The Role of Fiberoptic Bronchoscopy in the Diagnostic Algorithmof Solitary Pulmonary Nodule

The role of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodule is controversial. The aim of the study was to evaluate the results of routine bronchoscopy performed in patients with peripheral lung nodule of 5-40 mm in diameter. From 60 patients with peripheral lung nodule, who underwent routine diagnostic fiberoptic bronchoscopy between 2003 - 2005, we selected 36 patients in whom the final discrimination between malignant and benign tumor was achieved based on either pathological examination or radiological criteria (lack of growth within 2 years of radiological follow up). There were 22 (61%) patients with malignant tumor and 14 (39%) with benign nodule. All malignant tumors were lung carcinomas. In 10 of these patients we found macroscopic abnormalities during bronchoscopy and in 9 of them pathologic examination of specimens collected during the procedure could confirm malignant tissue. In two patients with benign lung nodule a second lung lesion (in different lung lobe) which proved to be lung cancer was identified during fiberoptic bronchoscopy. Sensitivity, specificity and diagnostic accuracy of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodules were 41%, 100%, and 64% respectively. Abandoning fiberoptic bronchoscopy in the diagnostic algorithm in patients with peripheral lung nodules seems unjustified, although its limitations should be taken into account.