Diagnostic value of fiberoptic bronchoscopy in lung cancer presenting as mediastinal mass(es)

The diagnostic yields of prebonchoscopy sputum specimens and fiberoptic bronchoscopy (including brushings, washings, and/or biopsies) were determined in 35 patients who presented primarily with middle or anterior mediastinal and/or paratracheal mass(es) on chest radiographs. The diagnosis was confirmed on histopathology of tissue obtained by needle biopsy, mediastinoscopy, thoracotomy, and/or autopsy. Thirty-one of the patients were found to have primary bronchogenic carcinomas. At bronchoscopy, extrinsic compression of trachea and/or bronchi was visualized in 23 (Group I) and the tracheobronchial tree appeared normal in 12 (Group II). Prebronchoscopy sputa gave a positive yield in only three of the 35 (8%) patients; the yield was similar in both groups of patients. One or more of the bronchoscopic modalities were diagnostic in 69% of Group I patients but were not helpful in Group II patients. The diagnostic yield of brushings, washings, and biopsies in Group I patients was 52%, 61%, and 37%, respectively. The addition of biopsies to washings and/or brushings did not significantly alter the yield. Washings and brushings are recommended as useful, non-invasive procedures in diagnosing middle mediastinal masses with extrinsic compression. Sputum cytology gives a very low yield.