Usefulness of ultrathin bronchoscopy in diagnosis of lung cancer
Introduction
Diagnosis of peripheral lung lesions can be problematic for chest physicians. Bronchoscopy is a first choice of examination to obtain materials for cytological and histological diagnosis, but does not always result in a final diagnosis. Use of bronchoscopes with an outer diameter of 3 mm or less are called ultrathin broncoscopes and came into use in the 1980’s [1], [2]. Because of the lack of a built-in channel in their first generation, these bronchoscopes were used only to observe peripheral airways [2], [3], [4], [5], [6], [7]. Afterward, ultrathin bronchoscopes with a built-in channel were developed and enabled brushing, biopsy, and bronchoalveolar lavage through the channel [8], [9], [10], [11], [12], [13]. However, until recently most usage had been limited to infants or treatment of inflammatory diseases [6], [7], [8], [10], [11], [12], and the reports on the diagnosis of lung cancer with ultrathin bronchoscopes has been limited [5], [9], [13]. The newest ultrathin bronchoscope, XP40 (Fig. 1), has a much wider range of movement of the tip, and a specialized forceps for biopsy, FD56D, has been developed. With these developments, it has been suggested that the diagnostic abilities of ultrathin bronchoscopy for peripheral lung lesions has been improving. In this paper, we report on the results of two independent studies. In the first study, we compared the diagnostic rates between ultrathin and conventional bronchoscopy. In the next study, we applied a rapid cytology test, which we have recently established, to bronchoscopic examination, and tested the usefulness of XP40 as a complement to conventional bronchoscopy [14].
Section snippets
Comparison between conventional and ultrathin bronchoscopy (Study A)
Among the patients who underwent bronchoscopy under fluoroscopic guidance in our hospital in 2000, 35 patients who had peripheral lung lesions that were small in size or located in the segment such as S1, S2, S1+2, and S6 where the approach with conventional bronchoscopes was considered difficult in general were subjected to the study. The median age was 64 years (range, 39–83 years); 19 patients were men and 16 patients were women. The median diameter of tumor was 21.7 mm (range, 10–40 mm).
Under
Diagnostic rate of ultrathin bronchoscopy
Final diagnosis consisted of 23 primary lung cancers, 1 metastatic lung cancer, 3 pulmonary tuberculosis, and 1 mycobacterium avium complex disease. Final diagnosis wasn’t determined in residual seven patients. The imaging, including chest computed tomography (CT), suggested that the lesions without final diagnosis were non-specific inflammatory processes, and most of these lesions showed a tendency to resolve during follow up. Twenty-two of 35 patients were diagnosed by either form of
Discussion
The improvement of ultrathin bronchoscopes, especially with the integration of a built-in channel, made it possible to perform brushing cytology, biopsy, and bronchoalveolar lavage utilizing the channel. Whereas most of the reports on ultrathin bronchoscopes so far have dealt with infant diseases or diffuse pulmonary diseases [6], [7], [8], [10], [11], [12], there are only a limited number of studies in which diagnostic ability for lung cancer was compared between ultrathin and conventional
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