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This Article Full Text (PDF) All Versions of this Article: chest.08-0160v1 134/3/507    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Ost, D. Articles by Fein, A. PubMed PubMed Citation Articles by Ost, D. Articles by Fein, A. Related Content Related Article

A randomized trial of CT fluoroscopic guided bronchoscopy versus conventional bronchoscopy in patients with suspected lung cancer

The work was performed at North Shore University Hospital and New York University. Affiliations: New York University School of Medicine, Division of Pulmonary & Critical Care Medicine, New York, NY (D.O.), North Shore University Hospital, Department of Radiology (R.S.) and Interventional Pulmonology (E. A., L. L., J. D., C. A.), Pro Health Associates, Lake Success, NY (A.F.)

david.ost{at}med.nyu.edu

Abstract

BackgroundPrior case series have shown promising diagnostic sensitivity for CT guided bronchoscopy. Methods: This was a prospective randomized trial comparing CT guided versus conventional bronchoscopy for the diagnosis of lung cancer in peripheral lesions and mediastinal lymph nodes. All procedures were performed using a protocolized number of passes for forceps, transbronchial needles, and brushes. Cytologists and pathologists were blinded as to bronchoscopy type. Patients with negative results underwent open surgical biopsy (for nodules or lymph nodes) or had observation for 2 or more years if they had a nodule under 1 cm in size. Results: Fifty patients were enrolled; 26 to CT guided and 24 to conventional bronchoscopy. Two patients dropped out, one from each arm. Ultimately 36 patients proved to have cancer, and 27 (75%) of these had their diagnosis made by bronchoscopy. Sensitivity for malignancy of CT guided versus conventional bronchoscopy for peripheral lesions was similar (71% versus 76%, p=1.0). Sensitivity for malignancy of CT guided versus conventional bronchoscopy for mediastinal lymph nodes was higher (100% versus 67%) but did not reach statistical significance (p=0.26). On a per lymph node basis there was a trend toward higher diagnostic accuracy with CT guidance (p=0.09). Diagnostic yield was higher in larger lesions (p=0.004) and when CT confirmed target entry (p=0.001). Conclusion: We failed to demonstrate a significant difference between CT guided and conventional bronchoscopy for peripheral lesions and mediastinal lymph nodes. Further study of improved steering methods combined with CT guidance for peripheral lesions is warranted.

Key Words: Bronchoscopy • Lung Cancer • CT Fluoroscopy • Transbronchial Needle Aspiration

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