The Role of Rigid Bronchoscopic Intervention for Bronchial Carcinoid

Abstract

Bronchial carcinoid is a rare malignant tumor that is categorized as a typical carcinoid or atypical carcinoid. Many institutions use flexible bronchoscopy for diagnosis. However, due to the hemorrhagic nature of the tumor, the amount of specimen obtained is often small, making it difficult to obtain an accurate diagnosis. The use of rigid bronchoscopy may not only contribute to obtaining a diagnosis but also be beneficial in the treatment plan. The aim of this study was to evaluate the efficacy of rigid bronchoscopic interventions for the diagnosis and treatment of bronchial carcinoids. All patients with bronchial carcinoids who underwent rigid bronchoscopic intervention under general anesthesia at our institution between June 2006 and August 2018 were analyzed retrospectively. Eight patients [3 men and 5 women; median age, 71 years (range 45-82 years)] were eligible for the analysis. None of the cases had accurate subtyping preoperatively before intervention. In contrast, all cases were diagnosed as carcinoid with subtypes (5 patients had typical carcinoid and 3 had atypical carcinoid) following rigid bronchoscopic intervention. All respiratory symptoms improved immediately after the procedure. One instance of bleeding occurred, and was easily controlled by argon plasma coagulation and intraluminal administration of epinephrine under flexible and rigid bronchoscopy. Four patients (3 with typical carcinoid and 1 with atypical carcinoid) underwent radical surgery sequentially, and no recurrences were observed. We conclude that rigid bronchoscopic intervention is safe and effective for accurate diagnosis and improvement of respiratory symptoms in patients with bronchial carcinoids.

Advances in Endoscopic Management of Endobronchial Carcinoid

“…They are classified into two groups: typical and atypical bronchial carcinoids, according to the 1999 World Health Organization classification which accepted the criteria proposed by TRAVIS based on the correlation between histologic differences and clinical prognosis of the patients [ 6 ]. Typical bronchial carcinoids (<2 mitoses/2 mm 2 of viable tumor) have a good prognosis with a 10-year survival rate of 90% compared with atypical carcinoids (2 to 10 mitoses/2 mm 2 , necrosis or architectural disruption) which have a higher rate of metastasis and recurrence, with a 10-year survival of less than 60% [ 6 ].…”