User login
, according to a multisite study of current and former smokers with suspected lung cancer.
Bronchoscopy has long played a role in the identification of lung lesions, but the yield varies according to many factors associated with the lesion and the type of bronchoscopy, and recent studies suggest that the yield may be lower than previously thought, wrote Gerard A. Silvestri, MD, of Medical University of South Carolina, Charleston, and colleagues.
In a study published in Chest, the researchers sought to assess the yield of bronchoscopy based on procedure and characteristics, as well as the physician-calculated pretest probability of cancer.
They conducted a secondary analysis of 687 patients from the AEGIS trial, a prospective 28-site study of current and former smokers who underwent bronchoscopy for suspected lung cancer. Patients under 21, those without a history of smoking, and those with a concurrent cancer or history of lung cancer were excluded. The average age of the participants was 63 years, and two-thirds were male. Of these, 474 had diagnostic bronchoscopies and 213 had nondiagnostic bronchoscopies.
The overall diagnostic yield was 69%. However, the diagnostic yield significantly higher (80%) with the use of EBUS-TBNA, compared with 55% for standard bronchoscopy with biopsy +/– fluoroscopy, 57% for electromagnetic navigation, and 74% for combination procedures.
Patients with diagnostic bronchoscopies were significantly more likely than were those who had nondiagnostic bronchoscopies to have lesions greater than 3 cm (67% vs. 45%), to have central locations (75% vs. 50%), and to have lymphadenopathy (57% vs. 55%).
In addition, yields were significantly higher (77%) for patients whose preprocedure physician-assessed probability of cancer was at least 60%, compared with yields in those whose preprocedure physician-assessed probability of cancer was less than 10% or 10%-60% (44% and 42%, respectively).
The study findings were limited by several factors including the high prevalence of cancer in the study population, a 1-year follow-up that may have missed slow-growing cancers, and lack of data on the presence or absence of a bronchus sign, the researchers noted. However, the results were strengthened by the large size, mixture of sites, and use of multiple technologies and presentations, they said.
The study is the largest to assess diagnostic yields and various bronchoscopy techniques and supports EBUS-TBNA as the most reliable, but patient selection and improved procedural training can help improve diagnostic yields, the researchers emphasized.
“While the overall yield of bronchoscopy is reasonable, EBUS-TBNA is the only technique that reliably provides a diagnosis in those suspected of having lung cancer, likely because the biopsy is targeting a central lymph node and there is direct visualization of the needle passing into the target,” they said. However,“better bronchoscopic technology is needed and there are devices in the development pipeline that promise improved diagnostic yield, though these products will require evaluation through prospective comparative effectiveness trials prior to widespread adoption,” they noted. Clinicians should be prepared to pursue alternatives to bronchoscopy if a diagnosis is unlikely, they concluded.
Dr. Silvestri disclosed research grant awards to his university from Olympus America, Auris robotics, Veracyte, and Veran Medical, as well as consulting fees from Olympus and Auris robotics.
SOURCE: Silvestri GA et al. CHEST. 2020 Jan 21. doi: 10.1016/j.chest.2019.12.024.
, according to a multisite study of current and former smokers with suspected lung cancer.
Bronchoscopy has long played a role in the identification of lung lesions, but the yield varies according to many factors associated with the lesion and the type of bronchoscopy, and recent studies suggest that the yield may be lower than previously thought, wrote Gerard A. Silvestri, MD, of Medical University of South Carolina, Charleston, and colleagues.
In a study published in Chest, the researchers sought to assess the yield of bronchoscopy based on procedure and characteristics, as well as the physician-calculated pretest probability of cancer.
They conducted a secondary analysis of 687 patients from the AEGIS trial, a prospective 28-site study of current and former smokers who underwent bronchoscopy for suspected lung cancer. Patients under 21, those without a history of smoking, and those with a concurrent cancer or history of lung cancer were excluded. The average age of the participants was 63 years, and two-thirds were male. Of these, 474 had diagnostic bronchoscopies and 213 had nondiagnostic bronchoscopies.
The overall diagnostic yield was 69%. However, the diagnostic yield significantly higher (80%) with the use of EBUS-TBNA, compared with 55% for standard bronchoscopy with biopsy +/– fluoroscopy, 57% for electromagnetic navigation, and 74% for combination procedures.
Patients with diagnostic bronchoscopies were significantly more likely than were those who had nondiagnostic bronchoscopies to have lesions greater than 3 cm (67% vs. 45%), to have central locations (75% vs. 50%), and to have lymphadenopathy (57% vs. 55%).
