European Geriatric Medicine

, Volume 9, Issue 2, pp 255–262 | Cite as

Safety and efficacy of diagnostic flexible bronchoscopy in very old patients with lung cancer

  • Shotaro Okachi
  • Kazuyoshi Imaizumi
  • Naoyuki Imai
  • Takahiro Shimizu
  • Tetsunari Hase
  • Masahiro Morise
  • Naozumi Hashimoto
  • Mitsuo Sato
  • Yoshinori Hasegawa
Research Paper



Although there is a remarkable increase in diagnostic flexible bronchoscopy (FB) in old patients, safety and efficacy of FB in very old patients remain to be elucidated. In this study, we aimed to evaluate the complications and diagnostic yield of FB in patients aged ≥ 80 years with lung cancer compared with those aged < 80 years.

Materials and methods

We retrospectively analysed the medical records of 668 consecutive patients, which included 89 patients aged ≥ 80 years (older group) and 579 patients aged < 80 years (younger group) who underwent bronchoscopy for the diagnosis or staging of lung cancer between April 2011 and March 2016.


The median age of the patients was 82 and 69 years in the older and younger groups, respectively. Performance status and Charlson comorbidity index were comparable between the study groups. Diagnostic yield in the older and younger groups was equivalent, and stage distribution in both the groups was similar. Sixty-one patients (68.5%) received anticancer treatment including surgery, radiation and chemotherapy with cytotoxic or molecular-targeted agents in the older group. There were no statistical differences in the occurrence of overall complications between the two groups.


Safety and efficacy of FB in the diagnosis of lung cancer in very old patients are comparable with those of younger patients. Accurate diagnosis established by bronchoscopy leads to appropriate treatment decision in very old patients.


Bronchoscopy Complications Diagnosis Old Lung cancer 



The authors are indebted to all of the participating clinicians. This study was supported by a Grant-in-Aid for scientific research from the Japan Society for the Promotion of Science (Grant Number 15K19282).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study was approved by the institutional review board (approved number; 2017-0018).

Informed consent

Although specific informed consent was not required for this retrospective study, an informed consent for each bronchoscopy was obtained before the procedure.


  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefPubMedGoogle Scholar
  2. 2.
    Cancer Information Service, National Cancer Center, Japan. National estimates of cancer incidence based on cancer registries in Japan.
  3. 3.
    Beckett P, Callister M, Tata LJ et al (2012) Clinical management of older people with non-small cell lung cancer in England. Thorax 67:836–839CrossRefPubMedGoogle Scholar
  4. 4.
    Hardique S, Jain P (2015) Safety of bronchoscopy in elderly. Curr Geriatr Rep 4:154–195CrossRefGoogle Scholar
  5. 5.
    José RJ, Shaefi S, Navani N (2013) Sedation for flexible bronchoscopy: current and emerging evidence. Eur Respir Rev 22:106–116CrossRefPubMedGoogle Scholar
  6. 6.
    Ogawa T, Imaizumi K, Hashimoto I et al (2014) Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy. Respir Investig 52:153–159CrossRefPubMedGoogle Scholar
  7. 7.
    Casal RF, Lazarus DR, Kuhl K et al (2015) Randomized trial of endobronchial ultrasound-guided transbronchial needle aspiration under general anesthesia versus moderate sedation. Am J Respir Crit Care Med 191:796–803CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Evison M, Crosbie PAJ, Martin J et al (2014) EBUS-TBNA in elderly patients with lung cancer: safety and performance outcomes. J Thorac Oncol 9:370–376CrossRefPubMedGoogle Scholar
  9. 9.
    Jones AM, O’Driscoll R (2001) Do all patients require supplemental oxygen during flexible bronchoscopy? Chest 119:1906–1909CrossRefPubMedGoogle Scholar
  10. 10.
    Shinagawa N, Yamazaki K, Kinoshita I, Ogura S, Nishimura M (2006) Susceptibility to oxygen desaturation during bronchoscopy in elderly patients with pulmonary fibrosis. Respiration 73:90–94CrossRefPubMedGoogle Scholar
  11. 11.
    Allan PF, Ouellette CD (2003) Bronchoscopic procedures in octogenarians a case-control analysis. J Bronchol 10:112–117CrossRefGoogle Scholar
  12. 12.
    Rokach A, Fridlevder ZG, Arish N (2008) Bronchoscopy in octogenarians. Age Ageing 37:710–713CrossRefPubMedGoogle Scholar
  13. 13.
    Haga T, Cho K, Nakagawa A et al (2016) The complications of fiberoptic bronchoscopy in very elderly adults. J Am Geriatr Soc 64:676–677CrossRefPubMedGoogle Scholar
  14. 14.
    Okachi S, Imai N, Imaizumi K et al (2013) Endobronchial ultrasound transbronchial needle aspiration in older people. Geriatr Gerontol Int 13:986–992CrossRefPubMedGoogle Scholar
  15. 15.
    Okachi S, Imai N, Imaizumi K et al (2016) Factors affecting the diagnostic yield of transbronchial biopsy using endobronchial ultrasonography with a guide sheath in peripheral lung cancer. Intern Med 55:1705–1712CrossRefPubMedGoogle Scholar
  16. 16.
    Hayama M, Izumo T, Matsumoto Y, Chavez C, Tsuchida T, Sasada S (2015) Complications with endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions. Respiration 45:1–7Google Scholar
  17. 17.
    Du Rand IA, Blaikley J, Booton R on behalf of the British Thoracic Society Bronchoscopy Guideline Group et al (2013) British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 68(Suppl 1):i1–i44CrossRefGoogle Scholar
  18. 18.
    Wahidi MM, Jain P, Jantz M et al (2011) American College of Chest Physicians consensus statement on the use oftopical anesthesia, analgesia, and sedation during flexible bronchoscopy in adultpatients. Chest 140:1342–1350CrossRefPubMedGoogle Scholar
  19. 19.
    Pallis AG, Gridelli C, van Meerbeeck JP et al (2009) EORTC Elderly task force and lung cancer group and international society for geriatric oncology (SIOG) experts’ opinion for the treatment of non-small-cell lung cancer in an elderly population. Ann Oncol 21:692–706CrossRefPubMedGoogle Scholar
  20. 20.
    Pallis AG, Gridelli C, Wedding U et al (2014) Management of elderly patients with NSCLC; updated expert’s opinion paper: EORTC elderly task force, lung cancer group and international society for geriatric oncology. Ann Oncol 25:1270–1283CrossRefPubMedGoogle Scholar
  21. 21.
    Inoue A, Kobayashi K, Usui K et al (2009) North East Japan Gefitinib Study Group. First-line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. J Clin Oncol 27:1394–1400CrossRefPubMedGoogle Scholar
  22. 22.
    Oki M, Yatabe Y, Saka H et al (2015) Feasibility and accuracy of molecular testing in specimens obtained with small biopsy forceps: comparison with the results of surgical specimens. Respiration 1:235–242CrossRefGoogle Scholar
  23. 23.
    Jurado J, Saqi A, Maxfield R et al (2013) The efficacy of EBUS-guided transbronchial needle aspiration for molecular testing in lung adenocarcinoma. Ann Thorac Surg 96:1196–1201CrossRefPubMedGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  1. 1.Department of Respiratory MedicineNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Respiratory MedicineFujita Health University School of MedicineToyoakeJapan
  3. 3.Respiratory Medicine, Gifu Prefectural Tajimi HospitalGifuJapan

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