FIBEROPTIC BRONCHOSCOPY IN THE EVALUATION OF CARCINOMA METASTATIC TO THE LUNG

To determine the clinical presentation of patients with malignancies m etastatic to the lung, the diagnostic utility of fiberoptic bronchosco py (FB), and the primary site of malignancies metastasizing endobronch ially, we retrospectively reviewed 1,853 FB records (1987 to 1991) and selected 111 cases for review Cases were divided on the basis of FB f indings into abnormal (44 patients) and normal (67 patients). Pulmonar y symptoms (cough, hemoptysis, and chest pain) prompted referral signi ficantly more often in the abnormal FB group (34/44) than in the norma l FB group (24/67). The finding of atelectasis on chest radiograph occ urred more frequently in patients with endobronchial abnormalities. Th e spectrum of extrapulmonary malignancies that metastasize endobronchi ally has changed during the AIDS epidemic. Our study shows the most fr equent causes of endobronchial mass lesions were Kaposi's sarcoma and the lymphoma group (Hodgkin's disease, nonHodgkin's lymphoma, chronic lymphocytic leukemia) and the most common malignancies causing submuco sal metastases were breast and the lymphoma group. In summary, the hig hest yield for FB can be expected in patients experiencing symptoms of cough of hemoptysis and/or having radiographic evidence of atelectasi s. We propose a new mnemonic ''KLAS'' (Kaposi's sarcoma, Lymphoma, Ade nocarcinoma, Sarcoma) to describe the malignancies most likely to meta stasize endobronchially in the 1990s.