Chest
Clinical Investigations: CT ScansCan Chest CT Decrease the Use of Preoperative Bronchoscopy in the Evaluation of Suspected Bronchogenic Carcinoma?
Section snippets
MATERIALS AND METHODS
We wanted to identify patients who satisfied the following criteria: (1) a PNM that was proven to be BC by either endobronchial biopsy, TBBX, TNB, or at surgery; (2) a preoperative diagnostic bronchoscopy performed at our institution; and (3) availability of chest radiographs and chest CT performed in our institution. Patients with the following imaging criteria were excluded: (1) presence of radiographic signs of atelectasis of a segment, lobe, or lung; (2) presence of one or more of the
RESULTS
Sixty-four patients satisfied the clinical and radiologic inclusion criteria. There were 60 men and 4 women whose mean age was 64 years (range, 38 to 89 years). The size of the PNM in these 64 patients ranged from 1.5 to 10.0 cm and their size distribution is shown in Figure 1. Mediastinal lymphadenopathy was found in 10 patients, and hilar adenopathy was found in 6 patients.
A diagnosis of malignancy was made by FOB in 22 of 64 patients (34%). TNB was performed in 37 patients and provided
DISCUSSION
In clinical practice, FOB is the mainstay of diagnosis of a PNM. Since a PNM in an immunocompetent adult >35 years old is considered malignant until proven to the contrary, the role of FOB includes obtaining a pathologic diagnosis of the PNM as well as assessment of the proximal airways for presence of endobronchial tumor. Both objectives are equally important for successful and efficient treatment of a patient with a presumed malignant PNM. Therefore, separation of diagnostic and staging
CONCLUSIONS
- (1)
In this study, CT failed to detect endobronchial tumor in 11 of 64 patients (17%). Because of the implication of new staging system, more studies are necessary before abandoning preoperative staging FOB.
- (2)
The CT bronchus sign has a very high positive and negative predictive value in the use of diagnostic FOB and should be used to guide the method of biopsy of a PNM.
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