Flexible Fiberoptic Bronchoscopy in the Teaching Hospital

We have prospectively analyzed the accuracy of and the rate of complications in 205 consecutive flexible fiberoptic bronchoscopic procedures, as performed in the setting of a teaching hospital. The objectives of the procedure were achieved in 89 percent of the cases, but the yield varied widely among 12 diagnostic and therapeutic subgroups. Except in the case of the peripheral nodule, a malignant neoplasm was correctly diagnosed or excluded with a sensitivity and specificity that were greater than 90 percent Diffuse pulmonary infiltrates in both immunosuppressed and normal hosts were histologically diagnosed via the fiberoptic bronchoscope in 83 percent (25) of the 30 cases. Transfiberoptic bronchoscopic lavage resulted in reexpansion of lobar atelectasis in 84 percent (16) of the 19 patients with nonmalignant inflammatory disease, but in only 25 percent (one) of the four patients with malignant neoplasms. The overall rate of complications (11 percent) is higher than has been reported by others. Severe bronchospasm occurred in three of four asthmatic patients and led to the death of one, while pneumothorax followed transbronchial biopsy in two immunosuppressed patients receiving therapy with corticosteroids. The flexible fiberoptic bronchoscopic procedure represents an extremely reliable tool in the diagnosis and treatment of a wide variety of pulmonary disorders; the morbidity is significant but acceptable.