Further testing justified for smokers with hemoptysis and normal chest x-ray


NEW YORK (Reuters Health), Oct 12 - Clinicians should continue to evaluate smokers with hemoptysis even if the chest x-ray is normal, as nearly 10% of these patients will have malignancy, say researchers from the U.K.

Because the optimal strategy for investigating these patients remains unclear, Dr. David C. Currie and colleagues from Mid Yorkshire Hospitals NHS Trust, West Yorkshire, analyzed data from 270 patients with hemoptysis and a normal chest x-ray to see whether further investigations were justified.

Fiber-optic bronchoscopy was performed in 269 patients, and CT was performed in 257 patients, according to the report in the October Thorax.

Twenty-six of these patients (9.7%) were found to have a respiratory tract malignancy, and nine of these were candidates for radical treatment. Six had curative surgical resection, one had radical radiotherapy, and one had photodynamic therapy, whereas one patient with non-small cell lung cancer refused radical treatment.

This cancer detection rate is similar to the 0% to 16% rate found in previous studies, the investigators say.

Nineteen of the patients were diagnosed as a result of their fiber-optic bronchoscopy, and 24 of those diagnosed had CT findings suggestive of cancer.

Based on these findings, the researchers conclude that "further investigation of hemoptysis in smokers with a normal chest radiograph is justified regardless of the amount or frequency of hemoptysis. We recommend that these patients are investigated with CT followed by bronchoscopy."

Thorax 2009;64:854-856.

Last Updated: 2009-10-09 18:00:26 -0400 (Reuters Health)

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