High diagnostic yield and treatment impact of bronchoscopy in elderly lung cancer patients (≥ 80 years): A single-center retrospective study

Background: Although bronchoscopic biopsy serves as a cornerstone for diagnosing lung cancer in elderly patients, whether this procedure leads to clinically relevant outcomes is still unclear. This study aimed to clarify the clinical significance of diagnostic bronchoscopy in lung cancer patients aged ≥80 years. Methods: We retrospectively analyzed 803 patients diagnosed with lung cancer who underwent bronchoscopy at our hospital from April 2015 to March 2019. Those aged ≥80 years and <80 years were classified as the elderly group (n = 154) and young group (n = 649), respectively. Results: The diagnostic yield of bronchoscopy in the elderly and young groups was 92.9 % and 83.5 %, respectively; complication rates were 9.6 % and 7.2 %. Approximately 89 % of the patients in the elderly group received specific lung cancer treatment. The 5-year survival rates for elderly and young patients who underwent surgery were 74.5 % and 78.2 %, respectively. In the elderly group, 11 % of the patients chose best supportive care (BSC) only, compared with 2 % in the young group. Notably, patients with non-diagnostic bronchoscopic results selected BSC more frequently in the elderly versus young groups (30.4 % versus 0 %, respectively). Conclusions: Bronchoscopy in elderly patients with lung cancer demonstrated a high diagnostic yield and an acceptable safety profile, enabling specific treatments in the majority of cases. These findings support the clinical usefulness of bronchoscopy in guiding treatment decisions for elderly patients. However, non-diagnostic results were associated with a higher likelihood of BCS, highlighting the importance of achieving a definitive diagnosis in this population.