TFNABTransthoracic Fine-Needle Aspiration Biopsies
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Figure 3 shows a summary of the sensitivities reported for the 4 minimally invasive diagnostic tests (sputum cytology, bronchoscopy, TFNAB, and thoracoscopy) by practitioner type for large and small central and peripheral lesions, with the estimated median test sensitivities ranked relative to each other.
A comparison of Figure 3 with practitioners' selections for first diagnostic test shown in Figures 1 and 2 reveals that all respondents estimated that thoracoscopy was the most sensitive diagnostic test for peripheral lesions, with TFNAB ranked second, but no physicians selected thoracoscopy as their first diagnostic test for any of the peripheral lesion simulations.
The findings described here suggest that clinicians' perceptions of diagnostic test sensitivities for the tests examined are lower than actual values, and that they underestimate sensitivities for sputum cytology and TFNAB to the greatest degree.
For example, for large (>5 cm) peripheral lesions with a high probability of malignancy (90%), physicians considered as a group and pulmonologists considered separately most frequently chose bronchoscopy (Figure 2) as their first diagnostic test; there was a high degree of variability in responses, with a minority of clinicians choosing a test with either a high estimated sensitivity (eg, TFNAB) or cost-effectiveness (eg, TFNAB or sputum cytology).
However, in spite of a perception of a relatively high level of sensitivity for TFNAB for peripheral lesions, they selected bronchoscopy most frequently as their first diagnostic test.
For example, tests could only be ordered once (eg, TFNAB could not be repeated if negative) and other tests (eg, CT scanning) were excluded.