Background Current NICE guidelines for lung cancer advocate referral to fast track clinic for unexplained haemoptysis in patients who are aged 40 and over. The current practice in our respiratory department and in most units across United Kingdom is to investigate this with a CXR, computed tomography (CT) thorax and flexible bronchoscopy regardless of the findings of the CT.
Aim The aim of this study was to evaluate whether bronchoscopy adds any further value to the findings of highly sensitive CT scans in the current era. We particularly wanted to look at number of serious pathologies such as cancer detected by flexible bronchoscopy in these patients.
Methods A retrospective analysis was conducted using our local bronchoscopy database which identified 148 flexible bronchoscopy episodes that fulfilled our inclusion criteria (all patients undergoing bronchoscopy for haemoptysis who had already undergone CT thorax which did not identify a cause for this). The cases were included irrespective of their smoking status and age and covered a period of 4 years between 2011 and 2015.
Results A total of 148 flexible bronchoscopy episodes were reviewed. Female to male ratio was 1:3 and mean age was 59 years. 72% of patients were smokers. There was no case of lung cancer identified in this cohort of patients. No pathological finding was identified in 87% (129) of the cases. The common abnormal findings included nasal bleed-2%, haemangioma/telangiectasia-3%, purulent secretions-2%, dynamic airway collapse-1%, aberrant anatomy-1% and possible tumour-1%. The two cases of possible tumour were further evaluated with nasendoscopy and rigid bronchoscopy and no cancers were identified on biopsies. A single case of oral cancer was identified 1 year post bronchoscopy on follow up review of these cases.
Conclusion In conclusion our study shows that in patients with haemoptysis with no relevant finding identified on CT and irrespective of their smoking status, flexible bronchoscopy does not reveal any significant serious pathogy. We would recommend that further studies are required to evaluate the investigative pathway for haemoptysis particularly if CT thorax does not identify a cause for haemoptysis.