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 κ = 0.683,p< 0.001), and severity (65%, Quadratic κ = 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.
背景：恶性中央气道阻塞（MCAO）是肺癌治疗中的一项重大挑战，具有显著的发病率和死亡率影响。虽然支气管镜检查是确认MCAO、评估阻塞亚型（内源性、外源性、混合性）和严重程度的既定诊断标准，但计算机断层扫描（CT）作为初步筛查工具。然而，CT与支气管镜检查结果在MCAO方面的一致性程度尚不明确。方法：为评估支气管镜检查与CT之间的相关性，我们对罗斯威尔公园综合癌症中心的108例患者进行了回顾性分析，通过CT和支气管镜检查结果记录MCAO的存在、严重程度和亚型。结果：CT正确识别了99%的病例（107/108）中的MCAO。在阻塞亚型（80.8%，Cohen's κ = 0.683，p < 0.001）和严重程度（65%，二次加权κ = 0.657，p < 0.001）方面的一致性为中等。CT在评估阻塞程度时倾向于同等程度地高估（7/19）和低估（7/19）。CT在识别混合型MCAO的黏膜受累方面表现较差。结论：CT在检测阻塞方面与支气管镜检查具有合理的一致性。然而，当CT显示MCAO阳性结果时，建议进行支气管镜检查。这是因为CT在确定阻塞严重程度和识别混合型疾病的黏膜成分方面缺乏可靠性。
Correlation of Bronchoscopy and CT in Characterizing Malignant Central Airway Obstruction
肿瘤(癌症)患者之家