FIBREOPTIC BRONCHOSCOPY

One of the common indications for fibreoptic bronchoscopy in clinical practiceis patients presenting with radiological hilar and parahilar mass lesions. The study was aimed at better understandingof disease pattern on fibreoptic bronchoscopy in such patients. Objectives: To determine frequency of variousdiseases confirmed on fibreoptic bronchoscopies conducted for hilar and parahilar radiological opacities. Determine thefrequency of complications during fibreoptic bronchoscopy. Design: Descriptive study. Place and Duration of Study:This study was conducted at Military Hospital Rawalpindi from June 2002 to Dec 2002, which is a tertiary carehospital for armed forces. Materials & Methods: Sixty patients undergoing fibreoptic bronchoscopy for hilar andparahilar opacities were included in the study. Endobronchial biopsies, bronchial washing and brushing were performedfor histopathological and cytological analysis. Results: The most frequent finding on Bronchoscopy was anendobronchial mass lesion in 41 (68.3%) cases followed by inflammatory changes in 5(8.4%) and external compressionin 7(12%) cases. No endobronchial mass was seen in 7(12%) patients. Diagnostic yield was highest in patients in whoma mass lesion was seen on bronchoscopy, yielding a diagnosis in 97.5% of cases. Bronchogenic carcinoma was themost common diagnosis( 87.8%) in such cases with squamous cell carcinoma as the most frequent subtype 24 (58.5%).The diagnostic yield was low when either inflammatory changes, external compression or normal bronchial findings wereobserved on bronchoscopy. Overall Histopathological and cytological examination of the biopsies showed bronchogeniccarcinoma in 40(65%) cases, squamous cell in 28(70%) cases, small cell in 10 (25%) cases and adenocarcinoma in2(5%) cases, squamous metaplasia in 3(5%), non-specific inflammation in 7(10%), chronic non-caseatinggranulomatous inflammation in 2(3.3%) and caseating granuloma (tuberculosis) in 1(1.7%) case. No large cell orundifferentiated carcinoma was seen in this study. No histological diagnosis could be made in 8(14%) cases. Majorbleed occurred in one (1.6%) case who had a highly vascular tumor bleeding on biopsy. Minor bleed was seen in 3(5%)cases and marked fall in O2 saturation was noted in 2(3.3%) patients. No complications were observed in 54(90%)patients. Conclusion: Fibreoptic bronchoscopy is a high yield diagnostic procedure in hilar and parahilar lung shadowsand is completely safe and is highly recommended in all such cases as most will have malignant tumors requiringhistological diagnosis. Tuberculosis is an uncommon diagnosis in such patients. Complications of the procedure arefew and mostly minor .