Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules.

STUDY OBJECTIVES To evaluate factors affecting the diagnostic yield of flexible fiberoptic bronchoscopy in evaluating solitary pulmonary nodules (SPNs). DESIGN Retrospective analysis of bronchoscopies performed over a 4-year period. SETTING A tertiary teaching hospital. PATIENTS One hundred seventy-seven patients with pulmonary nodules without endobronchial lesions who underwent bronchoscopy with brushing, washing, and transbronchial biopsy. RESULTS There were 151 malignant and 26 benign lesions. The diagnostic accuracy of bronchoscopy in malignant and benign lesions were 64% (97 of 151) and 35% (9 of 26), respectively. The yield of bronchoscopy was directly related to lesion size (p < 0.001, chi(2)). When lesions were grouped according to distance from the hilum, yields of bronchoscopy in central, intermediate, and peripherally located lesions were 82, 61, and 53%, respectively (p = 0.05, chi(2)). When we stratified distance from the hilum by lesion size, the difference in yield was not significant. However, lesions </= 2 cm had a diagnostic yield of 14% (2 of 14) when located in the peripheral third vs 31% (5 of 16) when located in the inner two thirds of the lung. There was a trend toward higher combined diagnostic yield in right middle and lingular lobes when compared to all other segments (p = 0.09, chi(2)). Transbronchial biopsy, washing, and brushing were complementary in improving the yield of bronchoscopy. CONCLUSIONS Size is the strongest determinant of diagnostic yield in bronchoscopy when evaluating SPNs. The yield of bronchoscopy is particularly low in lesions </= 2 cm that are located in the outer third of the lung. Thus, alternative diagnostic approaches may be preferable in this situation.