Primarily; bronchoscopy is a diagnostic device. Bronchoscopy is most frequently used for searching the causes of respiratory symptoms such as hemoptysis, coughing and unexpressed, especially one-sided wheezy respiration in patients with normal chest graph and tomography. Other primary indications are listed as centrally located lung mass, volume depletion on chest x-ray, pneumopyothorax, permanent infiltrations, deviation in trachea and main bronchi, unexplained pleural effusions or the examination of the airways in diaphragm elevations.
Additionally, bronchoscopy is used in peripheral lesions, in presence of hilar-mediastinal lymphadenopathy, in peripheric sampling of the lung in pulmonary parenchymal diseases. Lastly, bronchoscopy provides useful information for the evaluations of patients with positive sputum cytology in spite of their normal radiographic findings at stage of lung cancer, of airways with the possibility of foreign bodies or thoracic trauma.
Indications are summarized in Table-1.
Table 1: Indications for bronchoscopy
- Evaluations of symptoms (hemoptysis, localized “wheeze”, unexplained cough lasting longer than 3 weeks)
- Evaluation of bronchial disease (tumor, foreign body, stricture, fistula, mucus plug, thermal harm)
- Evaluations of abnormalities in chest x-ray (mass, infiltration, atelectasis, pleural effusion).
- Evaluations of hilar and mediastinal lymph nodes with endobronchial ultrasonography.
II. With the intent of monitoring the course of disease
- Lung transplantation
- Staging of lung cancer
III. Therapeutic / interventional
- Foreign body removal
- Endobronchial laser, cryo, argon and electrocauterization
- Endobronchial stent application
IV. For research purpose
- Bronchoalveolar lavage application in diffuse lung diseases
- Endobronchial biopsy and brushing in asthma
As it is seen in indications, bronchoscopy is mostly used for diagnosis and staging of lung cancer. This procedure, previously made with rigid bronchoscopes, is now performed predominantly with fiberoptic bronchoscopes. Rigid bronchoscopy, on the other hand, maintains its importance predominantly in the applications of therapeutic bronchoscopy. Indications are given in Table-2. As fiberoptic bronchoscopy (FB) applications are much more common in other countries as in our country, information about FB will be presented here.
Table 2: Indications for rigid bronchoscopy
- Massive hemoptysis
- Foreign body removal
- Mechanical resection
- Mechanical dilatation
- Treatment of tracheobronchial stenosis
While FB has a high diagnostic value such as 90-95% in tumors of the central airways, in peripheral lung carcinomas; this rate decreases to 50-60%. The diagnostic value is around 30% in peripheral tumors smaller than 3 cm. With this method, which has the lower rate of complications, other lung diseases can be diagnosed. The overall diagnostic value varies between 55-75% depending on the indications of diagnostic bronchoscopy.
Table 3- Bronchoscopy contraindications:
- As a result of 100% O2 application; if PaO2 remains <60 mmHg – Type II respiratory failure
- Severe bronchospasm
- Unstable asthma
- Cardiovascular diseases (MI within 6 months, stabilized angina, arrhythmia, hypertension)
- The presence of cerebrovascular pathology
- Increased intracranial pressure
- Existence of convulsion
- Bleeding diathesis
- Thrombocytopenia (<20,000 / mm3 for BAL, <50,000 / mm3 for biopsy)
- Platelet dysfunction
- Severe anemia
- Portal hypertension