Non-invasive assessment of Benign Tracheal Stenosis.

Abstract

Research Article Non-invasive assessment of Benign Tracheal Stenosis Bruno Chambel1, Josué Pinto2, Cláudia Freitas1,2, Mariana Coinceição3, Hélder Novais Bastos1,2,4* 1Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal 2Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal 3Department of Pulmonology, Centro Hospitalar Tondela-Viseu, Avenida Rei Dom Duarte, 3504-509 Viseu, Portugal 4Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal Abstract Background: Benign tracheal stenosis (BTS) management is challenging. Although bronchoscopy is the gold standard for diagnosis, its inherent risks makes it a less than ideal follow-up method. This study aims to assess the impact of BTS-related symptoms on quality of life and to correlate BTS severity with non-invasive measures, in order to optimize the follow-up and management. Methods: Patients with BTS were recruited. Data was collected from clinical files and by patient interview. Respiratory function tests and cervicothoracic imaging were performed within 6 months of clinical assessment. Stenosis Index (SI) was objectively measured using image analysis software (ImageJ) applied to radiological images. We analysed the correlation between lung function values and stenosis features. Results: Of 28 patients enrolled (mean age 55.1±15.9 years, 53.6% female), 89.3% had complex stenosis. The most common etiology was post-intubation (67.8%) and the most common location was subglottic (71.4%). The majority (81%) presented <50% of airway narrowing. A SI ≥50% was associated with higher FEV1/PEF ratio and lower PEF value (p=0.042 and p=0.045, respectively). FEV1/PEF ratio accurately classified those cases with SI ≥50% (AUC=0.80; 95%CI 0.53-1.00). Overall, patients were symptomatic, which had impact in quality of life (QoL). Remarkably, the number of total endoscopic procedures during follow-up was inversely correlated with QoL (r=-0.427, p=0.023). Conclusions: Spirometry is a potential method to predict BTS severity, and with potential utility at monitoring these patients, thus reducing the need of diagnostic bronchoscopies during follow-up.