Chest
Volume 75, Issue 2, February 1979, Pages 141-145
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Clinical Investigations
Biopsy and Brushing of Peripheral Lung Cancer with Fluoroscopic Guidance

https://doi.org/10.1378/chest.75.2.141Get rights and content

Forty-eight patients underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance, with biopsy and brushing of an endoscopically invisible primary cancer of the lung. A diagnostic (abnormal) specimen was obtained by biopsy or brushing (or both) in 29 patients (60 percent), by biopsy alone in 22 (46 percent), and by brushing alone in 19 (40 percent). Success in obtaining diagnostic tissue was related to cellular type, location by bronchopulmonary segment, size of the tumor, and distance of the tumor from the hilum.

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MATERIALS AND METHODS

Records of all patients who underwent a flexible fiberoptic bronchoscopic procedure and who had both a biopsy and a brushing done with fluroscopic guidance between December 1976 and December 1977 were reviewed. The bronchoscopic examination was performed with the use of local anesthesia. An oral tracheal tube was in place throughout the procedure, and supplemental oxygen was administered. Less than 30 minutes was spent on each bronchoscopic examination. A single bronchoscopic examination was

RESULTS

Of the 29 patients (60 percent) in whom diagnostic tissue was obtained, one had an abnormal result on frozen sections, with no brushing or washing being done. Therefore, 28 patients had abnormal results on bronchoscopic procedures and had biopsy, brushing, and washing. In these 28 patients, whenever the washing was abnormal, the biopsy or the brushing (or both) also was abnormal. In six of the 28 patients, the biopsy alone was abnormal. In nine (19 percent) of 47 patients, the biopsy was

Overall Results of Biopsy and Brushing

This study included only patients with primary lung cancer who had normal results on endobronchial examination by flexible fiberoptic bronchoscopy and who underwent both biopsy of the lung and brushing of the lesion under fluoroscopic guidance. Our studies show that the washings added no more information to the biopsy and brushing in this selected series. The biopsy and brushings were complementary.

Richardson et al1 reported a positive diagnosis with brushings under fluoroscopic guidance in 39

CONCLUSION

The results of this study and review of other series of cases of primary lung cancer occurring as peripheral lesions that are not endoscopically visible indicate that 50 to 80 percent can be diagnosed by biopsy and brushing using the flexible fiberoptic bronchoscope with fluoroscopic guidance. Rates of abnormal biopsies range from 30 to 75 percent, whereas rates of abnormal brushings range from 20 to 80 percent. In our series, the overall rate of abnormal results for the bronchoscopic procedure

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Manuscript received April 3; revision accepted July 26.

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