Fiberoptic Bronchoscopy Findings Research Articles

Clinical Profile and Positivity Rate of Fiber Optic Bronchoscopy (FOB) Procedures in Lung Cancer

Fiber Optic Bronchoscopy (FOB) is an invasive procedure that has been traditionally used both as diagnostic and therapeutic purposes in the field of pulmonary diseases. However, it is mainly used as diagnostic method in lung cancer diagnosis, followed by appropriate sampling procedures including needle aspiration, forceps biopsy, brushing, and washing. We aim to characterize the profile of FOB results including the positivity rate (the rate in which pathology results yield either class IV or class V cells) of each FOB procedure. This is an observational descriptive study using retrospective approach using existing FOB results from our patients. The most common FOB finding was compressive stenosis (35.4%), followed by obstructive (34.8%), and infiltrative stenosis (29.8%). Positivity rate for needle aspiration was 50% for infiltrative and 57.15% for obstructive stenosis; Positivity rate for forceps biopsy was 42.1% for infiltrative and 73.33% for obstructive stenosis; Positivity rate for brushing was 6.66% for compressive, 38.24% for infiltrative, and 25.72% for obstructive stenosis; and positivity rate of washing was 5.36% for compressive, 17.54% for infiltrative, and 6.12% for obstructive stenosis. These results showed that as the main method in lung cancer diagnosis, FOB procedures have excellent results depending on the choice of sampling procedures used based on FOB findings.

Analysis of Fiberoptic Bronchoscopy Findings in Respiratory Unit at Ba" Aquba Teaching Hospital in 2020-2021

Analysis of Fiberoptic Bronchoscopy Findings in Respiratory Unit at Ba" Aquba Teaching Hospital in 2020-2021

Fiberoptic Bronchoscopic Findings in Patients Suffering from Emerging Pulmonary Lophomoniasis: A First Registry-Based Clinical Study

Background Lophomonas blattarum is an emerging protozoan agent that mainly infects the lower respiratory system, causing pulmonary lophomoniasis. The bronchoscopic findings in patients with pulmonary lophomoniasis have not been investigated yet. Accordingly, we assess the bronchoscopic findings of lophomoniasis in patients suffering from pulmonary lophomoniasis through a registry-based clinical study. Methods In this retrospective study, of 480 patient candidates for bronchoscopy, 50 Lophomonas-positive patients were enrolled. Demographic data, relevant characteristics, and bronchoscopy findings of the patients were recorded and analyzed. Results Overall, 50 (male = 32, female = 18) patients with an average age of 61.8 ± 13.3 years were examined. Nineteen patients (38%) had normal bronchoscopic findings, and 31 patients (62%) had abnormal bronchoscopic findings. According to the severity index, most (52%) of patients had mild severity, followed by moderate (30%) and severe (18%) cases. The highest involvement was in the right lung bronchus (46%), and the lowest was in the carina (8%). Furthermore, purulent and mucosal secretions in the right and left lung bronchus were the most abnormalities found in different anatomical locations. Conclusion For the first time, the current study demonstrated that pulmonary lophomoniasis does not have pathognomonic bronchoscopic findings. However, each suspected patient must be checked for lophomoniasis, even with normal bronchoscopic findings, particularly in endemic areas.

The Importance of Flexible Bronchoscopy in Difficult-to-treat Asthma from a Pediatric Pulmonology Perspective.

