PREOPERATIVE BRONCHOSCOPIC ASSESSMENT OF AIRWAY INVASION BY ESOPHAGEAL CANCER - A PROSPECTIVE-STUDY

Background: Bronchoscopy is frequently used to assess invasion of esop hageal cancer into the tracheobronchial tree. Prospective studies eval uating the role of bronchoscopy in pretherapeutic staging of esophagea l cancer are lacking. Study objectives: To evaluate the diagnostic uti lity of fiberoptic bronchoscopy for the assessment of airway involveme nt by esophageal carcinoma and its resectability. Patients and methods : In a prospective study, we analyzed 150 bronchoscopies in 116 consec utive patients with potentially operable esophageal carcinoma, and cor related the findings with other staging modalities, intraoperative eva luation, and histopathologic data. Results: One unknown additional bro nchial cancer was found. In 32% of bronchoscopies performed in patient s with esophageal cancer located above the tracheal bifurcation, some macroscopic abnormality was detected in the trachea and main bronchi, with mobile protrusion of the posterior tracheal wall being the most f requent abnormality (20.7%). When compared with histologic results, no rmal macroscopic appearance of the trachea and main bronchi had a nega tive predictive value of 98.5%, but the positive predictive value of a ll macroscopic abnormalities for the diagnosis of airway involvement w as low, particularly after radiation therapy. The overall accuracy of bronchoscopy with multiple blush cytology and biopsy sampling in provi ng or excluding airway invasion in patients with otherwise operable co nditions was 95.8% (95% confidence interval, 88.3 to 99.1%). Bronchosc opy was the sole decisive staging procedure, resulting in exclusion fr om surgery because of airway invasion, in 9.7% of patients with otherw ise potentially operable conditions. The results of bronchoscopy and C T were discordant in 40% of the patients; the specificity and positive predictive value were higher for bronchoscopy than for CT. Conclusion s: When performed as the last investigation in the staging workup, bro nchoscopy with biopsy and brush cytology is a very accurate procedure in evaluating possible airway invasion of esophageal cancer; macroscop ic findings alone are not reliable.