Concordance of Bronchoscopic and Radiological Findings in Suspected Lung Cancer and its Outcome- A Cross Sectional Study in a Tertiary Care Hospital

Abstract

Background: Bronchoscopy and CT thorax are the most common investigations utilized to screen and diagnose lung cancer. Their individual utility in diagnosing lung cancer has been described affirmatively in existing literature. Studies correlating the airway characteristics of the two modalities in lung cancer are limited. Objectives: To analyze and characterize lung lesions bronchoscopically and correlate the same radiologically by CT of the thorax and thus assess its positive predictive value. Methods: In this prospective study, 56 consecutive adults who presented to the Respiratory Medicine Department at a tertiary care hospital in South India from November 2018 to June 2020, having Clinico-radiological suspicion of malignancy and fulfilling study criteria, were recruited. They were subjected to CECT of thorax and bronchoscopy. All bronchoscopic procedures were performed using a protocolized number of passes for biopsy. The baseline demographic and clinical data, findings of bronchoscopy and CT and biopsy reports were recorded. Cohen’s kappa coefficient was used to estimate the agreement of findings on the two modalities. Statistical analysis was performed using SPSS software. Results: Bronchoscopy was normal in 22.14% of cases, the corresponding CTs also revealed normal airway. Bronchoscopy revealed airway lesions in 78.6% of cases; the corresponding CT revealed airway abnormalities in only 46.41% of cases; among these, 52.1% of cases revealed an exophytic growth. There was fair strength of agreement for the two modalities in the detection of airway lesions of lung cancer. (k = 0.38, p = <0.001). CECT thorax has a negative predictive value of 44%, a sensitivity of 59.1% and a specificity of 100% at 95% CI in the detection of airway lesions. Conclusion: CT may not be definitive in the evaluation of lung cancer, especially in those with central disease. A combination of the two modalities may improve the diagnostic outcome in patients with lung cancer.