ObjectiveAsthma is the most common chronic lung disease in childhood. Difficult-to-treat asthma is defined as the continuation of symptoms or attacks of patients despite step 4 or 5 of Global Initiative for Asthma therapy. In the differential diagnosis of these patients, flexible fiberoptic bronchoscopy is recommended to exclude other lung diseases. In this study, we aimed to examine the clinical and radiologic features and flexible fiberoptic bronchoscopy findings of patients referred to our pediatric pulmonology department due to difficult-to-treat asthma and determine the effects of flexible fiberoptic bronchoscopy on the differential diagnosis and treatment.Materials and MethodsThe demographic characteristics and flexible fiberoptic bronchoscopy results of 62 patients who were diagnosed as having difficult-to-treat asthma in our pediatric pulmonology department between January 2015 and June 2020 were evaluated retrospectively. The symptoms, history, medications, physical examination findings, pulmonary function tests, and radiologic findings of patients who underwent flexible fiberoptic bronchoscopy were evaluated.ResultsThe median age of the patients was 69 (interquartile range: 42-108 months). The most common reasons for the referral of these patients were chronic cough, recurrent pulmonary infections, and persistent wheezing. All patients had chest radiography and 37 (59.7%) had chest computed tomography at their first admission; 14 (37.8%) patients had abnormal findings on chest computed tomography. There was no significant difference in terms of age, physical examination findings, pulmonary function test results, and radiologic examinations between patients with and without pathologic bronchoscopy findings. None of the patients had complications during and after flexible fiberoptic bronchoscopy. The most common diagnoses of patients based on flexible fiberoptic bronchoscopy were persistent bacterial bronchitis in 19 (30.6%) patients, tracheomalacia and/or bronchomalacia in 12 (19.4%), and anatomic anomalies in 3 (4.8%) patients (separation of lingula into 3, separation of right upper lobe bronchus into 4, and tracheal dyskinesia). Mycobacterium tuberculosis growth was observed in the tuberculosis culture of 1 patient. According to the flexible fiberoptic bronchoscopy and bronchoalveolar lavage results, antituberculosis treatment was initiated in 1 patient and polypoid mass excision was performed in 1 patient. A proton pump inhibitor was started in 9 (15.5%) patients, physiotherapy in 5 (8.0%), antibiotics in 14 (22.5%), and ipratropium bromide in 7 (11.2%) patients. All patients were followed up with the diagnosis of asthma except for 2 patients.ConclusionTo date, there is no prospective study evaluating the importance of flexible fiberoptic bronchoscopy in difficult-to-treat asthma in childhood. In our small cohort, persistent bacterial bronchitis, airway tracheomalacia and/or bronchomalacia, gastroesophageal reflux, and other anatomic anomalies were successfully diagnosed using flexible fiberoptic bronchoscopy and treated without any complications, suggesting that flexible fiberoptic bronchoscopy is an important diagnostic tool with a low complication rate in children with difficult-to-treat asthma.KeywordsDifficult-to-treat asthma, flexible fiberoptic bronchoscopy, persistent bacterial bronchitis, gastroesophageal reflux

Bronchogenic Carcinoma: Endoscopy versus Histopathology

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.

Risks and Benefits of Bronchoscopy during the First 100 Days Following Allogeneic Hematopoietic Cell Transplantation

