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Thorac Cardiovasc Surg 2014; 62(07): 593-598
DOI: 10.1055/s-0034-1377062
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Value of Flexible Bronchoscopy for the Preoperative Assessment of NSCLC Diagnosed Using Percutaneous Core Needle Biopsy

Kyung-Wook Jo
1   Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
,
Hyeong Ryul Kim
2   Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
,
Dong Kwan Kim
2   Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
,
Yong-Hee Kim
2   Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
,
Seung-Il Park
2   Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
,
Se Hoon Choi
2   Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
,
Chang-Min Choi
1   Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
› Author Affiliations
Further Information

Publication History

18 January 2014

01 April 2014

Publication Date:
15 July 2014 (online)

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Abstract

Background We aimed to investigate the value of routine flexible bronchoscopy (FB) for the preoperative assessment of early-stage non-small cell lung cancer (NSCLC) diagnosed using percutaneous core needle biopsy (PCNB).

Methods We enrolled 688 NSCLC patients who were treated at our hospital between January 2003 and December 2012 and who met the following criteria: (1) early-stage lung cancer (stage I or II); (2) lung cancer had been diagnosed using PCNB; and (3) no evidence of endobronchial disease in the airways other than the primary cancer site on both chest computed tomography (CT) and positron emission tomography-CT (PET-CT). All NSCLC patients were from the same tertiary referral center, where FB is routinely performed preoperatively for this disease, and their medical records were reviewed retrospectively.

Results Of the 688 patients included in the study, 451 (65.6%) were male and the median age was 65 years. Pathology analysis revealed that adenocarcinoma was the most frequently observed cell type (516/688, 75.0%). The distribution of preoperative clinical staging for the 688 patients was (1) IA (54.5%, 375/688); (2) IB (22.1%, 152/688); (3) IIA (18.2%, 125/688); and (4) IIB (5.2%, 36/688). The majority of these patients (95.2%, 655/688) underwent surgical resection. Unsuspected malignant endobronchial lesion on FB was found in only two cases (0.3%), and the surgical strategy had to be modified for both of these patients.

Conclusion Preoperative FB is not beneficial for screening the airways of almost any patient with early-stage NSCLC, provided that neither PET-CT nor CT reveal any evidence of endobronchial malignant involvement other than at the primary cancer site.

Keywords

bronchoscopy - NSCLC - PET-CT - CT
 

  • References

  • 1 Aristizabal JF, Young KR, Nath H. Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma?. Chest 1998; 113 (5) 1244-1249
    CrossrefPubMedSearch in Google Scholar
  • 2 Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143 (5, Suppl): e142S-e165S
    CrossrefPubMedSearch in Google Scholar
  • 3 Torrington KG, Kern JD. The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule. Chest 1993; 104 (4) 1021-1024
    CrossrefPubMedSearch in Google Scholar
  • 4 Goldberg SK, Walkenstein MD, Steinbach A, Aranson R. The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule. Chest 1993; 104 (1) 94-97
    CrossrefPubMedSearch in Google Scholar
  • 5 Schwarz C, Schönfeld N, Bittner RC , et al. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules. Eur Respir J 2013; 41 (1) 177-182
    CrossrefPubMedSearch in Google Scholar
  • 6 National Comprehensive Cancer Network clinical practice guideline in oncology, non-small cell lung cancer. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp . Assessed March 2014
    PubMedSearch in Google Scholar
  • 7 de Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J 2002; 20 (5) 1271-1276
    CrossrefPubMedSearch in Google Scholar
  • 8 Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest 1995; 107 (2) 430-432
    CrossrefPubMedSearch in Google Scholar
  • 9 Gould MK, Donington J, Lynch WR , et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143 (5, Suppl): e93S-e120S
    CrossrefPubMedSearch in Google Scholar
  • 10 Maziak DE, Darling GE, Inculet RI , et al. Positron emission tomography in staging early lung cancer: a randomized trial. Ann Intern Med 2009; 151 (4) 221-228 , W-48
    CrossrefPubMedSearch in Google Scholar
  • 11 Kim YC, Kwon YS, Oh IJ , et al. National Survey of Lung Cancer in Korea, 2005 [in Korean]. J Lung Cancer 2007; 6: 67-73
    CrossrefPubMedSearch in Google Scholar