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ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 3  |  Page : 173-175

Flexible fiberoptic bronchoscopy (FOB) as a diagnostic tool in endobronchial lesions


1 Department of TB and Chest Diseases, RIMS Medical College, Ongole, Andhra Pradesh, India
2 Department of TB and Chest Diseases, Guntur Medical College, Government Fever Hospital, Guntur, Andhra Pradesh, India
3 Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

Date of Web Publication10-Oct-2016

Correspondence Address:
Srikanti Raghu
12-14-1, Opp Sivalayam Road, Kothapeta, Guntur - 522 001, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.191840

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  Abstract 

Introduction: Flexible fiberoptic bronchoscopy (FOB) has revolutionized the way pulmonary lesions are diagnosed, especially when endobronchial involvement is suspected. We aimed to evaluate the role of FOB by comparing the efficacy of forceps biopsy, bronchial brushings, and bronchial washings individually and in combination.
Materials and Methods: This study was performed on 40 patients whose diagnosis was uncertain despite various diagnostic techniques. After initial screening, FOB was performed on patients suspected of endobronchial tumor. During the procedure of biopsy, brushings and washings were collected and sent for microbiology, cytology, and histopathology. The criteria for FOB included chronic cough, recurrent hemoptysis, and abnormal radiological opacity.
Results: Twenty-five patients had visible endobronchial tumor, mean age of presentation was 41-70 years, and males were predominant. The chief complaint was cough followed by persistant fever. Lung cancer (84%) was the most common etiology followed by tuberculosis (TB) (16%). Bronchial brushings gave the highest yield, slightly higher than forceps biopsy.
Conclusion: FOB is a very useful and safe diagnostic technique for the evaluation of endobronchial tumor. Because of the high prevalence of TB, the possibility of TB should be considered next to lung cancer. Bronchial brushings has an advantage over forceps biopsy in situations where biopsy forceps cannot reach or open at the site of growth.

Keywords: Endobronchial tumor, fiberoptic bronchoscopy (FOB), lung cancer, tuberculosis (TB)


How to cite this article:
Raghu S, Rachaputi CS, Somisetty LK. Flexible fiberoptic bronchoscopy (FOB) as a diagnostic tool in endobronchial lesions. J NTR Univ Health Sci 2016;5:173-5

How to cite this URL:
Raghu S, Rachaputi CS, Somisetty LK. Flexible fiberoptic bronchoscopy (FOB) as a diagnostic tool in endobronchial lesions. J NTR Univ Health Sci [serial online] 2016 [cited 2019 Jul 22];5:173-5. Available from: http://www.jdrntruhs.org/text.asp?2016/5/3/173/191840


  Introduction Top


For the diagnosis of endobronchial lung tumors, no method has proven valuable than endoscopic examination of the bronchial tree. The direct visualization and the advantage of tissue sampling makes it a more yielding investigation for diagnostic purposes and to know the extent of involvement than any other investigation.

Various diagnostic techniques using fiberoptic bronchoscopy (FOB) have been studied for the yield and accuracy. The most common are forceps biopsy, bronchial brushings, and bronchial washings.

The etiology remained uncertain despite careful clinical, radiological, and sputum analyses. We aimed to evaluate the role of FOB by comparing the efficacy of forceps biopsy, bronchial brushings, and bronchial washings individually and in combination.[1]

The accuracy of diagnosis depends on the type of sample and the site from where the sample was taken. For a centrally located tumor biopsy, brushings are equally effective but for peripheral tumors brushing is more advantageous.[2]

Lung cancer was found to be the most common etiology followed by tuberculosis (TB). Because of high diagnostic yield, considering FOB under Revised National Tuberculosis Control Programme (RNTCP) for the diagnosis of suspected cases of sputum smear negative cases through public private partnership may add to the success of national program.[3]


  Materials and Methods Top


Study design

This is an observational study conducted on patients attending the Department of Tuberculosis and Chest Diseases, Guntur Medical College/Government Fever Hospital, Guntur, Andhra Pradesh, India over a period of 2 years.

Study population

Forty patients suspected to have endobronchial lesions clinically and/or radiologically underwent FOB. Specific indications for FOB were both clinical and radiological.

Inclusion criteria

  1. Age above 30 years, smokers with 15-20 pack years and above.
  2. Cough, hemoptysis, chest pain, unexplained fever, weight loss, dysphagia, and hoarseness of voice.
  3. Localized wheeze.
  4. Any abnormal radiological opacity such as:
    • Pulmonary mass.
    • Solitary/multiple pulmonary nodule.
    • Unresolved pneumonia.
    • Atelectasis of segment or lobe.
    • Pleural effusion.
    • Hilar adenopathy or mediastinal enlargement with or without infiltration or atelectasis.
    • Lung abscess.


Exclusion criteria

  1. Noncooperative patients.
  2. Bleeding diathesis.
  3. Severe respiratory insufficiency.
  4. Pulmonary arterial hypertension.
  5. Low cardiopulmonary reserve.


Study protocol

Injection atropine was used as premedication followed by topical anesthesia with 2% Xylocaine.

Bronchoscopy was performed first on the radiologically normal side followed by the diseased side. Whenever intrabronchial growth was noted, bronchial brushing, washings, and biopsy were done in sequence and sent for cytology and histopathology.

Brushing were taken first in each case as the trauma and bleed was minimal. Washings taken after brushing improve the diagnostic yield due to increased exfoliation of tumor cells into the lumen.


  Results Top


In the present study, 40 patients suspected to have endobronchial tumor clinically or radiologically were subjected to bronchoscopy. Out of them, 25 patients had endoscopically visible lesions.

