Kg. Torrington et Jd. Kern, THE UTILITY OF FIBEROPTIC BRONCHOSCOPY IN THE EVALUATION OF THE SOLITARY PULMONARY NODULE, Chest, 104(4), 1993, pp. 1021-1024
To determine the value of routine, preoperative, fiberoptic bronchosco
py (FB) for diagnosing and treating patients (pts) with solitary pulmo
nary nodules (SPNs), we retrospectively reviewed the records of all pt
s with SPNs undergoing FB at Walter Reed Army Medical Center between j
anuary 1986 and December 1989. We defined SPNs radiographically as les
s-than-or-equal-to 6 cm peripheral pulmonary lesions completely surrou
nded by pulmonary parenchyma. Of 191 charts reviewed, 91 (72 bronchoge
nic carcinomas [BC], 7 carcinoid tumors, 12 benign) constitute the stu
dy population. Fifty-four charts were eliminated because preoperative,
clinical-radiologic staging revealed advanced (greater than stage I)
BC or extrathoracic malignancy metastatic to the lung (44), the clinic
ians suspected benign disease and elected medical followup (3), the pt
had medically inoperable disease (3), or the pt refused surgery (4).
Forty-six charts were incomplete or unavailable. Fiberoptic bronchosco
py revealed one unsuspected vocal cord carcinoma and no occult synchro
nous BCs. Five pts had submucosal or endobronchial tumors and biopsy s
pecimens showed BC in four of five tumors from which specimens were ta
ken. Four of 66 (6 percent) cytologic evaluations of bronchial brushin
gs or washings diagnosed BC. In pts shown at surgery to have BC, 9 of
30 transbronchial lung biopsy (TBBx) specimens showed BC. Diagnostic y
ield of TBBx specimens was not improved in the pts who underwent biops
ies under fluoroscopic guidance. The 16 FB specimens positive for BC c
oncurred 100 percent with the surgical specimens. The FB findings did
not obviate the need for surgery nor alter the surgical stage of BC. A
preoperative diagnosis of malignancy did not affect operative time or
operative procedure, because many pts required frozen-section biopsy
of mediastinal lymph nodes prior to lung resection. At our institution
, routine, preoperative FB did not measurably benefit pts with SPNs.