Fibreoptic bronchoscopy: ten years on.

Current status of fibreoptic bronchoscopy

“…The tumour is bronchoscopically visible in 48% of patients and in these a histological diagnosis can be made in over 90%o of cases (Mitchell et al, 1980;Martini and McCormick, 1978). If the tumour is not visible, the positive biopsy rate falls to about 40%o.…”

“…If the tumour is not visible, the positive biopsy rate falls to about 40%o. Peripheral endobronchial tumours beyond the visual range of the fibrescope may still be biopsied with fluoroscopy as may lung parenchymal tumours using fluoroscopy and transbronchial lung biopsy: here a positive histology rate of about 60%1o is found (Mitchell et al, 1980). The diagnostic yield may be increased by combining forceps biopsy with brush cytology (Kvale, Bode and Kini, 1976).…”

“…Whenever sputum cytology is positive but the chest radiograph appears normal, bronchoscopy should be performed. Out of 499 patients with carcinoma, 12 had a normal chest radiograph; of these five had a positive mucosal biopsy at bronchoscopy (Mitchell et al, 1980). Intravenous administration of a derivative of haematoporphyrin, which has an affinity for malignant tissue, considerably increases the ease with which endobronchial tumour can be seen when viewed with red light from an argon dye laser.…”

“…Without screening the diagnostic rate is less, 36-62% (Clarke et al, 1977;Knight, 1981) but improves to 64-97% with fluoroscopy (Hanson et al, 1976;Lefrak and Tuteur, 1977). The diagnostic yield is particularly high in sarcoidosis, 82%, (Mitchell et al, 1980), and increases with the stage of the disease from 57% in stage I, 77% in stage II and 91% in stage III (Knight, 1981). In fibrosing alveolitis where the histology varies between different parts of the lung, transbronchial lung biopsy has been less useful in making a tissue diagnosis and open lung biopsy is preferred.…”

“…At the Brompton Hospital an average of 855 fibreoptic bronchoscopies have been performed annually since 1975. An earlier analysis of 1,223 of these showed that in most (81%), a histological diagnosis was made and no further diagnostic procedure was required (Mitchell et al, 1980).…”