Number of procedures and time needed to diagnose lung cancer: Being right the first time

Aim: To study the number of procedures and time taken to diagnose lung cancer and factors that cause a delay in diagnosis. Methods: A retrospective analysis of patients who consecutively underwent diagnostic bronchoscopy in 1 year (October 2013 – September 2014) and were diagnosed with lung cancer. Results: 101 patients were diagnosed with lung cancer from bronchoscopy. Average time interval between 1st abnormal computed tomogram (CT) scan to 1st procedure, 1st procedure to diagnosis, and 1st abnormal CT scan to diagnosis was 16±26, 11±19, and 27±33 days respectively. Multivariate analysis revealed inconclusive 1st procedure to be the predictor of prolonged (>30 days) CT scan to diagnosis time (p=0.041). 29 patients (28.7%) required repeat procedures (n=63). The reasons behind the need for repeat procedures was inadequate sample obtained (n=14), inaccessibility of the lesion (n=9), inappropriate procedure (n=5), mutation analysis (n=2), and others (n=2). 50 patients had visible endo-bronchial lesion, 20 had positive bronchus sign, and 83 had enlarged mediastinal/hilar lymph-nodes or central masses adjacent to the airways. Fewer procedures, and shorter procedure to diagnosis time were observed in those who underwent convex probe endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) (p=0.004). Conclusion: Most patients exhibit enlarged mediastinal lymph node or mass adjacent to the central airway accessible by convex probe EBUS-TBNA. Hence combining it with the conventional bronchoscopic techniques like bronchoalveolar lavage, brush and forceps biopsy, increases detection rate, and reduces number of procedures and time needed to establish the diagnosis of lung cancer.