Chest
Volume 99, Issue 4, April 1991, Pages 809-814
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Clinical Investigations
Diagnostic, Morphologic, and Histopathologic Correlates in Bronchogenic Carcinoma: A Review of 1,045 Bronchoscopic Examinations

https://doi.org/10.1378/chest.99.4.809Get rights and content

Information on the correlation between bronchoscopically visible aspects, histopathologic classification, and diagnostic yield is very scarce. To contribute to the knowledge of the subject, we reviewed the bronchoscopic charts of 1,045 patients with lung cancer who were seen in the years from 1983 to 1989 at the Bronchology Service of the A. Carle Hospital. Tumors were more often located centrally and superiorly. No preference as to side was found. Squamous carcinomas were, by far, the most frequent cell type. Forceps biopsies, brushings, and washings were positive in 79 percent, 38 percent, and 32 percent of the obtained specimens, respectively. Bronchoscopically, squamous and small-cell carcinomas were more often visualized as central tumor-like lesions, which were better diagnosed by forceps biopsies. Adenocarcinomas, on the contrary, were more frequently peripheral and showed infiltrative, compressive, or aspecific findings. In these latter tumors, cytologic studies were more fruitful. Large-cell anaplastic carcinomas had an intermediate behavior. Cell type, endoscopic appearance, and diagnostic success are interrelated features. Visible characteristics at bronchoscopy can therefore anticipate the more likely histotype and guide the diagnostic approach.

Section snippets

Materials and Methods

The patients of this series were selected from 3,292 who underwent fiberoptic bronchoscopy in the years from 1983 to 1989 at the Bronchology Service of the A. Carle Hospital. Examinations were carried out at the request of physicians of the medical units of both the A. Carle Hospital and the surrounding hospitals. Nearly all patients were referred because of abnormal chest x-ray findings or hemoptysis with normal roentgenograms. Eligible for this study were patients with a carcinoma of the lung

Results

The study population (1,045 patients who underwent bronchoscopy and ultimately were proven to have lung cancer) had the following anthropometric characteristics: median age, 63 years; range, 34 to 87 years; and M/F sex ratio, 8/1 (930 male patients and 115 female patients). In all, 782 pathologic diagnoses were available.

Figure 2 shows the overall diagnostic accuracy of the diverse techniques of sampling: forceps biopsies were positive in 79 percent of the 841 performed biopsies (64 percent of

Discussion

This study has diverse results but has one message of particular interest. The number of biopsy specimens needed to obtain an optimal diagnostic yield is an important consideration in applying fiberoptic bronchoscopy. Although recommendations exist in the literature for performing up to six forceps biopsies,17 the optimal number of specimens has not been defined. In 1982, Popovich et al18 found a diagnostic yield of 92 percent, after six biopsies of each endobronchial lesion and 40 histologic

Acknowledgment

We thank Dr. Luigi Aschero and Dr. Ferruccio Vola, bronchoscopists of our hospital, for their cooperation. Professor Savino Rua, Chief of the Laboratory of Histopathology of the Cuneo City Hospital System (USSL-58), is responsible for the pathologic data. Mr. James Beauchamp provided English editing.

References (21)

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Manuscript received April 25; revision accepted July 17.

Presented in part at the 8th Congress of the European Society of Pneumology, Freiburg, West Germany, Sept 10–14, 1989, and at the XVI World Congress on Diseases of the Chest, Boston, Oct 30–Nov 3, 1989.

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