VALUE OF REPEAT FIBEROPTIC BRONCHOSCOPIES AND SIGNIFICANCE OF NONDIAGNOSTIC BRONCHOSCOPIC RESULTS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

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Abstract
Out of 286 patients with the acquired immunodeficiency syndrome (AIDS) who had fiberoptic bronchoscopies performed for the diagnosis of pulmonary disease, 21 (7.3%) patients (Group I) had repeat procedures after 1 to 30 days (mean, 14.8 days) because of persistent pulmonary infiltrates despite therapy, and 46 (15.9%) patients (Group II) had repeat procedures after 2 to 32 months (mean, 7.5 months) because of recurrent pulmonary infiltrates after initial clinical and radiographic improvement. Pneumocystis carinii pneumonia was the most common diagnosis in both groups on initial evaluation, being found in 55% of the patients. Repeat bronchoscopy yielded a new treatable diagnosis in 1 (5%) of 21 patients in Group I and in 27 (59%) of 46 patients in group II. Sixty-two percent of patients in Group I died within 1 month. It appears that in patients with AIDS who have persistent or worsening pulmonary infiltrates despite therapy, repeat bronchoscopy after a short interval (i.e., less than 1 month) is unlikely to have therapeutic implications. In contrast, those patients whose pulmonary involvement resolves initially may benefit from an aggressive diagnostic approach if new pulmonary infiltrates appear. In both groups, nondiagnostic bronchoscopies were common (29% overall). The most commonly missed bronchoscopic diagnoses (proved by open lung biospy) were cytomegalovirus pneumonia and Kaposi''s sarcoma, and neither had much therapeutic implication. Further, 12 patients in Group II with nondiagnostic bronchoscopies improved both radiographically and clinically even though no treatment was given.