A comprehensive evaluation of bronchoscopy at a large urban public hospital in South Africa

Abstract

Background: A definitive diagnosis of respiratory pathology is often elusive without tissue biopsy. Bronchoscopy is indispensable to visualise and sample endobronchial lesions and lung parenchyma. Objectives: To describe the practise of fibreoptic bronchoscopy at Chris Hani Baragwanath Academic Hospital (CHBAH). Outcomes include patient demographics, as well as indications and findings of fibreoptic bronchoscopy. To define possible associations between demographic characteristics and final diagnosis. Methods: Retrospective record review of patients who had undergone fibreoptic bronchoscopy at CHBAH over a 8-year period (2011–2018). Results: Bronchoscopy records were retrieved for 830 patients. Two thirds of patients were male; the mean age of patients was 56.1 (+/−13.3) years. Human Immunodeficiency virus (HIV) status was reported in 74%. Twenty-two percent of this population was seropositive for HIV (median CD4 count 233 cells/mm3, IQR: 85–434 cells/mm3). Most were performed for suspected endobronchial lesions (52%), and 12% for pulmonary infiltrates. The most common final diagnosis was lung malignancy in 39% of patients. Squamous cell carcinoma was identified in 43%, followed by adenocarcinoma (31%). Women and HIV positive patients were less likely to be diagnosed with malignancy compared to men and HIV negative patients. The complication rate for bronchoscopy was 2%. Conclusion: Suspected endobronchial lesions were the most common indication for bronchoscopy, and the most common diagnosis was primary lung cancer. Bronchoscopy is a useful tool in the diagnosis of respiratory disease with a low complication rate.