Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy

Study objectives: To determine the extent to which on-site cytopathology assessment improves diagnostic yield when sampling lung nodules or masses and/or hilar or mediastinal lymphadenopathy by fiberoptic bronchoscopy (FOB), Design : Prospective cohort study. Setting: Two teaching hospitals in Baltimore, MD. Patients: Consecutive adult patients (greater than or equal to 18 years) undergoing FOE for evaluation of lung nodules or masses and/or hilar or mediastinal lymphadenopathy. Intervention: Prospective collection of data on patient factors and details of the procedure on standardized report forms, Measurements a,ln results: The primary outcome measure was a new diagnosis obtained by FOE. On-site assessment was used in 81 of 204 cases (40%), and overall diagnostic yield was 62%. Yield was greater when on-site cytopathology assessment was used, in unadjusted analysis (81% vs 50%, p < 0.001) and in a multivariate model (odds ratio, 4.5; 95% confidence interval, 2.1 to 10.0), Other significant predictors of a new diagnosis included older patient age, higher dose of narcotic used during FOE, and shorter procedure time, Conclusions: We conclude that diagnostic yield was greater when on-site cytopathology was used to assist FOE evaluation of intrathoracic adenopathy an(Vor lung nodules or masses. increasing the use of on-site cytopathology assessment may improve the quality of FOE services.