Chest
Volume 104, Issue 4, October 1993, Pages 1021-1024
Journal home page for Chest

Clinical Investigations: Bronchos-Copy/Lavage
The Utility of Fiberoptic Bronchoscopy in the Evaluation of the Solitary Pulmonary Nodule

https://doi.org/10.1378/chest.104.4.1021Get rights and content

To determine the value of routine, preoperative, fiberoptic bronchoscopy (FB) for diagnosing and treating patients (pts) with solitary pulmonary nodules (SPNs), we retrospectively reviewed the records of all pts with SPNs undergoing FB at Walter Reed Army Medical Center between January 1986 and December 1989. We defined SPNs radiographically as ≤6 cm peripheral pulmonary lesions completely surrounded by pulmonary parenchyma. Of 191 charts reviewed, 91 (72 bronchogenic carcinomas [BC], 7 carcinoid tumors, 12 benign) constitute the study population. Fifty-four charts were eliminated because preoperative, clinical-radiologic staging revealed advanced (greater than stage I) BC or extrathoracic malignancy metastatic to the lung (44), the clinicians suspected benign disease and elected medical followup (3), the pt had medically inoperable disease (3), or the pt refused surgery (4). Forty-six charts were incomplete or unavailable. Fiberoptic bronchoscopy revealed one unsuspected vocal cord carcinoma and no occult synchronous BCs. Five pts had submucosal or endobronchial tumors and biopsy specimens showed BC in four of five tumors from which specimens were taken. Four of 66 (6 percent) cytologic evaluations of bronchial brushings or washings diagnosed BC. In pts shown at surgery to have BC, 9 of 30 transbronchial lung biopsy (TBBx) specimens showed BC. Diagnostic yield of TBBx specimens was not improved in the pts who underwent biopsies under fluoroscopic guidance. The 16 FB specimens positive for BC concurred 100 percent with the surgical specimens. The FB findings did not obviate the need for surgery nor alter the surgical stage of BC. A preoperative diagnosis of malignancy did not affect operative time or operative procedure, because many pts required frozen-section biopsy of mediastinal lymph nodes prior to lung resection. At our institution, routine, preoperative FB did not measurably benefit pts with SPNs.

Section snippets

Methods

We retrospectively reviewed bronchoscopy records of all pts evaluated with FB by the Walter Reed Army Medical Center Pulmonary Service between January 1986 and December 1989. This time frame was chosen to allow a minimum 2-year postoperative follow-up. Records that described SPNs suspicious for BC were selected for further review, and an attempt was made to locate information from hospital in-patient records and duplicate files maintained in the Pulmonary, Thoracic Surgery, Oncology, and

Results

Table 1 lists by calendar year (1986 to 1989) the 191 pts whose charts were screened. Ninety-one pts met inclusion criteria and constitute the subject of this report. The remaining 100 charts from 1986 to 1989 were eliminated for the following reasons (Table 2): < stage I BC (diagnosed during clinical-radiologic staging) or extrathoracic carcinoma metastatic to the lung (44), clinically suspected benign disease with planned medical followup (3), medically inoperable (3), and surgery recommended

Discussion

In this retrospective review, we screened 191 charts before selecting a study group of 91. Fifty four charts were eliminated for the reasons listed in Table 2. An additional 46 charts were deleted because they were incomplete or unavailable. We cannot rule out the possibility that our failure to evaluate this group could have introduced a bias into the analysis of our data and conclusions.

This study evaluated a subset of 91 pts in whom the possible risk of malignancy was suitably high that

References (15)

There are more references available in the full text version of this article.

Cited by (0)

Supported by Department of Clinical Investigation Protocol 1748. The findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents.

View full text