Diagnosis Of Bronchogenic Carcinoma Research Articles

A new versatile transbronchial cytology needle for the staging and diagnosis of bronchogenic carcinoma : Gittlen SD, Erozan Y, Wang KP. Pulmonary Division, Johns Hopkins Hospital, Baltimore, MD 21205. Chest 1988;94:561-5

A new versatile transbronchial cytology needle for the staging and diagnosis of bronchogenic carcinoma : Gittlen SD, Erozan Y, Wang KP. Pulmonary Division, Johns Hopkins Hospital, Baltimore, MD 21205. Chest 1988;94:561-5

Fibreoptic bronchoscopy for early diagnosis of bronchogenic carcinoma: A comparison of yield of biopsy, bronchial lavage and brush biopsy

Fifty-one patients with endoscopically visible bronchogenic carcinoma underwent fibreoptic bronchoscopy. At the same sitting, bronchial brush cytology was taken followed by collection of bronchial washings after lavage with 10 ml of 0.9 per cent saline. Three specimens of bronchial tissue were taken from different sites of a tumour. Bronchial biopsy, was found to be the most sensitive procedure as it was positive in 36 (70.5%) patients as compared to bronchial was (64.7%) and brush cytology (55%). Bronchial lavage alone was positive in five and only brush cytology was contributory in four. Massive bleeding was encountered in three patients and one of them required urgent blood transfusion. There was no mortality.

A New Versatile Transbronchial Cytology Needle for the Staging and Diagnosis of Bronchogenic Carcinoma

A new versatile transbronchial needle, the modified type 2B retractable needle, was used for the staging and diagnosis of bronchogenic carcinoma. It combines the advantages of its predecessors, the fixed type 1A needle and the retractable type 2A needle, such as convenience of usage and the added ability to sample peripheral as well as central lesions. The new modified type 2B retractable needle provides better protection of the airways and bronchoscope than the fixed type 1A needle and eliminates the type 2A needle's requirement for total removal of the guidewire before aspiration. The new type 2B needle was compared with either the original fixed type 1A or the retractable type 2A needle in 20 patients at 34 transbronchial sites and found a similar diagnostic yield. The modified type 2B retractable needle was the most versatile needle of those studied and can be used for transbronchial needle aspiration of both central and peripheral lesions.

Transbronchial Needle Aspiration in the Diagnosis of Bronchogenic Carcinoma

Transbronchial needle aspiration (TBNA) was performed as a diagnostic procedure in 91 consecutive patients ultimately proven to have bronchogenic carcinoma. Results of TBNA were compared, in the same patients, to the diagnostic yield of cytologic examination of sputum, endobronchial brushings and washings, and endobronchial/transbronchial biopsy. The diagnostic yield for sputum was 13 percent (10 of 75); brushings, 40 percent (34 of 84); washings, 29 percent (26 of 89); biopsy, 56 percent (42 of 75); and TBNA, 45 percent (41 of 91). Aspirates were positive in 35 percent of patients with adenocarcinoma, 41 percent with squamous cell carcinoma, 52 percent with large cell undifferentiated carcinoma, and 55 percent of patients with small cell carcinoma. Carinal aspirates were positive in 54 percent (6 of 11); paratracheal aspirates, 57 percent (13 of 23); parabronchial aspirates, 39 percent (11 of 28); endobronchial, 78 percent (7 of 9), and peripheral mass or solitary pulmonary nodule, 40 percent (17 of 42). The overall diagnostic yield for brushings, washings, and biopsy was 64 percent. The addition of TBNA increased the yield to 71 percent. Bronchogenic carcinoma was diagnosed solely by TBNA in six patients, all with extrabronchial or extratracheal lesions. We conclude that TBNA increases the diagnostic yield of bronchoscopy, particularly in patients with extratracheal and extrabronchial lesions. An equally important observation is that TBNA fails to contribute significantly to the diagnosis of cancer in patients with lesions readily accessible by conventional bronchoscopic techniques. Exceptions to this observation include occasional patients with necrotic endobronchial tumors, submucosal lesions, and rarely patients with peripheral lung nodules or masses.

