We read with interest the article by Laroche et al on the cost effectiveness of performing computed tomographic (CT) scanning before fibreoptic bronchoscopy (FOB) in patients with suspected endobronchial carcinoma.¹ Compared with the group in which FOB was performed blind to the result of the CT scan, in the group in which the CT result was available before FOB was performed the FOB was obviated in 24% of patients, a higher proportion of the FOBs were diagnostic, and the initial invasive investigation was more frequently diagnostic. The authors do not specify which CT appearances determined that FOB should not be undertaken.

We have recently performed a complementary study² evaluating the ability of CT scanning to predict in which patients with an abnormal chest radiograph and high clinical suspicion of bronchial carcinoma FOB is likely to provide a positive histological diagnosis. In distinction to Laroche et al, we excluded patients . . . [Full text of this article]