BACKGROUND Pulmonary infiltrates are common after allogeneic hematopoietic cell transplantation (HCT) and can have infectious or non-infectious etiologies. Fiberoptic Bronchoscopy (FOB) with bronchoalveolar lavage (BAL) is frequently used to evaluate these patients. However, the diagnostic yield can be highly variable according to patient populations, and the impact on management is not well defined, especially in the era of modern antimicrobial therapies. The aim of this study was to investigate the diagnostic and therapeutic yield of FOB-BAL in adult patients with pulmonary infiltrates during the first 100 days following HCT. METHODS We retrospectively reviewed the medical records of adult HCT patients who underwent FOB-BAL during the first 100 days post HCT between January 2005 and December 2015 at Mayo Clinic, Rochester, MN. The interval from HCT to FOB was stratified into early (days 1-30) vs. late (days 31-100). The finding of progressively more hemorrhagic effluent and/or ≥ 20% hemosiderin-laden macrophages in BAL were considered diagnostic for diffuse alveolar hemorrhage (DAH). Univariate and multivariate logistic regression models were fit to identify clinical and transplant characteristics that may impact the diagnostic yield of FOB-BAL. RESULTS A total of 114 patients (median age 55 years), representing 12% of all HCT patients underwent FOB-BAL. Underlying diagnoses were AML in 36%, MDS in 16%, ALL in 16%, MPN in 12% , CLL in 7%, and other in 13%. Transplants were from matched related donor in 43%, matched unrelated donor in 40%, and other donor/matching status in 17%. FOB-BAL was performed during the early period in 61% and during the late period in 39% of patients. In the early period, FOB-BAL provided a specific diagnosis in 49% of patients (30% DAH and 19% infection). In the late period, FOB-BAL had a diagnostic yield of 55% (14% DAH and 36% infection) (Figure 1). The distribution of bacterial and viral infections identified via BAL were similar during the early period (39% and 38%, respectively), whereas more bacterial than viral infections were identified in the later period (56% vs. 19%, respectively) (Figure 2). Non-invasive testing for respiratory tract infection was performed in 34% of patients. These included nasopharyngeal swab for RSV/Influenza PCR in 16% (all negative), multiplex respiratory pathogen PCR in 5% (1 positive for coronavirus), and sputum culture in 21% (positive in 8 patients). This compares with the identification of an infectious pathogen via BAL in 36% of patients; bacterial in 16%, viral in 11%, and fungal in 10%. Transbronchoscopic lung biopsy biopsies were performed in 8 patients and provided diagnostic information in 3 patients (eosinophilic pneumonia, organizing pneumonia and diffuse alveolar damage each in 1 patient). Procedural complications occurred in 3 patients; 2 after transbronchoscopic lung biopsy (1 bleeding and 1 pneumothorax) and 1 during FOB-BAL (atrial fibrillation with rapid ventricular rate). In a multivariable logistic regression model, the underlying diagnosis, presence of acute respiratory failure, and early vs. later time period after HCT were independently affecting the diagnostic yield of FOB-BAL, with higher likelihood of DAH being diagnosed in patients with AML/MDS and during the early post-HCT period, and higher likelihood of DAH being diagnosed in patients with acute respiratory failure (Table 1). In 40% of patients, FOB-BAL findings lead to treatment changes. These included addition of antimicrobials in 24% and addition of corticosteroids in 22% (17% DAH, 2% idiopathic pneumonia syndrome, and 1% organizing pneumonia) (Figure 3). FOB findings lead to more antimicrobial modifications in the early than in the later period (32% vs. 18%, respectively). Overall survival was poor in all the three groups, although significantly better in patients with non-diagnostic FOB findings (median of 2, 3, and 11 months in patients with DAH, infection, or non-diagnostic FOB finings, respectively) (p = 0.03) (Figure 4). CONCLUSION FOB-BAL provides clinically useful information in the post-transplant period. BAL findings were diagnostic in 51% of patients, and led to management changes in 40% of patients. Transbronchoscopic lung biopsy is associated with higher rates of procedural complications. Further characterization of the underlying diagnosis in patients with non-diagnostic FOB-BAL findings remains an unmet clinical goal. Disclosures Sakemura: Humanigen: Patents & Royalties. Kenderian:Morphosys: Research Funding; Kite/Gilead: Research Funding; Lentigen: Research Funding; Humanigen: Other: Scientific advisory board , Patents & Royalties, Research Funding; Tolero: Research Funding; Novartis: Patents & Royalties, Research Funding. Patnaik:Stem Line Pharmaceuticals.: Membership on an entity's Board of Directors or advisory committees.

Indications of early intubation for patients with inhalation injury.

AimFor patients with inhalation injury, the indications for early intubation are diverse. The purpose of this study was to identify the most reliable symptoms, physical findings, and medical examinations with which to determine the indications for early intubation in patients with inhalation injury.MethodsWe retrospectively collected patient data from medical records. Collected data included age, sex, burn size, symptoms, physical findings, carboxyhemoglobin levels (COHb), and bronchial wall thickness (BWT) determined from chest computed tomography images. We analyzed the relationships between these findings and the early intubation. We performed fiberoptic bronchoscopy in all patients, and analyzed the relationships between bronchoscopic severity and other findings.ResultsOf the 205 patients, 80 patients were diagnosed as having inhalation injury, and 34 patients were intubated. Burn size, facial burns, neck burns, use of accessory respiratory muscles, and COHb seemed to be related with intubation, whereas singed nasal hair was not. If the patients suffered ≥27% total body surface area burn and BWT ≥3.5 mm, the positive predictive value for early intubation was 1.00. If the patients suffered smaller cutaneous burn without neck burn, and their COHb <4.0%, the negative predictive value for early intubation was 0.97. Fiberoptic bronchoscopy findings from above the glottis were mainly related with patients’ symptoms. Findings from below the glottis were mainly related with BWT and COHb.ConclusionsPatients’ symptoms, especially use of accessory respiratory muscles, are reliable, and BWT and COHb are also useful tools, for determining the indication for early intubation.

気管支腺様嚢胞癌の 1 切除例 : 気管支鏡所見と切除標本における病変の広がりとの対比

気管支腺様嚢胞癌の 1 切除例 : 気管支鏡所見と切除標本における病変の広がりとの対比

The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis.

