Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: Discussion

Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: DiscussionApart from the diagnosis of cancer, fiberoptic bronchoscopy contributed little to the evaluation of hemoptysis. Except for the two cases of tracheitis and some cases of bronchitis, the non-cancer diagnoses listed in Table 2 were based on clinical presentation rather than on bronchoscopic findings. With regard to bronchitis, only 26 of 54 patients ultimately given this diagnosis had mucosal inflammation seen at bronchoscopy, and nine patients who had such inflammation received diagnoses other than bronchitis.
There were no complications of fiberoptic bronchoscopy reported in this series. fully

Discussion
Six of 106 men more than 40 years old who underwent fiberoptic bronchoscopy for hemoptysis and a nonsuspicious chest roentgenogram were discovered to have cancer, a rate of 5.7 percent. This represents one cancer detected for every 18 bronchoscopic examinations performed. This finding does not support the conclusion of several other studies regarding the benign nature of this presentation, at least in older men with substantial smoking histories. Rather, our results are similar to the 8.5 percent cancer rate in patients more than 50 years old reported by Poe et al in the only other large series of older patients.
Because patients less than 40 years old with hemoptysis and a nonsuspicious chest roentgenogram have been previously shown to be at negligible risk for lung cancer, the present study was limited to older patients. Even so, age remained an important predictor of cancer in this series. A history of heavy smoking also has been previously shown to be a predictor of lung cancer in patients with hemoptysis and a nonsuspicious chest roentgenogram. Our series contained too few nonsmokers for comparison, but one third of our patients had not smoked in five years and no cancers were found in this group. This finding is consistent with the well described reduction in lung cancer risk associated with prolonged smoking cessation.

Category: Bronchoscopy

Tags: bronchoscopy, chest roentgenogram, hemoptysis, lung cancer