CLINICO-PATHOLOGICAL PROFILE OF BRONCHOSCOPICALLY INVISIBLE MALIGNANT PERIPHERAL PULMONARY LESIONS DIAGNOSED IN A TERTIARY CARE CENTER

Background: With the evolution of risk factors along with development of newer diagnostic tools, the clinical and pathological characteristics of lung cancers show a changing trend over time. The diagnosis of lung cancers presenting as peripheral pulmonary lesions (PPL) remains a challenge. This study aims to look at the current trend of PPLs who underwent diagnostic workup in a tertiary care center located in India. Methods: This retrospective analysis using a prospectively maintained hospital database was performed in patients who underwent diagnostic evaluation of PPLs and were subsequently diagnosed with lung cancer. Radial probe endobronchial ultrasound (RP-EBUS) guided biopsy was the initial diagnostic modality used. The data was processed and analyzed using the Microsoft Excel Sheet version 2013 and SPSS version 20. Results: Sixty patients underwent evaluation for PPLs during the study period. Lung cancer was the final diagnosis in 27 patients. Mean age was 60±12 years and 21 (77.8%) were females. Majority of patients were either current (n=13, 48%) or reformed (n=8, 29.6%) smokers. Adenocarcinoma (n=17, 62.9%) was the most common pathological diagnosis. The most common location of the lesions was upper lobes (n=19, 70.4%) followed by right lower lobe (n=5, 18.5%). Two patients developed pneumothorax and respiratory failure requiring intubation, one with terminal stage adenocarcinoma died during hospitalization. Conclusions: The presence of adenocarcinoma, female sex, smoking status and upper lobe predominance reflects the current trend of peripheral lung cancers. RP-EBUS is a newer modality and may be a useful initial diagnostic tool for PPLs and with a good safety profile.