In addition, yields were significantly higher (77%) for patients whose preprocedure physician-assessed probability of cancer was at least 60%, compared with yields in those whose preprocedure physician-assessed probability of cancer was less than 10% or 10%-60% (44% and 42%, respectively).
The study findings were limited by several factors including the high prevalence of cancer in the study population, a 1-year follow-up that may have missed slow-growing cancers, and lack of data on the presence or absence of a bronchus sign, the researchers noted. However, the results were strengthened by the large size, mixture of sites, and use of multiple technologies and presentations, they said.
The study is the largest to assess diagnostic yields and various bronchoscopy techniques and supports EBUS-TBNA as the most reliable, but patient selection and improved procedural training can help improve diagnostic yields, the researchers emphasized.
“While the overall yield of bronchoscopy is reasonable, EBUS-TBNA is the only technique that reliably provides a diagnosis in those suspected of having lung cancer, likely because the biopsy is targeting a central lymph node and there is direct visualization of the needle passing into the target,” they said. However,“better bronchoscopic technology is needed and there are devices in the development pipeline that promise improved diagnostic yield, though these products will require evaluation through prospective comparative effectiveness trials prior to widespread adoption,” they noted. Clinicians should be prepared to pursue alternatives to bronchoscopy if a diagnosis is unlikely, they concluded.
Dr. Silvestri disclosed research grant awards to his university from Olympus America, Auris robotics, Veracyte, and Veran Medical, as well as consulting fees from Olympus and Auris robotics.
SOURCE: Silvestri GA et al. CHEST. 2020 Jan 21. doi: 10.1016/j.chest.2019.12.024.
, according to a multisite study of current and former smokers with suspected lung cancer.
Bronchoscopy has long played a role in the identification of lung lesions, but the yield varies according to many factors associated with the lesion and the type of bronchoscopy, and recent studies suggest that the yield may be lower than previously thought, wrote Gerard A. Silvestri, MD, of Medical University of South Carolina, Charleston, and colleagues.
In a study published in Chest, the researchers sought to assess the yield of bronchoscopy based on procedure and characteristics, as well as the physician-calculated pretest probability of cancer.
They conducted a secondary analysis of 687 patients from the AEGIS trial, a prospective 28-site study of current and former smokers who underwent bronchoscopy for suspected lung cancer. Patients under 21, those without a history of smoking, and those with a concurrent cancer or history of lung cancer were excluded. The average age of the participants was 63 years, and two-thirds were male. Of these, 474 had diagnostic bronchoscopies and 213 had nondiagnostic bronchoscopies.
The overall diagnostic yield was 69%. However, the diagnostic yield significantly higher (80%) with the use of EBUS-TBNA, compared with 55% for standard bronchoscopy with biopsy +/– fluoroscopy, 57% for electromagnetic navigation, and 74% for combination procedures.
Patients with diagnostic bronchoscopies were significantly more likely than were those who had nondiagnostic bronchoscopies to have lesions greater than 3 cm (67% vs. 45%), to have central locations (75% vs. 50%), and to have lymphadenopathy (57% vs. 55%).
In addition, yields were significantly higher (77%) for patients whose preprocedure physician-assessed probability of cancer was at least 60%, compared with yields in those whose preprocedure physician-assessed probability of cancer was less than 10% or 10%-60% (44% and 42%, respectively).
The study findings were limited by several factors including the high prevalence of cancer in the study population, a 1-year follow-up that may have missed slow-growing cancers, and lack of data on the presence or absence of a bronchus sign, the researchers noted. However, the results were strengthened by the large size, mixture of sites, and use of multiple technologies and presentations, they said.
The study is the largest to assess diagnostic yields and various bronchoscopy techniques and supports EBUS-TBNA as the most reliable, but patient selection and improved procedural training can help improve diagnostic yields, the researchers emphasized.
“While the overall yield of bronchoscopy is reasonable, EBUS-TBNA is the only technique that reliably provides a diagnosis in those suspected of having lung cancer, likely because the biopsy is targeting a central lymph node and there is direct visualization of the needle passing into the target,” they said. However,“better bronchoscopic technology is needed and there are devices in the development pipeline that promise improved diagnostic yield, though these products will require evaluation through prospective comparative effectiveness trials prior to widespread adoption,” they noted. Clinicians should be prepared to pursue alternatives to bronchoscopy if a diagnosis is unlikely, they concluded.
Dr. Silvestri disclosed research grant awards to his university from Olympus America, Auris robotics, Veracyte, and Veran Medical, as well as consulting fees from Olympus and Auris robotics.
SOURCE: Silvestri GA et al. CHEST. 2020 Jan 21. doi: 10.1016/j.chest.2019.12.024.
FROM CHEST