Correlation of Bronchoscopy and CT in Characterizing Malignant Central Airway Obstruction

Malignant Central Airway Obstruction (MCAO) is a serious complication of lung cancer, leading to increased morbidity and mortality. MCAO can present in three major ways, with tumor pressing in on the airways from outside, tumor growing inside the airway, or a combination of both. While doctors often use bronchoscopy to confirm and assess MCAO, CT scans are used as an initial screening tool for treatment planning purposes. We studied 108 patients to see how well CT scans matched up with bronchoscopy results. CT scans correctly identified MCAO in most cases but were often discrepant in their estimates of severity by as much as 25% as compared to bronchoscopic evaluation. We found that CT scans were also limited in their ability to predict the type of airway blockage encountered on bronchoscopy. We conclude that, while CT scans are a useful screening tool for MCAO, bronchoscopic confirmation is recommended. Background: Malignant Central Airway Obstruction (MCAO) presents a significant challenge in lung cancer management, with notable morbidity and mortality implications. While bronchoscopy is the established diagnostic standard for confirming MCAO and assessing obstruction subtype (intrinsic, extrinsic, mixed) and severity, Computed Tomography (CT) serves as an initial screening tool. However, the extent of agreement between CT and bronchoscopy findings for MCAO remains unclear. Methods: To assess the correlation between bronchoscopy and CT, we conducted a retrospective review of 108 patients at Roswell Park Comprehensive Cancer Center, analyzing CT and bronchoscopy results to document MCAO presence, severity, and subtype. Results: CT correctly identified MCAO in 99% of cases (107/108). Agreement regarding obstruction subtype (80.8%, Cohen's kappa = 0.683, p < 0.001), and severity (65%, Quadratic kappa = 0.657, p < 0.001) was moderate. CT tended to equally overestimate (7/19) and underestimate (7/19) the degree of obstruction. CT was also poor in identifying mucosal involvement in mixed MCAO. Conclusions: CT demonstrates reasonable agreement with bronchoscopy in detecting obstruction. Nevertheless, when CT indicates a positive finding for MCAO, it is advisable to conduct bronchoscopy. This is because CT lacks reliability in determining the severity of obstruction and identifying the mucosal component of mixed disease.<br /> .