This study aimed to investigate the additional diagnostic value of endobronchial biopsy (EBB) in the diagnosis of pulmonary sarcoidosis. This retrospective cross-sectional study included 59 patients with a preliminary diagnosis of sarcoidosis who were admitted to the Pulmonary Diseases Outpatient Clinic of a tertiary healthcare center between January 2005 and October 2012. The socio-demographic characteristics of the patients as well as clinical and radiological findings were recorded. All patients, irrespective of the presence of an endobronchial lesion (EBL), underwent fiberoptic bronchoscopy (FOB); two to four specimens were taken using EBB from the carina of the right middle lobe in the patients with EBL. Of the patients, 39 (66.1%) had normal bronchoscopic findings, while 5 had EBL. Diagnosis was based on EBB in 11 patients (18.6%). Six patients (15.3%) with normal bronchial mucosae were pathologically diagnosed by EBB. There was no statistically significant relationship between the diagnostic ratio of EBB and disease stage, extrapulmonary involvement, FOB findings, elevated lymphocyte rate in bronchoalveolar lavage (≥ 13%), a CD4/CD8 ratio of ≥ 3.5, and serum angiotensin-converting enzyme (ACE) level (p> 0.05). EBB not only offers the advantage of a high diagnostic ratio in patients with mucosal abnormalities but also contributes to pathological diagnosis in patients with normal mucosa. We recommend using EBB to support diagnosis with a low complication rate for patients undergoing FOB with a preliminary diagnosis of sarcoidosis in healthcare centers, where endobronchial ultrasound (EBUS) is unavailable.

Study of Clinical Profile and Fiber Optic Bronchoscopy Findings in Patients Diagnosed with Lung Cancer and their Correlation with Histopathological Findings

Study of Clinical Profile and Fiber Optic Bronchoscopy Findings in Patients Diagnosed with Lung Cancer and their Correlation with Histopathological Findings

Computed Tomography Correlation of Airway Disease With Bronchoscopy—Part II: Tracheal Neoplasms

This pictorial essay illustrates, describes, and correlates computed tomographic findings of tracheal neoplasms with fiberoptic bronchoscopy findings. Corresponding computed tomography (CT) and bronchoscopy findings of common primary tracheal neoplasms; squamous cell papilloma, papillomatosis, squamous cell carcinoma, adenoid cystic adenoma, non-Hodgkin׳s lymphoma, and a secondary malignant neoplasm of the trachea; and renal cell carcinoma were correlated.

Computed Tomography Correlation of Airway Disease With Bronchoscopy: Part I—Nonneoplastic Large Airway Diseases

To illustrate and describe computed tomographic large airway pathology and correlate with fiberoptic bronchoscopy findings. Commonly encountered diseases of the large airway include tracheobronchial amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, relapsing polychondritis, Wegener granulomatosis, sarcoidosis, and tracheal stenosis. Computed tomography manifestations and bronchoscopic findings of these selected large airway diseases are discussed.

Multidetector computed tomography with virtual bronchoscopy in patients with bronchiectasis or osteochondroplastic tracheobronchopathy

Aim. The primary aim of this study was to evaluate a role of virtual bronchoscopy as a part of multidetector computed tomography (MDCT) for diag nosis of bronchiectasis and its complications. The second aim was to determine a role of minimalintensity projection (minIP) and 3dimensional reconstructions for assessment of structure of trachea and bronchi. Methods. MDCT was performed in 16sliced scanner Toshiba Aquilion 16 and 320sliced scanner Aquilion ONE. To evaluate central and distal air ways, threshold values of –400 HU to –600 HU and –750 HU were used, respectively. A software was used for virtual bronchoscopy with simulta neous postprocessing reformation of native images (minIP and maxIP images) and 3dimensional reconstructions. Results of virtual bronchoscopy were compared with fiberoptic bronchoscopy findings. Results. Virtual bronchoscopy allowed investigation of inner surfaces of trachea, carina, main, segmental and subsegmental bronchi (with the small est diameter of 1–2 cm). Bronchiectasis was seen as deformities of bronchial lumen. Nontumoral bronchial stenosis did not impede visualization of more distal part of the bronchus during virtual bronchoscopy compared to fiberobronchoscopy. Visualization of bronchial inner surface depended on extent of bronchiectasis and could reach subsegmental bronchi of 5–6 generation. Conclusion. MDCT virtual bronchoscopy technique based on combined evaluation of minIPimages, 3Dreformations and virtual bronchoscopy has been developed. This technique allows complete assessment of structure of trachea and bronchi in patients with bronchiectasis or osteochon droplastic tracheobronchopathy.

