[Bronchoscopic diagnosis of lung malignancies.]

To assess the diagnostic yield of fiberoptic bronchoscopy in patients with a variety of radiographic findings suspected of malignancy.

The study group was composed of all patients who underwent bronchoscopy in our hospital over a seven year period (1986-1993) where cytologic samples were obtained. Schematic drawings of endobronchial and radiographic findings done at the time of bronchoscopy were reviewed and the results of cytologic and histologic samples were compared for sensitivity and diagnostic accuracy.

Bronchoscopy and cytologic sampling was performed on 189 patients. Tissue samples were obtained in 109 patients from visible endobronchial abnormalities or peripheral lesions using the transbronchial approach with fluoroscopic guidance. A total of 64 malignancies were diagnosed, 43 by bronchoscopy (67%). Among 58 patients who had primary malignancy of the lung, adenocarcinoma was the most frequent histologic type (50%) followed by squamous cell carcinoma (22%) and small cell carcinoma (17%). The diagnostic sensitivity of cytology was 30% whereas that of tissue biopsy was 70% among those patients where both tests were obtained. The two methods complemented each other to give a joint sensitivity of 76%. Among 13 patients with malignancy and normal endobronchial appearance, transbronchial biopsy was performed in 10 of which seven were diagnostic. Patients with primary malignancy who underwent surgery had a five year survival of 37% while the overall five year survival was 15.5%.

In this study histology was much more sensitive than cytology as a sampling technique during bronchoscopy (p< 0.01). Adenocarcinoma has become the most frequent histologic type of primary lung malignancy in Iceland and overall survival among patients with primary tumors compares with recent international trends.