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(Chest. 2003;124:1985-1992.)
© 2003 American College of Chest Physicians

Diagnostic Accuracy and Safety of Flexible Bronchoscopy With Multiplanar Reconstruction Images and Ultrafast Papanicolaou Stain*

Evaluating Solitary Pulmonary Nodules

Shuji Bandoh, MD, PhD; Jiro Fujita, MD, PhD, FCCP; Yasunori Tojo, MD; Hiroyasu Yokomise, MD; Katashi Satoh, MD, PhD; Shoji Kobayashi, MD, PhD and Toshihiko Ishida, MD, PhD

* From the First Department of Internal Medicine (Drs. Bandoh, Fujita, Tojo, and Ishida), Second Department of Surgery (Dr. Yokomise), Department of Radiology (Dr. Satoh), and Department of Diagnostic Pathology (Dr. Kobayashi), Kagawa Medical University, Kagawa, Japan.

Correspondence to: Shuji Bandoh, MD, PhD, First Department of Internal Medicine, Kagawa Medical University, 1750-1, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan; e-mail: sbandoh{at}mailbox.kms.ac.jp

Study objectives: To assess the diagnostic accuracy and safety of flexible bronchoscopy with multiplanar reconstruction (MPR) images and ultrafast Papanicolaou (UFP) stain in evaluating solitary pulmonary nodules (SPNs).

Design: Prospective study of bronchoscopies performed between June 2000 and June 2002.

Patients: One hundred consecutive patients with SPNs underwent bronchoscopy with MPR and UFP (MPR and UFP group). The data on historical control were collected in a retrospective fashion, between July 1997 and June 2000.

Method: All information obtained from MPR regarding the leading bronchus of the SPNs was used to guide biopsy. Samples obtained by curette biopsies were stained with UFP and evaluated by a cytopathologist during the bronchoscopy procedure.

Results: There were 88 malignant and 12 benign lesions in the MPR and UFP group, and 97 malignant and 3 benign lesions in the historical control group. The total diagnostic accuracy of bronchoscopy in the MPR and UFP group (91%) was significantly higher compared with the historical control group (58%) [p < 0.05]. Although the yield of bronchoscopy was significantly related to the lesion size in the historical control group (p < 0.05), there was no significant association between the diagnostic yield and lesion size in the MPR and UFP group. The diagnostic yield for SPNs < 4.0 cm in the MPR and UFP group was significantly higher compared with the historical control group (p < 0.05). In addition, the diagnostic yield in both upper lobes in the MPR and UFP group was significantly higher compared with the historical control group (p < 0.05). On the contrary, the complication rate was significantly lower in the MPR and UFP group (2%) compared with the historical control group (13%) [p < 0.05].

Conclusion: Combined use of the MPR image and UFP during flexible bronchoscopy improved diagnostic accuracy and safety in evaluating SPNs using a double-hinged curette.

Key Words: flexible bronchoscopy • multiplanar reconstruction image • solitary pulmonary nodule • transbronchial biopsy • ultrafast Papanicolaou




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