Surgical treatment of an endobronchial lipoma obstructing the right upper bronchus: Imaging features with pathological correlation

Endobronchial lipomas are rare benign unusual tumors of the respiratory tract. We describe a 65-year-old Chinese man with a history of cough due to an endobronchial tumor. The endobronchial biopsy was not excisional and was unable to evaluate the whole tumor. Then the mass was successfully resected via a right lateral thoracotomy. The histopathological diagnosis confirmed a benign lipoma arising from the membranous trachea. His CT features and fiberoptic bronchoscopic findings are shown along with the pathological results. In describing the management of this case, we stress that the clinical treatment of such tumors should be individualized according to the characteristics of each patient and mass.

Achados de fibrobroncoscopia em pacientes com diagnóstico de neoplasia pulmonar

To compile fiberoptic bronchoscopy findings in patients diagnosed with lung cancer and to correlate those with histopathological findings. This was a retrospective study involving 212 patients with a confirmed diagnosis of lung cancer by cytological evaluation of BAL specimens or by histopathological evaluation of endobronchial or transbronchial biopsy specimens. The data were collected at the Respiratory Endoscopy Sector of Hospital São Salvador, located in the city of Goiânia, Brazil, between 2005 and 2010. The endoscopic findings were classified as endoscopically visible tumor, endoscopically invisible tumor, mucosal injury, as well as being classified by the presence/type of secretion. The visible tumors were also classified according to their location in the tracheobronchial tree. Endobronchial mass (64%) and mucosal infiltration (35%) were the main endoscopic findings. The histological type was determined in 199 cases, the most prevalent types being squamous carcinoma, in 78 (39%), adenocarcinoma, in 42 (21%) small cell carcinoma, in 24 (12%), and large cell carcinoma, in 2 (1%). More than 45% of the visible tumors were at the upper bronchi. Squamous carcinoma (n = 78) was most commonly visualized as an endobronchial mass (in 74%), mucosal infiltration (in 36%), luminal narrowing (in 10%), or external compression (in 6%). Our results show that the endobronchial mass is the most common bronchoscopic finding that is suggestive of malignancy. Proportionally, mucosal infiltration is the most common finding in small cell carcinoma. In adenocarcinoma, luminal narrowing, external compression, mucosal injury, and endobronchial secretion prevail.

Comparison of virtual bronchoscopy with fiberoptic bronchoscopy findings in patients exposed to sulfur mustard gas

Fiberoptic bronchoscopy (FB) is the best modality for evaluation of tracheobronchial endoluminal lesions. Virtual bronchoscopy (VB) with the aid of computed tomography (CT) makes it possible to reconstruct endoscopic-like visualization of major airways. Sulfur mustard (SM) used during the Iraq-Iran war affects respiratory tracts and can lead to tracheobronchial stenosis. To compare VB with FB in SM-exposed patients suspected for airway stenosis. Thirty-one patients were evaluated with CT and bronchoscopic studies about 15 years after chemical attacks. The median age of patients was 40 years. Spiral CT scans were obtained and data were transferred to a workstation to generate VB images of major airways. Less than one week after CT scan, FB was performed. For the tracheal pathologies seen in FB, the sensitivity, specificity, and accuracy of VB was 90.9%, 95%, and 93.5% for tracheal stenosis, 40%, 96.2%, and 87.1% for vocal cord problems, 100%, 100%, and 100% for postoperative changes, and 100%, 96.7%, and 96.8% for intratracheal nodule. The inflammation of mucosal surface could not be assessed by VB. The bronchial pathologies seen in FB included eight cases of stenosis, and one case of nodule. Sensitivity, specificity, and accuracy of VB for detection of bronchial stenosis was 62.5%, 97.8% and 92.6%, respectively. Overall sensitivity, specificity and accuracy of VB in detecting tracheobronchial stenosis were 78.9%, 97.0%, and 92.9%, respectively. Our study indicates that VB is an accurate method for evaluating stenoses, endoluminal nodules, and poststenotic areas within the tracheobronchial tree of SM-exposed victims. This complementary method could be helpful in revealing hidden post-stenotic lesions and also better depict the long tracheal strictures and their actual length.

