Diagnostic Yield of Different Bronchoscopic Procedures for Lung Cancer: A Retrospective Study

1. Assistant Professor, Department of Respiratory Medicine, B J Medical College, Ahmedabad, Gujarat, India. 2. Associate Professor, Department of Respiratory Medicine, GMERS Medical College, Himmatnagar, Gujarat, India. 3. Assistant Professor, Department of Respiratory Medicine, GMERS Medical College, Sola, Ahmedabad, Gujarat, India. 4. Resident, Department of Community Medicine, B J Medical College, Ahmedabad, Gujarat, India.

Abstract

Introduction: Lung cancer represents the leading cause of cancer-related mortality globally, accounting for 1.76 million deaths annually worldwide. Flexible bronchoscopy remains the cornerstone diagnostic procedure for suspected pulmonary malignancy, offering multiple sampling techniques with varying diagnostic efficacy. Limited comparative data exists regarding optimal technique selection across different tumour presentations and morphological patterns in resource-constrained healthcare settings.

Aim: To study comparison between different bronchoscopy techniques like Bronchial Brushings (BB), bronchial biopsy, and Bronchoalveolar Lavage (BAL) for diagnosis of lung cancer across different tumour locations and morphological patterns.

Materials and Methods: The present hospital-based retrospective observational study was conducted at the Department of Pulmonary Medicine, BJ Medical College, Ahmedabad, Gujarat, India, data was collected from September 2018 to September 2020 and analysed during 2024-2025. A total of 50 patients aged ≥18 years with histopathologically confirmed lung malignancy who underwent diagnostic bronchoscopy were included. Given the retrospective nature utilising de-identified data, formal ethical clearance was exempted with verbal departmental approval obtained. Parameters which were evaluated include diagnostic yields of BBs, bronchial biopsy, and BAL across different tumour locations and morphological patterns, demographic characteristics, clinical presentations, smoking associations, radiological findings, and procedural complications. Statistical analysis was done using Microsoft Excel 2019 and R software version 4.0, utilising Chi-square tests for categorical variables, Fisher's-exact test when expected frequencies were <5, independent t-tests for continuous variables, and proportion tests for diagnostic yield comparisons, with significance defined as p <0.05.

Results: Patient demographics were male predominance with 34 patients (68.0%) versus 16 females (32.0%), and elderly clustering with 34 patients (68.0%) between 66-80 years. Exposure to smoking affected 33 patients (66.0%), with strong association with squamous cell carcinoma (14/16 cases, 87.5%) whereas adenocarcininoma was equally distributed as in smokers (10 cases, 20.0%) versus non-smokers (10 cases, 20.0%). BBs yielded superior diagnostic yields of 16/25 procedures (64.0%, 95% CI: 42.5-82.0) in central tumours and 10/14 procedures (71.4%, 95% CI: 41.9-91.6) in peripheral lesions significantly better than bronchial biopsy (12/22 procedures, 54.5% central; 7/12 procedures, 58.3% peripheral) and Bronchial Washing (BW) (4/30 procedures, 13.3% central; 3/20 procedures, 15.0% peripheral). Brushings continued to outperform all patterns of morphology, with 66.7% yield in difficult mucosal irregularity cases. Adenocarcinoma was the most frequent (20 cases, 40.0%), followed by squamous cell carcinoma (16 cases, 32.0%). Total complications affected 16 patients (32.0%), primarily bleeding (12 cases, 24.0%) and pneumothorax (3 cases, 6.0%).

Conclusion: These findings provide evidence-based support for prioritising BBs in lung cancer diagnostic protocols, particularly valuable for resource-limited healthcare settings seeking optimal conventional techniques.

Bronchoalveolar lavage, Bronchial brushing, Bronchial washing