Bronchoscopy to assess patients with hemoptysis: which is the optimal timing?

BMC Pulmonary Medicine

Giuseppe Cipolla¹  Silvia Marani²  Giovanni Sotgiu³  Stefano Gasparini⁴  Michele Mondoni⁵  Paolo Carlucci⁵  Stefano Centanni⁵  Alessandro Fois⁶ 

[1] ASST Lodi, UOC Pneumologia;ASST Mantova, Dipartimento Cardio-Toraco-Vascolare, Unità Operativa di Pneumologia e UTIR;Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari;Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche;Department of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo Hospital;Lung Disease Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari;

关键词: Bronchoscopy;    Hemoptysis;    Lung cancer;    Bronchiectasis;    Pneumonia;   

DOI  :  10.1186/s12890-019-0795-9

来源: DOAJ

【 摘 要 】

Abstract Background Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53–76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration ClinicalTrials.gov (identifier: NCT02045394).

【 授权许可】

Unknown