B. J. Arun1, Guruprasad Antin2, B. Vidyasagar3
INTRODUCTION: Endobronchial examination was first carried out in the last decade of nineteenth century for the purpose of removing inhaled foreign bodies, and as long as 1904 a rigid bronchoscope with provision for suction & illumination came into use(1) Technologic advances during the next century facilitated development of bronchoscopy as a pivotal diagnostic tool in pulmonary medicine. The Diagnostic and therapeutic indications of fiberoptic bronchoscopy are many. Also new instruments and techniques such as transbronchial needle aspiration, Cryo, Laser, Endobronchial ultrasound will continue to expand the utility and importance of flexible bronchoscopy. This study is an attempt to analyze the role of fiberoptic bronchoscopy in the diagnostic application of suspected cases of lung malignancy at our tertiary care hospital. MATERIAL AND METHODS: After informed consent, detailed history and clinical examination along with relevant investigations were done in patients with a Clinico-radiological suspicion of malignancy. Then the patients underwent diagnostic fiberoptic bronchoscopy as per British Thoracic Society (BTS) guidelines along with biopsy brushings and bronchio-alveolar lavage where relevant, specimens were analyzed by histopathological evaluation and cytology and tabulated. RESULTS: Of the 54 patients included in the study, 46 (85.19%) were males and 8 (14.81%) were females. The age group among the patients studied varied from 35 to 85 with mean age of 60.91. The diagnostic yield of bronchial washings, brushings and forceps biopsy were 54.13%, 85.71% and 95.65% for endoscopically visible lesions and it is 37.04%, 60% and 55.56% for endoscopically not visible lesions. Bronchoscopy resulted in a definitive diagnosis in more than half of the patients analyzed in our study with a positive yield of 59.26%. Among the 39 patients with definite diagnosis of malignancy, most common cell type in our study was of Squamous Cell Carcinoma occurring in 16 (41%) patients. The complications following bronchoscopic procedure were very few, minor hemorrhage following forceps biopsy and respiratory distress requiring observation was seen in 2(3.70%) patients, Hypoxia requiring postponement of the procedure occurred in 1(1.85%) patient. CONCLUSIONS: Males constituted majority of our study population (85.19%) with mean age of 60.91. The most common symptom in our study was cough followed by breathlessness. FOB was extremely useful in the diagnosis of malignancy, with a overall positive diagnosis following FOB in more than half of the patients(59.26%), forceps biopsy being the most yielding procedure with an overall yield of 84.38%, more so among endobronchially visible lesions. Trivial complications associated with bronchoscopy, makes it a safe procedure in our selected cases.