Transbronchoscopic lung biopsy for localized pulmonary disease

Our results demonstrate that flexible fiberoptic bronchoscopic examination with biopsy and brushing under fluoroscopic guidance is a helpful diagnostic tool in patients with peripheral endoscopically invisible primary and metastatic lung cancer. Examination can be performed under local anesthesia with very little risk to the patient. The size of the lesion had a bearing on the results of the bronchoscopic procedure in this series. Lesions smaller than 2 cm in size were almost uniformly not diagnosed endoscopically. If lesions less than 2 cm in diameter are excluded from our study, the diagnostic yield in primary bronchogenic carcinoma is 66% and the yield in nodular metastatic cancer is 64%. Radke and associates also report a low yield (28%) for lesions less than 2 cm in diameter, while the yield was 64% for lesions greater than 2 cm in diameter. These results suggest that lesions less than 2 cm in diameter should be investigated by alternative methods. Transthoracic needle-aspiration has been shown to be highly effective in the diagnosis of peripheral small malignant lesions in the lung. Bronchoscopy probably is not indicated in patients with small (less than 2 cm) peripheral lesions except to assess operability. Evaluation of the patient's risk of cancer, pulmonary function, and general medical condition will continue to aid in determining whether to recommend surgery or to observe these small peripheral lesions.