Among the 25 patients, most of them belonged to age group of 41-70 years (80%). Among them, 88% were males and 12% were females. 86.4% were found to be smokers. The most common presenting symptom was cough (100%) followed by breathlessness (80%), hemoptysis (56%), chest pain (24%), fever (24%), and hoarseness of voice (16%).

Among clinical signs, signs of consolidation (40%) followed by signs of mass lesion (32%) and signs of collapse (16%) were noted.
Table 1: Etiological Diagnosis Of Various Endobronchial Lesions

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Table 2: Diagnostic Accuracy Of The Different Tissue Sampling Techniques (N = 25)

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Regarding bronchoscopic finding, the most common side involved was the right side (64%); left side lesions were present in 36%. Upper lobe bronchus (40%) was the commonest site of growth followed by lower lobe bronchus (36%) and main stem bronchus (20%).

Lung cancer was the most common etiology (76%) followed by TB (16%).

In the present study, the highest diagnostic yield was obtained with bronchial brushings (84%) followed by forceps biopsy (76%) and lowest yield with bronchial washings (8%). No complications related to the procedure were observed in the present study.


  Discussion Top


Bronchoscopy and guided techniques have a definite role in the diagnosis of endobronchial lesions. The accuracy of diagnosis depends on the type of sample and the site from which the sample is taken. The addition of brushing and washing to biopsy increases the diagnostic yield from 78% to 92%.[4]

In the present study, diagnosis was established by brushings alone in two cases (8%). In one case, growth was seen in the right upper lobe posterior segment. In the subsegment level, forceps cannot reach and there was difficulty in opening the forceps at the site of lesion. Brush sample and washing were obtained from the growth and confirmed the diagnosis.[5]

In another case, biopsy was taken after brushings and biopsy specimen was reported to contain mostly blood clot. The growth was bleeding on touch and diagnosis was made based on the cytology and reported as squamous cell carcinoma.[6],[7]

Rajesh Kumar Jain et al. in their study suggested that the diagnostic yield of fiberoptic bronchoscopy was 70% in suspected cases of pulmonary TB with sputum smear for acid-fast bacillus (AFB) negative, which makes it a necessary tool in all cases with x-ray complications in our selected cases.

Lung cancer is the most common etiology (76%) followed by TB (16%) and brush biopsy is advantageous over forceps biopsy in certain growths where forceps cannot reach or cannot be opened at the site of growth. In the above situation, brush can be passed back and forth over the surface of growth to get a cluster of malignant cell for diagnosis.[8]


  Conclusion Top


  1. Lung cancer is the most common etiology followed by TB. This study shows FOB as a necessary tool to diagnose TB when there is a strong suspicion in spite of all other investigations aimed to diagnose TB are negative. Bronchial brushings gave the highest yield in the present study (88%), which was slightly higher than forceps biopsy (80%). Bronchial brush biopsy is advantageous over forceps biopsy as in situ ations where biopsy forceps cannot reach or cannot open at the site of growth, brush specimens can give better yield. Not only malignancy but the possibility of TB (8%) should also be considered in endobronchial lesions, especially in TB endemic countries such as India.


  2. Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

     
      References Top

    1.
    Fuladi AB, Munje RP, Tayade BO. Value of washings, brushings, and biopsy at fibreoptic bronchoscopy in the diagnosis of lung cancer. JIACM 2004;5:137-42.  Back to cited text no. 1
        
    2.
    Ahmad M, Afzal S, Saeed W, Mubarik A, Saleem N, Khan SA, et al. Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours. J Pak Med Assoc 2004;54:13-6.  Back to cited text no. 2
    [PUBMED]    
    3.
    Rajesh Kumar Jain S, Arun BJ, Paramjyothi GK. Role of fiberoptic bronchoscopy in patients with sputum smear negative for acid fast bacilli and chest X-Ray suggestive of pulmonary tuberculosis. J Evid Based Med Healthc 2015;2:155-64.  Back to cited text no. 3
        
    4.
    Fauzi AR, Balakrishnan L, Rathor MY. Usefulness of cytological specimens from bronchial brushings and bronchial washings in addition to endobronchial biopsies during bronchoscopy for lung cancer: 3 years data from a chest clinic in a general hospital. Med J Malaysia 2003;58:729-34.  Back to cited text no. 4
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    5.
    Gaur DS, Harsh M, Kishore S, Kohli S, Kusum A, Pathak VP. Efficacy of bronchial brushings and trans bronchial needle aspiration in diagnosing carcinoma lung. J Cytol 2007;24;46-50.  Back to cited text no. 5
        
    6.
    Raiza D, Rout S, Reddy KP, Ramalaxmi PV, Prithvi BK, Harikishan KS. Efficacy of bronchial wash and brush cytology and its correlation with biopsy in lung lesions. IJHRMIMS 2014;21-4.  Back to cited text no. 6
        
    7.
    Bodh A, Kaushal V, Kashyap S, Gulati A. Cytohistological correlation in diagnosis of lung tumors by using fiberoptic bronchoscopy: Study of 200 cases. Indian J Pathol Microbiol 2013;56:84-8.  Back to cited text no. 7
    [PUBMED]  Medknow Journal  
    8.
    Rawat J, Sindhwani G, Saini S, Kishore S, Kusum A, Sharma A. Usefulness and cost effectiveness of bronchial washing in diagnosing endobronchial malignancies. Lung India 2007;24:139-41.  Back to cited text no. 8
      Medknow Journal  



     
     
        Tables

      [Table 1], [Table 2]



     

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Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
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