FIBREOPTIC BRONCHOSCOPY

DIAGNOSTIC OUTCOME AND COMPLICATIONS IN PATIENTS WITH HILAR AND PARAHILAR LUNG OPACITIES

Abstract

One of the common indications for fibreoptic bronchoscopy in clinical practice
is patients presenting with radiological hilar and parahilar mass lesions. The study was aimed at better understanding
of disease pattern on fibreoptic bronchoscopy in such patients. Objectives: To determine frequency of various
diseases confirmed on fibreoptic bronchoscopies conducted for hilar and parahilar radiological opacities. Determine the
frequency of complications during fibreoptic bronchoscopy. Design: Descriptive study. Place and Duration of Study:
This study was conducted at Military Hospital Rawalpindi from June 2002 to Dec 2002, which is a tertiary care
hospital for armed forces. Materials & Methods: Sixty patients undergoing fibreoptic bronchoscopy for hilar and
parahilar opacities were included in the study. Endobronchial biopsies, bronchial washing and brushing were performed
for histopathological and cytological analysis. Results: The most frequent finding on Bronchoscopy was an
endobronchial mass lesion in 41 (68.3%) cases followed by inflammatory changes in 5(8.4%) and external compression
in 7(12%) cases. No endobronchial mass was seen in 7(12%) patients. Diagnostic yield was highest in patients in whom
a mass lesion was seen on bronchoscopy, yielding a diagnosis in 97.5% of cases. Bronchogenic carcinoma was the
most common diagnosis( 87.8%) in such cases with squamous cell carcinoma as the most frequent subtype 24 (58.5%).
The diagnostic yield was low when either inflammatory changes, external compression or normal bronchial findings were
observed on bronchoscopy. Overall Histopathological and cytological examination of the biopsies showed bronchogenic
carcinoma in 40(65%) cases, squamous cell in 28(70%) cases, small cell in 10 (25%) cases and adenocarcinoma in
2(5%) cases, squamous metaplasia in 3(5%), non-specific inflammation in 7(10%), chronic non-caseating
granulomatous inflammation in 2(3.3%) and caseating granuloma (tuberculosis) in 1(1.7%) case. No large cell or
undifferentiated carcinoma was seen in this study. No histological diagnosis could be made in 8(14%) cases. Major
bleed occurred in one (1.6%) case who had a highly vascular tumor bleeding on biopsy. Minor bleed was seen in 3(5%)
cases and marked fall in O2 saturation was noted in 2(3.3%) patients. No complications were observed in 54(90%)
patients. Conclusion: Fibreoptic bronchoscopy is a high yield diagnostic procedure in hilar and parahilar lung shadows
and is completely safe and is highly recommended in all such cases as most will have malignant tumors requiring
histological diagnosis. Tuberculosis is an uncommon diagnosis in such patients. Complications of the procedure are
few and mostly minor .