An Unusual Presentation of Bronchial Rupture

Persistent hydropneumothorax was diagnosed in a 62-year-old female with a history of blunt trauma, although she was treated with chest tube and closed underwater seal drainage. Computed tomography and fiberoptic bronchoscopy findings were consistent with "fallen lung" syndrome. Fiberoptic bronchoscopy also found a cavitary lesion at the right tracheobronchial angle. Forceps biopsy of the cavitary lesion indicated bronchogenic carcinoma. Our final diagnosis was tracheobronchial complete rupture and fallen lung syndrome secondary to malignancy.

Sequential use of bronchial aspirates, biopsies and washings in the preoperative management of lung cancers.

BackgroundThe combination of cytology and biopsies improves the recognition and typing of small cell (SCLC) versus non small cell (NSCLC) lung cancers in the fiberoptic bronchoscopy assessment of centrally located tumours.MethodsWe studied whether bronchial aspirates performed before biopsies (BA) and washings performed after biopsies (BW) could increase the diagnostic yield of fiberoptic bronchoscopy. A series of 334 consecutive samples taken in patients with suspicious fiberoptic bronchoscopy findings was studied. Two hundred primary tumours were included in the study. The actual diagnosis was based on surgical tissue specimen analysis and/or imaging techniques. The typing used was that of the 1999 WHO/IASLC classification.ResultsThe diagnosis of malignancy and tumour typing were analyzed according to the sequential (combined) or single use of tests. Malignancy was assessed by cytology in 144/164 (87.8%) positive biopsy cases and in 174/200 tumour cases (87.0%). BA before biopsies allowed 84.0% of cancers to be diagnosed, whereas BW after biopsies allowed 79.0% of cancers to be found (p = ns). However, combining biopsies with BW allowed 94.0% of cancers to be diagnosed, whereas 82.0% were diagnosed by biopsies alone (p < 0.001). The highest diagnostic yield was obtained with the combination of BA, biopsies and BW, with 97.0% sensitivity. Exact concordance in typing was obtained in 83.8% of cases. The six surgically resected cases (3.0%) with negative cytology and biopsy results included four squamous cell carcinomas with necrotizing or fibrous surface and two adenocarcinomas, pT1 stage.ConclusionFiberoptic bronchoscopy may reach a yield of close to 100% in the diagnosis and typing of centrally located, primary lung cancers by combining bronchial aspirates, biopsies and washings.

Results of the Study Comparing Devices Used for Lung Isolation Are Rather Concerning

Results of the Study Comparing Devices Used for Lung Isolation Are Rather Concerning

Functional evaluation of trachea in patients with COPD

Severe cough associated with COPD can induce dynamic instability of trachea. It is important to investigate large airways in COPD patients and to create diagnostic program for evaluation of this dynamic changes. Aim: to investigate sensitivity and specificity of different methods for detection of dynamic tracheal instability in COPD patients. Of fifty five patients involved in this study 30 ones were selected according to inclusion criteria. They were divided into 2 groups: 20 COPD stage 2 patients with dynamic tracheal instability detected by fiberoptic bronchoscopy (the 1-st group; 14 females, 6 males; the mean age, 60.9 ± 7.9 yrs; BMI, 28.2 ± 4.3 kg / m2; the smoking history, 35.4 ± 5.2 pack-year) and 10 COPD stage 2 patients without dynamic tracheal instability according to fiberoptic bronchoscopy findings (the 2nd group; 2 females and 8 males; the mean age, 55.2 ± 4.8 yrs; BMI, 26.8 ± 2.6 kg/m2; the smoking history, 28.2 ± 3.4 pack-year). Clinical examination, flow-volume curve, body plethysmography, impulse oscillometry, X-ray examination of trachea, fiberoptic bronchoscopy, and electron-beam tomography were used in our work. As a result, the most sensitive functional method was impulse oscillometry (Se = 85 %). Electron-beam tomography is more sensitive (Se = 90 %) than X-ray examination of trachea (Se = 65 %) while diagnosing dynamic tracheal instability in the COPD patients.