J Cancer 2020; 11(19):5547-5555. doi:10.7150/jca.47183

Research Paper

The development of bronchoscopy in China: a national cross-sectional study

Dongchen Shi1#, Fuqi Li1#, Kaicheng Wang1#, Chen Kong1#, Haidong Huang1#, Qiang Li2#, Faguang Jin3#, Chengping Hu4#, Changhui Wang5#, Hui Shi1, Zhenli Hu1, Yuchao Dong1, Yunye Ning1, Kosmas Tsakiridis6, Konstantinos Sapalidis7, Christoforos Kosmidis7, Anastasios Vagionas8, Wolfgang Hohenforst-Schmidt9, Lutz Freitag10, J Francis Turner11, Konstantinos Drevelegas12, Eleni-Isidora Perdikouri13, Tomi Kovacevic14, Tatjana Sarcev14, Bojan Zaric14, Savas Petanidis15, Sofia Baka16, Ioannis Boukovinas17, Stylianos Kakolyris18, Paul Zarogoulidis7✉, Chong Bai1✉

1. Department of Respiratory and Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China.
2. Department of Respiratory, Oriental Hospital, Tongji University, Shanghai, China.
3. Department of Respiratory, Tangdu Hospital, The Fourth Military Medical University, Xian, China.
4. Department of Respiratory, Xiangya Hospital, Central South University, Changsha, China.
5. Department of Respiratory, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
6. Thoracic Surgery Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
7. 3rd Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
8. Oncology Department, (NHS) General Hospital of Kavala, Kavala, Greece
9. Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany.
10. Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
11. University of Tennessee Graduate School of Medicine, Department of Medicine, Knoxville, TN, USA.
12. Radiology Department, ``G. Papageorgiou`` University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
13. Oncology Department, General Hospital of Volos, Volos, Greece
14. Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia
15. Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
16. Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
17. Oncology Department, ``Bioclinic`` Private Hospital, Thessaloniki, Greece
18. Oncology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
# These authors contributed equally to this work

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Shi D, Li F, Wang K, Kong C, Huang H, Li Q, Jin F, Hu C, Wang C, Shi H, Hu Z, Dong Y, Ning Y, Tsakiridis K, Sapalidis K, Kosmidis C, Vagionas A, Hohenforst-Schmidt W, Freitag L, Turner JF, Drevelegas K, Perdikouri EI, Kovacevic T, Sarcev T, Zaric B, Petanidis S, Baka S, Boukovinas I, Kakolyris S, Zarogoulidis P, Bai C. The development of bronchoscopy in China: a national cross-sectional study. J Cancer 2020; 11(19):5547-5555. doi:10.7150/jca.47183. Available from http://www.jcancer.org/v11p5547.htm

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Objective: To investigate the development of bronchoscopy in China and compare it with its application in the early 21st century.

Methods: The data collection was based on questionnaires. Three hundred and nineteen hospitals, which distributed across 30 provinces and 130 cities, were included in the study. Data about the application of bronchoscopy in Shanghai and Hunan province in the early 21st century are also involved for comparison.

Results: The median period of performing diagnostic and therapeutic bronchoscopy was 19.7±11.0 and 7.4±7.0 years, respectively. On average, about 155.2 cases and 28.4 cases received diagnostic and therapeutic bronchoscopy in each hospital per month. The average area and number of the examination room was 122.7m2 and 2.2m2, respectively. More examination items were performed in specialty hospitals than those in general hospitals (P<0.05) and specialty hospitals owned more rooms exclusively for bronchoscopy (P<0.05), while no difference of the number of allocated doctors was found (P>0.05). On the other side, the whole amount of diagnosis and therapeutic items in teaching hospitals was slightly higher than that in non-teaching hospitals (P<0.01). Comparison of diagnosis and therapeutic endoscopy in Shanghai and Hunan province shows that the number of flexible bronchoscopy increased by 5.8 times in Shanghai from 2002 to 2017, while that increased by 3.4 times in Hunan province from 2005 to 2017. Furthermore, the average number of allocated doctors increased by 0.85 times in Shanghai, which was more rapidly compared with that of Hunan province (0.66 times) (P<0.05). Besides, the development rate of the diagnosis and therapeutic projects in Shanghai was significantly higher than that in Hunan province (P<0.05).

Conclusion: All different classes of hospitals in China are capable of carrying out conventional bronchoscopy diagnosis and therapeutic projects, and newly developed bronchoscopy technology has gradually spread in high-level hospitals since 21st century. The higher class the hospital was, the earlier bronchoscopy was performed. Respiratory endoscopy in China has developed rapidly since the early 21st century and the construction of respiratory endoscopy center and the personnel training are on the right track, but it is also faced with inadequate equipment, unbalanced regional development and insufficient personnel allocation.

Keywords: bronchoscopy, education, Respiratory diseases