Investigation of the effectiveness of interventional methods used in diagnosis of lung cancer

Objective: Lung cancer has become an important public health problem since the middle of the 20th century, especially with the increase in smoking. Lung cancer is a disease that occurs as a combination of carcinogen exposure and genetic predisposition. The annual incidence of lung cancer is reported as 19.6 per hundred thousand in developed countries and 11.1 per hundred thousand in developing countries. It is the most common type of cancer in men in developing countries. In developed and developing countries, lung cancer ranks first in mortality rate in men. Most of the patients are in the advanced stage at the time of diagnosis and there is no chance of surgery. Fiberoptic bronchoscopy (FOB) is the leading diagnostic method used in patients diagnosed with lung cancer. Today, transthoracic needle aspiration biopsy (TTIAB) is another diagnostic method that is increasingly used. In our study, we aimed to examine the contribution of biopsy types to the diagnosis, especially in patients diagnosed with pathological tissue with FOB. Our aim is to contribute to the rapid and effective pathological diagnosis in the light of the obtained data. Materials and Methods: In our study, patients who applied to the Rize Recep Tayyip Erdoğan University Chest Diseases Clinic between January 2019 and December 2020 and were diagnosed with lung cancer were retrospectively examined. All patient data, including demographic information, vital data, imaging and procedure reports, were accessed from the electronic patient record system. In addition, data between the relevant dates were obtained from the patient records archived in the Bronchoscopy Unit. The patients were staged according to the 8th TNM system. Bronchoscopic findings were included in the study according to the Ikeda classification. Findings: Of the 297 patients included in the study, 279 (93.9%) were male and 18 (6.1%) were female. The mean age of the patients is 65.92±8.98 years. When the cigarette history was evaluated, 116 (39.1%) active smokers, 171 (57.6%) people who quit, and 10 (3.4%) never smoked people were recorded. It is evaluated that 96.7% of patients diagnosed with lung cancer have a smoking history. The most common comorbidities were hypertension (31.6%) and coronary artery disease (26.9%). The rate of chronic obstructive pulmonary disease (COPD) is 10.8%. Shortness of breath (40.1%), chest pain (39.4%) and cough (33%) were the most common complaints. The most common cancer types among 297 patients diagnosed with lung cancer are adenocarcinoma in 41.4%, squamous cell cancer in 38.7% and small-cell cancer in 15.2%. On Thorax CT, tumoral lesions are seen to be centrally viii located in 59.6% and peripherally in 40.4%. In the thorax CT evaluation, the mean size of the masses was 51.6±22.9 mm, and it was determined that 38% were located in the right upper lobe and 26.5% in the left upper lobe. It was determined that 54.2% of our patients were Stage 4 at the time of diagnosis. Our mean time to diagnose was found to be 19.34±13.8 days. The mean diagnosis time of our patients who used only FOB as a diagnostic method was 12.73±6.69 days. In our study, the diagnostic methods obtained in the diagnosis of pathological tissue are as follows, in order of frequency; FOB (46.5%), TNB (41.1%), EBUS (8%), metastasis biopsy (2.4%), resection (2%). FOB procedure, which is performed 230 times in total, is the most common method and the highest rate of diagnosis. As bronchoscopic sampling procedure, bronchial lavage (BL) was applied to 45% of the patients, endobronchial forceps biopsy (EFB) to 39%, bronchial brushing (BB) to 13% and endobronchial needle aspiration (EBNA) to 3% of the patients. The diagnostic values of the bronchoscopic diagnostic methods used in our study were EFB 84%, BL 38.6%, BB 61.5%, EBNA 53.8%. EFB was found to be statistically significant in patients with mass findings and in centrally located lesions radiologically (p<0.05). Results: In our study, endobronchial forceps biopsy is the procedure with the highest diagnosis rate among sampling procedures performed with FOB. Forceps biopsy was found to be a statistically significant success in lesions that were found to have a mass by endoscopic inspection and centrally located radiologically. It was observed that bronchial lavage and brush biopsy performed together with forceps biopsy did not make any additional contribution to the diagnosis. Studies are needed on how to increase the diagnostic efficiency by using more than one technique together in bronchoscopic biopsy procedures. Keywords: Fiberoptic bronchoscopy, lung cancer, diagnostic procedure