THE UTILITY OF FIBEROPTIC BRONCHOSCOPY IN THE EVALUATION OF THE SOLITARY PULMONARY NODULE

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.