Reporting of central airway obstruction on radiology reports and impact on bronchoscopic airway interventions and patient outcomes

Abstract

Background Central airway obstruction (CAO) is a serious condition that affects patients with both benign and malignant diseases. Timely recognition of CAO is crucial for prompt intervention aimed at improving the symptoms and quality of life of these patients. The aim of this study is to evaluate the formal radiology reporting of central airway obstruction and its impact on patients’ outcomes. Methods The medical records of patients who underwent advanced therapeutic bronchoscopy for CAO from August 2013 to September 2014 were retrospectively reviewed. Three researchers, each reviewed 14 of the 42 formal radiology reports that were performed at 16 different medical and radiology centers. Patient characteristics were reported as means, medians, and standard deviations for continuous variables; and as frequencies and relative frequencies for categorical variables. Results Out of 42 patients, who underwent advanced bronchoscopy for planned therapeutic intervention, only 30 had radiology and pulmonology concordance about the airway findings of CAO. This is an agreement rate of 71.4% (95% CI: 56.7 – 83.3%) or a disagreement rate of 28.6% (95% CI: 16.7 – 43.3%). The radiology reports did not mention 31% of CAO on CT scans. The median time from CT imaging to bronchoscopy was significantly longer in patients with CAO not reported by the radiologists (21 vs. 10 days; p=0.011). Most patients improved postoperatively with no significant difference between the two groups. Conclusions Findings of central airway obstructions were not described in a significant proportion of radiology reports. This results in significant delay in bronchoscopic airway management.

Prevalence and outcome of central airway obstruction in patients with lung cancer

“…A dedicated review of the central airways on CT scans increased the proportion with CAO detected by over 30%. This is consistent with previous reports and supports an argument that dedicated thoracic radiologists and interventional pulmonologists will improve disease recognition 12. Not all patients underwent bronchoscopy to confirm disease site; therefore, our CAO prevalence is likely to be an underestimate.…”

Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction

“…CT imaging of the chest is widely accepted as an essential component in the evaluation of malignant CAO for not only defining the location, extent and type of airway obstruction but also for procedural planning [1, 2, 6, 22]. Interestingly, in one retrospective study of patients undergoing therapeutic bronchoscopy for CAO, Harris et al found that airway obstruction on CT chest was often overlooked, omitted from 31% of radiology reports, and resulted in a significant delay in time to bronchoscopy (21 versus 10 days) for patients where the CAO was not reported [23]. Our study also highlights the importance of early radiographic identification of malignant CAO and prompt therapeutic intervention.…”

“…We did not collect objective data on changes in patient symptoms or quality of life with the interventions; however, this information was previously reported on a subset of our patients [3]. In addition, radiographic and visual assessment of the severity of CAO was used, which can be imprecise but is the standard of care and used routinely in other studies [3, 23, 24]. Although bronchoscopic debridement techniques and ablative modalities have not changed significantly over last 10 years [14], oncologic therapies have improved and can impact survival over the study period.…”

Malignant central airway obstruction

“…CAO is a relatively infrequent finding on chest imaging and evaluation of the central airways may be overlooked in the absence of clinical history. In a recent retrospective review of pre-treatment chest CT in 42 patients who eventually underwent therapeutic bronchoscopic interventions for CAO, the radiologist failed to identify CAO in 31% of studies and in the subgroup of patients that did not have CAO reported there was a significant delay in time to therapeutic intervention (15).…”