Bronchogenic Carcinoma: Endoscopy versus Histopathology

Abstract

Introduction: Lung cancer is the malignancy with the highest mortality (1.76 million deaths per year, 18.4% of the total) worldwide, being the only one whose incidence of death has progressively increased despite improved and more aggressive therapy in recent years. Early diagnosis plays an important role in increasing survival in lung cancer patients. Fiber Optic Bronchoscopy (FOB) is currently considered the first method for evaluating the tracheobronchial tree in patients with suspected lung cancer. Even though histopathological examination of bronchial biopsy specimen remains the confirmatory or the gold standard test, morphological appearance along with side and site of the lesion is also important in the diagnosis. Aim: To compare the bronchoscopic presentations of bronchogenic carcinoma in relation to side, site and morphology with histopathology. Materials and Methods: This descriptive cross-sectional study was conducted prospectively in the Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. It included 122 patients suspected clinico-radiologically and bronchoscopically with lung cancer and admitted to the hospital during the period from March 2018 to May 2019. FOB findings were noted carefully with regard to side, site and type of the lesion. One hundred and two patients were pathologically diagnosed with primary lung cancer. The bronchoscopic findings were correlated with histopathology. Statistical analysis were done using the chi-square test using the software IBM Statistical Package for the Social Sciences (SPSS) Statistics, Version 25.0. Results: A total of 102 patients (90 males and 12 females) with primary lung cancer were included in the study; most of them were in the sixth decade of life. The main anatomical site of bronchogenic carcinoma were; main bronchi (n=36, 35.29%), followed by lobar bronchi (n=28, 27.45%). Most common morphologic presentation was endobronchial growth (n=86, 84.31%) and for all the endobronchial growths, Squamous Cell Carcinoma (SQCC) was the most common histopathological diagnosis i.e., 32 cases out of 86 (37.21%). For Adenocarcinoma (AC), non-specific morphological finding was the most common (7 out of 13, 53.85%) rather than endobronchial growth (6 out of 13, 46.15%). External compression was the most common among the non-specific findings of AC (n=3 out of 13, 23.08%). Conclusion: Bronchoscopic appearance was associated to histological type. Both SQCC and Small Cell Carcinoma (SCC) were more in the central airways and endoscopically had the presentation of intraluminal growth commonly. ACs were more in the peripheral airways and endoscopically had non-specific findings more than endoscopic growth.