (30/35, 86%). Ov
erall, CT had positive and negative predictive values for positive FOE of 8
5% and 78% respectively, The accuracy of the overall CT prediction of posit
ive FOB was better than the accuracy of any of the individual factors. Seve
nteen of 62 (27%) patients had presumed metastatic disease suitable for per
cutaneous biopsy.
CONCLUSION: Computed tomography is useful in predicting the likelihood of a
chieving positive histocytology at FOE. The overall CT prediction is superi
or to any of the individual CT features taken alone, (C) 2000 The Royal Col
lege of Radiologists.