Endobronchial Tuberculosis Revisited

Analysis was made of 20 patients with endobronchial tuberculosis proven by fiberoptic bronchoscopy and bronchial biopsy. Unlike prechemotherapy reports, the disease affects the older age group and more men. Only one half of the patients had fever, and the characteristic localized wheeze was found in 15 percent of cases. Chest roentgenogram showed typical collapse-consolidation in most cases; however, it was clear in 20 percent of patients. Sputum/smear was negative for AFB in 85 percent of patients. When the gelatinous granulation tissue was not found during bronchoscopy, a diagnosis of bronchogenic carcinoma was made incorrectly in 30 percent of patients. At a mean period of 27 months postchemotherapy, all 12 patients recalled for study developed bronchostenosis proven by bronchoscopy/bronchography except one. Noninvasive methods such as chest roentgenogram and flow-volume loops were insensitive for detection of stenosis. Steroid therapy probably did not influence outcome of tuberculous endobronchitis.

The Value of Routine Cranial Computed Tomography in Neurologically Intact Patients with Primary Carcinoma of the Lung

The most common cerebral metastatic lesion is from carcinoma of the lung. Preoperative cranial computed tomography (CCT) with contrast enhancement was performed in 55 neurologically intact patients with a diagnosis of bronchogenic carcinoma; 3 patients (5%) demonstrated cerebral metastasis. CCT could spare a significant number of such patients from unnecessary surgery, with a net saving substantially greater than its cost.

Diagnosis of Early Bronchogenic Carcinoma

C ytologic examination of sputum has long been used in the diagnosis of bronchogenic carcinoma. Tumors of the segmental and larger bronchi may shed cells detectable in the sputum for many months prior to becoming symptomatic or radiographically apparent.’ During this period of their development, standard endoscopic techniques have frequently proven inadequate to localize the lesion with sufficient accuracy to permit definitive therapy.2 As increasing emphasis is being placed on early diagnosis and as sputum cytology becomes more widely used, we can expect an increasing need to evaluate patients whose diagnosis of cancer is based solely on sputum cytology. It is the purpose of this paper to summarize the endoscopic techniques and observations we have found useful in discovering the source of malignant cells found in the sputum of patients whose tumor site cannot otherwise be located. This work was performed at The Johns Hopkins Hospital as one aspect of a screening study designed to identify, localize and treat lung cancer discovered in a working population of cigarette smoking men over age 45 years.

An unusual presentation of carcinoma of the lung: 26 patients with cervical node metastases.

Carcinoma of the lung should be considered in the search for an unknown primary lesion when there is evidence of cervical lymph node involvement. Of 1,686 patients with a final diagnosis of bronchogenic carcinoma seen during a 10-year period at the University of Louisville Hospitals, 26 presented one or more clinically positive cervical nodes. The frequency of lung cancer in such instances varies from 1.5% (in the present report) to 32%, possibly because the term "cervical node" is used without clarification. More precise description of such metastases is urged.

Silent, chronic, massive pulmonary thromboembolism masquerading as bronchogenic carcinoma

A unique case is described of a 64-year-old white woman who had silent thromboembolic occlusion of the right pulmonary artery. Over the ensuing months, severe pulmonary hypertension developed, as manifested by marked dilatation and atherosclerosis of the right and left pulmonary arteries and severe right ventricular hypertrophy. Nevertheless, she remained fully ambulatory and felt generally well throughout this time. Eventually, however, the pulmonary arteries became so dilated that they compressed the recurrent laryngeal nerve as it looped under the aortic arch, and it was the resulting hoarseness that first caused the patient to seek medical attention. A work-up disclosed normal peripheral lung fields on x-ray study and a large dense right hilar mass. Accordingly, the patient was subjected to an exploratory thoracotomy on the reasonable but mistaken diagnosis of bronchogenic carcinoma. After the following operation, her condition deteriorated. She developed bronchopneumonia which, when superimposed on her already precariously reduced cardiopulmonary function, precipitated respiratory insufficiency. An independent stroke was the immediate cause of death.

