Factores relacionados con la rentabilidad diagnóstica de la biopsia bronquial en el carcinoma broncogénico primario

To analyze the diagnostic reliability of bronchial biopsy (BB) in bronchogenic carcinoma and the impact of several factors, among them patient symptoms and condition, tumor characteristics and the endoscopist's and pathologist's experience. One hundred eighty-four BB from 151 patients diagnosed of bronchogenic carcinoma in our hospital in the years 1993 and 1994 were reviewed. We first performed single variable analysis, and later logistical regression analysis taking BB positivity or negativity as the dependent variable. The independent variables were age, tumor stage, histological type, lesion necrosis, number of biopsy fragments collected, size of the largest fragment, the endoscopist who performed the BB and the pathologist who studied the specimen. The diagnosis sensitivity of BB was 69.6%. The variables that significantly influenced diagnostic accuracy, in both the single variable and multiple factorial analyses, were clinical status (p < 0.0004) and necrosis (p < 0.0057) with odds ratios of 4.6088 and 0.3766, respectively. The patient's clinical status and the presence or absence of necrosis are the factors that most influence diagnostic accuracy in BB for bronchogenic carcinoma. The likelihood of obtaining a diagnosis is 4.6 greater when clinical status is severe, and 2.7 times greater in the absence of necrosis. The experience of the bronchoscopist, after a learning period, and of the examining pathologist, do not appear to have a decisive effect on diagnostic reliability in this technique.