A Survey on the Indications, Diagnostic Efficacy and Safety of Fiberoptic Bronchoscopy in Tikur Anbessa Specialized Hospital: Retrospective study from Dec, 2021 to Nov, 2023
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Date
2024-03
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Addis Ababa University
Abstract
Background:In the field of respiratory medicine, Fiberoptic bronchoscopy (FOB) is a crucial diagnostic tool for both infectious respiratory diseases including Tuberculosis and non-infectious conditions, including lung cancer since it allows for direct visualization and sampling of the airways. Given the fact that both are one of the leading causes of morbidity and mortality in Ethiopia and worldwide, a comprehensive retrospective analysis of its usage, safety and diagnostic yield is beneficial to optimize its integration into the hospital's diagnostic protocols.
Objective:This study aims to assess the indications, diagnostic efficacy and safety of FOB in the context of Tikur Anbessa Specialized Hospital (TASH) over a two-year period from December 2021 to November 2023.
Methods:This study systematically analyses electronic medical records, bronchoscopy procedural reports and pathology and microbiology reports from TASH over a two-year period spanning from December 2021 to November 2023. Data extraction focuses on patient demographics,smoking history, platelet count and coagulation profile, indications for the procedure,bronchoscopic procedures and finally the safety and diagnostic outcomes of all patients whoundergo bronchoscopy over the specified period of time. A waiver was taken from the IRB forthe Ethical aspect of the study and patients’ information is anonymised. Collected data isevaluated for consistency and completeness by the investigator. Following collection, data iscleaned, coded, and analysed by SPSS version 26 software.
Results:From a total of 227 bronchoscopies, records were available for 205 procedures, with a meanpatient age of 43.63 years. The majority were male (52.2%), and 83.9% fell within the agerange of 18-65 years. From the cases with HIV testing result, 11/108 (10.2%) were positive.Common indications for bronchoscopy include suspected mass or malignancy (45.85%),tuberculosis (28.29%), and airway inspection (13.66%). Comorbiditiessuch ashypertension(14.15%) and bronchiectasis (11.71%) were identified. Samples collected during bronchoscopyinclude bronchoalveolar lavage (78.54%), transbronchial biopsy (25.85%), and endobronchialbiopsy (10.24%). The overall diagnostic yield for FOB was 75.6%, with specific diagnosticyields for TB, sarcoidosis, and lung cancer at 41.38%, 45.45%, and 51.06%, respectively. Lungcancer was diagnosed in 23.41% of all cases, with adenocarcinoma (43.3%) being the mostprevalent subtype. Tuberculosis and sarcoidosis were diagnosed in 14.63% and 5.36% of cases,respectively. Most cases (93.17%) were complication-free, with minor bleeding, hypertension,hypoxemia, and pneumothorax (on 2 patients) observed in a small percentage.
Conclusion:Our study shows that the commonest indication for FOB is workup of suspected mass. FOB inTASH has a better yield compared to most other reports from Africa. The highest yield asexpected was when there was a visible mass and coupled with endobronchial sampling.Cytology from fluid analysis has the lowest yield for malignancy. The practice of FOB inTASH is a safe procedure and even though rare, blind transbronchial biopsy has a risk ofpneumothorax. The commonest histologic type of lung cancer identified is Adenocarcinomabut it was squamous cell carcinoma among smokers.
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FOB usage safety diagnostic yield TASH, , , ,