The selection of patients with bronchogenic carcinoma for mediastinoscopy

The records of 112 patients treated at the Ochsner Foundation Hospital with the diagnosis of bronchogenic carcinoma were reviewed. A new concept for defining the location of central versus peripheral tumors is presented. Criteria important in selection of patients for whom mediastinoscopy is likely to be helpful are cell type, location (peripheral versus central), and radiographic evidence of mediastinal metastasis. The size of the tumor is not a useful criterion except possibly for squamous cell lesions. A high incidence of mediastinal metasis was found associated with central tumors (63 to 100 per cent) of all cell types and with peripheral lesions (63 per cent) of undifferentiated cell types. A relatively low incidence of mediastinal metasis was associated with peripheral asenocarcinomas or squamous cell tumors. We would, therefore, recommend mediastinoscopy for all patients with central lesions and those patients with peripheral lesions of an undifferentiated cell type. When correlated with radiographic findings, only 4.6 per cent of peripheral carcinomas of a differentiated cell type with a radiographically normal mediastinum were found to produce mediastinal metastases, and mediastinoscopy is not recommended. In patients with peripheral tumors of indeterminate cell type, a decision for mediastinoscopy may be influenced by other factors such as the operative risk of a thoracotomy and location of the primary tumor within the lung.

The radionuclide identification of tumors.

Tumor-seeking radiopharmaceuticals have been employed in the diagnosis of primary neoplasms, in the detection of distant disease, particularly in the localization of tumor foci to facilitate biopsies and the planning of radiation portals, and in assessing the response to tumor therapy. At the present, there is no ideal tumor-scanning agent. However, several approaches appear to be useful and offer promise for further study. The greatest experience has been with Gallium-67, which has major utility in the staging of Hodgkin's disease, in the diagnosis of bronchogenic carcinoma, in the detection of certain metastatic brain tumors, in the identification of recurrent disease, and in the noninvasive diagnosis of leukemic complications. A number of radiolabeled antibiotic and chemotherapeutic agents have shown promise, including tetracycline and bleomycin. A major drawback, however, of these agents which is shared with Gallium-67 is that they appear to be sequestered by inflammatory as well as neoplastic tissue. A most intriguing approach is the use of radiolabeled antibodies to tumor-associated antigens. Animal and clinical experiments have employed antifibrin, antifibrinogen, anticarcinoembryonic antigen, and antiferritin. Theoretically, agents such as these should allow for greater tumor specificity.

Xerotomographic Diagnosis of Central Bronchogenic Carcinoma

Xerotomography was used to examine 14 patients with substantial pulmonary opacities, in whom the diagnosis of bronchogenic carcinoma had been suspected. Xerotomography was valuable because it provided excellent delineation of the tracheobronchial tree, which assisted in differentiation of benign from malignant lesions. Malignancy was suggested by: 1) amputation, 2) eccentric narrowing of the bronchus, 3)irregularity of the bronchial wall, 4)presence of an intraluminal mass. Mediastinal and hilar node enlargement could also be assessed. The use of these criteria allowed a correct preoperative diagnosis in 12 of 14 patients. Due to the high radiation dosage, this method is not suitable for use as a screening procedure.

Bronchogenic Carcinoma in the Presence of Heart Disease: A Diagnostic Dilemma

These two case reports emphasize that delays in diagnosis of bronchogenic carcinoma may occur in patients with heart disease because of a similarity in symptoms. Only by maintaining a high index of suspicion in patients with heart disease can the diagnosis of bronchogenic carcinoma be established at an early age.

Fiberoptic bronchoscopy in respiratory failure.

Ikeda designed a flexible fiberoptic bronchoscope in 1966 and subsequently reported its ad-vantages over the rigid bronchoscope in the diagnosis of bronchogenic carcinoma.1 Since then, this instrument has gained widespread popularity and has seen a broad expansion in its applications. It is replacing the rigid instrument for diagnostic bronchoscopies.2 With the greater diameter aspirating channel of the newer fiber-optic models, removal of secretions can be per-formed with ease. Its use in the therapy of the patient with atelectasis secondary to retained secretions is increasing.3 Rigid bronchoscopy has been performed on patients while on ventilators; however, special attachments to the bronchoscope are necessary and the level of ventilation during the procedure is variable

