[Staged bronchial biopsies in the preoperative evaluation of primary bronchial cancer]

The systematic biopsying of the carina overlying a tumour, the main carina and of a contralateral carina was made a part of the work up in some patients with bronchial carcinoma, to assess operability. Different studies show that despite a normal macroscopic appearance these biopsies often reveal sub-mucous invasion. This microscopic extension might modify the resection planned, and even end in inoperability in the case of tracheal or contralateral tracheal invasion. We have studied the notes of 110 patients with primary bronchial carcinoma who have had systematic biopsies. All had a normal endoscopic appearance in the carinas biopsied and none revealed invasion by tumour. Of 110 patients, 37 had operations. In 1/3 (13/37) there was a discordance between the pre-operative bronchoscopic assessment and the local extension at thoracotomy, since 7 patients were subjected to a more extensive dissection than planned, 4 were exploratory thoracotomies only and in 4 the bronchial stumps were found to be invaded. Thus negative biopsies of healthy carinas overlying a tumour have proved to be false security and did not allow us to confirm the absence of tumour extension at peri-bronchial level in the local lymph nodes or in the mediastinum.