Abstract
Background: Fiberoptic bronchoscopy (FOB) is frequently used to evaluate possible invasion of the tracheobronchial tree by esophageal cancer.
Objective: To evaluate the diagnostic utility of FOB for the assessment of airway involvement by esophageal carcinoma and its resectability.
Material and Methods: Retrospective study of bronchoscopies in patients with potentially operable esophageal carcinoma, correlating its findings with other staging modalities, in the last 6 years.
Results: We included 40 patients, 87.5% male, mean age 63±13.2 years. Respiratory symptoms appeared in 15% of cases, all of them with endoscopic abnormalities.
In 16 (40%) patients, FOB revealed: extrinsic compression in 12 (30%) and infiltration of the bronchial mucosa in 4 (10%) cases. These features were more frequent at the left main bronchus (n=5) and middle third of the trachea (n=4).
Comparing CT with FOB, we found that observed or suspected invasion of the trachea on CT (21 patients), was only confirmed by FOB in 4 cases (19%). In 3 patients with endoscopic abnormalities, CT revealed no invasion of the bronchial tree.
In cases of suspected airway involvement (n=8) by endoscopic ultrasound (EUS), 3 had wall protusion without evidence of mucosa's infiltration.
The overall accuracy of FOB with multiple brush cytology and bronchial biopsy in confirming or excluding airway invasion was 95%. Normal endoscopic appearance had a negative predictive value of 100%.
In 3 patients FOB was the decisive staging procedure, excluding surgical treatment.
Conclusion: Bronchoscopy with biopsy and brush cytology is a very accurate procedure in assessing potential airway invasion by esophageal cancer. CT and EUS findings alone are not reliable.
- © 2011 ERS
