Application Of Bronchoscopy In Diagnosis Of Lung Cancer

Application of bronchoscopy in diagnosis of lung cancer Abstract Objectives To analysis of evaluation of bronchoscopy in diagnosis of lung cancer. Method To analysis retrospectively the data of 1315 patients diagnosed as lung cancer received bronchoscopy between 1998 and 2005. Medical statistic analysized by SPSS10.0. Results Total 1315 patients were diagnosed as lung cancer in 5416 patients received bronchoscopy examination during recent 8 years, with male 935(71.1%), and female 380(28.9%). The ratio of male to female was 2.5, and median age 60 (range 12-85). The percentage of squamous cell carcinoma in smokers was 39.6%, which was significantly higher than those of other types of lung cancer; the percentage of adenocarcinoma in non-smokers was 40.0%, which was higher than those of other types. The symptoms included cough(47.1%), hemoptysis(22.7%), sputum(13.7%), chest pain(12.3%), and dyspnea(12.2%). There were mass or nodules in chest x-ray in 73.7% patients. The final pathological diagnosis were squamous cell carcinoma 408(31.0%), adenocarcinoma 418(31.8%), small cell cancer 12, undeterminated lung cancer 111, and other types 26. 78.6%(1034/1315) patients could be diagnosed through bronchoscopy, with positivity of forceps 83.4%(966/1158), brush 14.0%(176/1257), BALF 31.0%(26/84), TBLB 73.9%(17/23), and TBNA 63.6%(14/22). The central type of lung cancer were 1180(89.7%), and peripheral type 135(10.3%). Squamous cell carcinoma, adenocarcinoma and small cell cancer were mainly central type, and adenocarcinoma (60.0%) was main type in peripheral type. 417 cases originated from upper lobes, which was higher than lower lobe, middle lobe and lingual lobe (P＜0.001). The appearance of bronchoscope were neoplasm type 800(60.8%), infiltration type 370(28.1%), outer suppression type 37(2.8%), and normal type 107(8.2%). Neoplasm type in squamous cell carcinoma was 40.6%, which was higher than those of adenocarcinoma and small cell cancer (P＜0.001), and percentage of infiltration type (48.9%), outer suppression type (57.4%), and normal type (63.0%) in adenocarcinoma were higher than those of squamous cell carcinoma and small cell cancer (P＜0.001). The positivity of forceps in squamous cell carcinoma and small cell cancer were 81.6% and 89.1%, which were hiher than those of adenocarcinoma((P＜0.001 and P=0.023), the positivity of brush for squamous cell carcinoma was lower than those of adenocarcinoma(13.2%)(P=0.029) and small cell cancer(21%)(P=0.001). Central type carcinomas were mainly neoplasm type(66.7%), and peripheral type carcinomas were mainly normal type(80.0%). The positivity of forceps and brush for central type carcinomas were 80.3% and 14.4%, which both were significantly higher than those of peripheral type carcinomas (P＜0.001). The positivity of forceps and brush for neoplasm type carcinomas were 88.4% and 15.6%, which both were significantly higher than those of other type carcinomas (P＜0.001). Conclusions 1. The percentage of lung cancer in male patients was higher than that of female patients; mainly squamous cell carcinoma in male patients and adenocarcinoma in female patients., the percentage of lung cancer in female patients was increasing. 2. There were mainly squamous cell carcinoma in patients aged≥50, and adenocareinoma and small cell cancer in patients＜50.3. Central type carcinoma was most common in lung cancer, which was mainly neoplasm type and squamous cell carcinoma; for peripheral type carcinoma, mainly normal type and adenocarcinoma.4. Neoplasm type was most common type in lung cancer, which was mainly in squamous cell carcinoma; and infiltration type, outer suppression type or normal type mainly in adenocarcinoma. 5. Bronchoscopy was one of most important methods for diagnosis of lung cancer with 78.7% positivity for combined all methods: 83.4% for forceps biopsy, 14.0% for brush cytology, 31.0% for BALF, 73.9% for TBLB, and 63.6% for TBNA. 6. The positivity of forceps biopsy was higher in squamous cell carcinoma and small cell cancer than that of adeonocarcinoma. 7.The positivity of forceps biopsy and brush cytology were higher in central type than those of peripheral type. 8. The positivity of forceps biopsy and brush cytology were higher in neoplasml type than those of other type. 9. The positivity in normal type cancer could be improved by combined methods significantly, 10. TBNA was safe and effective, especially for small cell cancer.