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The Role of Conventional Bronchoscopy in the Workup of Suspicious CT Scan Screen-Detected Pulmonary Nodules.
van 't Westeinde, Susan C. MD; Horeweg, Nanda MD; Vernhout, Rene M. MD; Groen, Harry J. M. MD, PhD; Lammers, Jan-Willem J. MD, PhD; Weenink, Carla MD; Nackaerts, Kristiaan MD, PhD; Oudkerk, Matthijs MD, PhD; Mali, Willem MD, PhD; Thunnissen, Frederik B. MD, PhD; de Koning, Harry J. MD, PhD; van Klaveren, Rob J. MD, PhD
[Article] Chest. 142(2):377-384, August 2012.

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Background: Up to 50% of the participants in CT scan lung cancer screening trials have at least one pulmonary nodule. To date, the role of conventional bronchoscopy in the workup of suspicious screen-detected pulmonary nodules 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 with a positive result on a CT scan lung cancer screening between April 2004 and December 2008 were enrolled. The diagnostic sensitivity and negative predictive value 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 participants. The mean /- SD diameter of the nodules was 14.6 /- 8.7 mm, whereas only 2.8% of nodules were > 30 mm in diameter. The sensitivity of bronchoscopy was 13.5% (95% CI, 9.0%-19.6%); the specificity, 100%; the positive predictive value, 100%; and the negative predictive value, 47.6% (95% CI, 41.8%-53.5%). Of all cancers detected, 1% were detected by bronchoscopy only and were retrospectively invisible on both low-dose CT scan and CT scan with IV contrast.

Conclusion: Conventional white-light bronchoscopy should not be routinely recommended for patients with positive test results in a lung cancer screening program.

Trial registration: Nederlands Trial Register; No.: ISRCTN63545820; URL: www.trialregister.nl.