Diagnosis of Bronchogenic Carcinoma with Atelectasis

Diagnosis of Bronchogenic Carcinoma with Atelectasis

Preintubation Pap Smears of Vocal Cords and Larynx

To the Editor.— We note in theQUESTIONS AND ANSWERSsection of your March 27th issue that Dr. Sam Nixon of Floresville, Tex, is interested in the possibility of early diagnosis of laryngeal carcinoma by routine swabbing of the vocal cords, prior to intubation, by the anesthesiologist. Dr. William J. Fable of Richmond, Va, answered that this could very well be done if an interested anesthesiologist were to be found. We, in fact, are very interested in the development of diagnostic procedures for the early detection of unsuspected airway cancers in anesthetized patients undergoing routine surgery. Procedures which might be tedious in the awake subject become simple under narcosis. Since 1969, we have been conducting a research project for the early diagnosis of bronchogenic carcinoma during general endotracheal anesthesia. Through the support of various grants we have been able to maintain a fully staffed cytology laboratory on the operating room

Validity of Lung Cancer Mortality Data

To the Editor:— The concern about the accuracy of lung cancer mortality statistics evinced by Dr. Skinner (198:1374, 1966) is shared by other observers. Autopsy follow-up of cases clinically diagnosed as bronchogenic carcinoma has often revealed the pulmonary lesion to be secondary to carcinoma of the pancreas, breast, stomach, colon, prostate, kidney, or adrenal gland. With approximately 300,000 deaths from cancer annually, the potentiality for mistaken diagnoses is considerable. When an erroneous diagnosis of bronchogenic carcinoma is corrected at autopsy, there are no procedures readily available for the amending of death certificates, nor is modification encouraged by local or national authorities. By the time the pathologic examination has been completed, the case has long been classified as primary lung cancer in official vital statistic bureaus and tumor registries. There is an even greater reservoir for inaccuracy in lung cancer data in the vast majority of cases certified without autopsy

Relative accuracy of various procedures in the diagnosis of bronchogenic carcinoma. Bronchoscopy, scalene-node biopsy, and cytology

Relative accuracy of various procedures in the diagnosis of bronchogenic carcinoma. Bronchoscopy, scalene-node biopsy, and cytology

Relative Accuracy Of Various Procedures in the Diagnosis Of Bronchogenic Carcinoma

Any discussion relative to the comparative diagnostic accuracy of bronchoscopy, scalene-node biopsy, and exfoliative cytology has two implied restrictions: (1) The patients under consideration are lung cancer suspects. They have signs or symptoms suggestive of lung cancer or have suspicious roentgenographic findings (usually both). This excludes any evaluation of these techniques for screening healthy populations. Only cytology in this diagnostic triad would be feasible for such study, and it would be contrasted with roentgenographic results, not those of bronchoscopy or scalene-node biopsy. (2) This is a comparison of microscopic diagnoses and therefore excludes bronchoscopic visual diagnoses. Our comparative results are demonstrated in Tables 1 and 2. Bronchoscopy A bronchoscopic biopsy positive for malignancy is still the most valuable preoperative finding. False-positive diagnoses are rare. They usually occur when the pathologist, trying to avoid equivocation, bases his diagnosis on insufficient evidence. Unfortunately, the percentage of bronchial biopsies positive for malignancy

NEW METHOD FOR DIAGNOSIS OF BRONCHOGENIC CARCINOMA: A PRELIMINARY REPORT.

IT IS KNOWN that the administration of tetracycline results in visible yellow fluorescence of tumor tissue. 1 The purpose of this paper is to communicate our experiences in the recovery of fluorescent material from the gastric contents in subjects with known bronchogenic carcinoma. Method Thirty male patients at the Veterans Administration Hospital, Oklahoma City, were studied. Fifteen of these patients had histologically proven bronchogenic carcinomas at different stages of the disease. The other 15 patients were diagnosed as having acute or chronic pulmonary diseases other than carcinoma. All study subjects received 1.0 gm of oxytetracycline in divided doses, orally, for five consecutive days, followed by a one day interval to allow for the disappearance of any residual tetracycline particles in the stomach and for the elimination of fluorescence from normal tissues. An overnight sputum specimen was obtained for exfoliative cytology. In the early morning of the seventh day, the stomach was