Diagnostic accuracy of flexible bronchoscopy for lung cancer diagnosis in an expert center

Introduction: Bronchoscopy plays a major role in lung cancer diagnosis. In this retrospective study we report clinical effectiveness of bronchoscopy when performed in first line for lung cancer diagnosis in Toulouse university expert center during the year 2017. Materials and Methods: We retrospectively reviewed all patients diagnosed with lung cancer in 2017, who underwent flexible bronchoscopy as first line diagnostic tool and collected the repartition of the different techniques, their respective yields as well as the alternative techniques in cases of failures. Results: Diagnosis of lung cancer was obtained using bronchoscopy in 333 of 377 patients (89%). This includes advanced bronchoscopy techniques such as radial-probe EBUS (RP-EBUS) alone or associated with electromagnetic navigation bronchoscopy (ENB) (n=149). Diagnosis was obtained using RP-EBUS in 113 patients, with a diagnostic yield 76%. We performed RP-EBUS under general anesthesia for 90 patients and under local anesthesia for 59 patients. Final diagnosis was adenocarcinoma in 203 patients (54%), squamous cell carcinoma in 90 patients (24%) and small-cell carcinoma in 47 patients (12%). In cases where bronchoscopy failed, diagnosis was obtained with CT-guided fine needle aspiration in 21 patients (6%), surgery in 5 patients (1%) and other approaches in 17 patients (4%) including patients who were treated by radiotherapy or radiofrequency thermoablation without histology. Conclusion: This study highlights the major place taken by bronchoscopy, in particular new guidance techniques, for the diagnosis of lung cancer in an expert center