Diagnosis of Peripherally Located Bronchogenic Carcinoma: Utility of Non-Guided Flexible Bronchoscopy

Background: The role of flexible bronchoscopy in diagnosis of peripheral pulmonary neoplasia remains controversial.  Aim of the work: To assess the diagnostic yield of non-guided flexible bronchoscopy biopsy techniques in diagnosis of peripherally located bronchogenic carcinoma. Patients and Methods:This cross-sectional study was conducted on 49 out of 85 patients with confirmed bronchogenic carcinoma; they were subjected to flexible bronchoscopy forceps biopsy [FB], bronchoalveolar lavage [BAL], transbronchial needle aspiration [TBNA], and bronchial brushing [BB]. Results: Diagnostic yield of bronchoscopy was positive in 40.8%. The procedures were; BAL in 26.5% of patients with positive yield in 15.0%, FB in 18.4% of patients with positive yield in 70.0%, TBNA in 26.5% of patients with no positive yield [0.0%] and BB in 18.4% of patients with positive yield in 15.0%. More than ≥6 Biopsy were taken in 79.6% and < 6 biopsies was taken in 20.4%. Lesions in the lower lobes had a high diagnostic yield [60.0%] [P0.007]. Lesions > 3cm had a diagnostic yield of 70% compared to 30 % in lesions ≤ 3 cm [P 0.001]. Cases with CT-Bronchus sign had a higher diagnostic yield [85.0%] [p 0.003]. Also, ≥ 6 Biopsy had higher diagnostic yield than those with lesions ˂ 3cm [100.0% and 34.5% respectively] [P 0.003]. The presence of bronchial lesions and its lobar locations had higher diagnostic yield. Conclusion: The diagnostic yield of bronchoscopy in peripherally locating bronchogenic carcinoma depends on a several factors, including lower lobe location, lesion size≥ 3cm, presence of CT bronchus sign, presence of bronchial lesion, and ≥ 6 biopsies.