The role of conventional bronchoscopy in the work-up of suspicious CT screen detected pulmonary nodules
Menée sur 308 patients présentant des nodules pulmonaires suspects identifiés par tomographie numérique, cette étude évalue l'intérêt d'un examen supplémentaire par bronchoscopie conventionnelle pour détecter un cancer du poumon
Background: Up to 50% of the participants in computer tomography (CT) lung cancer screening trials have at least one pulmonary nodule. The role of a conventional bronchoscopy in the work-up of suspicious screen-detected pulmonary nodules to date is unknown. If a bronchoscopic evaluation could be eliminated, the cost-effectiveness of a screening program could be enhanced and the potential harms of bronchoscopy avoided.Methods: All consecutive participants showing a positive test result between April 2004 and December 2008 were enrolled. The diagnostic sensitivity and negative predictive value (NPV) were calculated at the level of the suspicious nodules. In 95% of the nodules the gold standard for the outcome of the bronchoscopy was based on surgical resection specimens.Results: A total of 318 suspicious lesions were evaluated by bronchoscopy in 308 subjects. The diameter of the nodules averaged 14.6 mm (SD: 8.7) while only 2.8% of nodules were> 30 mm in diameter. The sensitivity of bronchoscopy was 13.5% (95% confidence interval (CI): 9.0%-19.6%), the specificity 100%, the PPV 100% and the NPV 47.6% (95% CI: 41.8%-53.5%) Of all cancers detected, 1% was detected by bronchoscopy only and retrospectively invisible on both low-dose CT and CT with intravenous contrast.Conclusion: Conventional white-light bronchoscopy should not be routinely recommended for test-positive participants in a lung cancer screening program.
Chest , résumé, 2012