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The role of conventional bronchoscopy in the work-up of suspicious CT screen detected pulmonary nodules.
MedLine Citation:
PMID:  22302298     Owner:  NLM     Status:  Publisher    
ABSTRACT: BACKGROUND:Up to 50% of the participants in computer tomography (CT) lung cancer screening trials have at least one pulmonary nodule. The role of a conventional bronchoscopy in the work-up of suspicious screen-detected pulmonary nodules to date is unknown. If a bronchoscopic evaluation could be eliminated, the cost-effectiveness of a screening program could be enhanced and the potential harms of bronchoscopy avoided. METHODS:All consecutive participants showing a positive test result between April 2004 and December 2008 were enrolled. The diagnostic sensitivity and negative predictive value (NPV) were calculated at the level of the suspicious nodules. In 95% of the nodules the gold standard for the outcome of the bronchoscopy was based on surgical resection specimens. RESULTS:A total of 318 suspicious lesions were evaluated by bronchoscopy in 308 subjects. The diameter of the nodules averaged 14.6 mm (SD: 8.7) while only 2.8% of nodules were> 30 mm in diameter. The sensitivity of bronchoscopy was 13.5% (95% confidence interval (CI): 9.0%-19.6%), the specificity 100%, the PPV 100% and the NPV 47.6% (95% CI: 41.8%-53.5%) Of all cancers detected, 1% was detected by bronchoscopy only and retrospectively invisible on both low-dose CT and CT with intravenous contrast. CONCLUSION:Conventional white-light bronchoscopy should not be routinely recommended for test-positive participants in a lung cancer screening program.
Susan C van 't Westeinde; Nanda Horeweg; René M Vernhout; Harry J M Groen; Jan-Willem J Lammers; Carla Weenink; Kristiaan Nackaerts; Matthijs Oudkerk; Willem Mali; Frederik B Thunnissen; Harry J de Koning; Rob J van Klaveren
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-2
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Department of Pulmonary Medicine, Erasmus MC Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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