Carcinomatous solitary pulmonary nodules: evaluation of the tumor-bronchi relationship with thin-section CT.

Abstract

To investigate the value of computed tomography (CT) for depicting the relationship between carcinomatous solitary pulmonary nodules and the bronchial tree and predicting the results of various bronchoscopic biopsy techniques, the authors retrospectively reviewed CT scans from 27 consecutive patients with solitary pulmonary nodules associated with a positive bronchus sign. All patients underwent bronchoscopy and transbronchial biopsy. Macroscopic demonstration of the tumor-bronchi relationship was obtained in 18 patients. Five basic types of tumor-bronchus relationships were identified with CT: (a) bronchus cut off by the tumor, (b) bronchus contained within the tumor, (c) bronchus compressed by the tumor, (d) thickening and smooth narrowing of the bronchus leading to the tumor, and (e) thickening and irregular narrowing of the bronchus leading to the tumor. The diagnostic yield of transbronchial forceps biopsy and bronchial brushing was significantly higher in nodules characterized by a cut-off or contained bronchus. Transbronchial needle aspiration was performed in six patients, and results were positive in five, all of whom had a compressed or thickened bronchus. These results confirm that yield of transbronchial biopsy is determined by the type of tumor-bronchus relationship and the biopsy technique performed.

CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses

“…Furthermore, FB-negative results due to inaccuracy of CT in differentiating between endobronchial and submucosal/peribronchial disease, and depicting amputation of many subsegmental bronchi [3,27] can be considerably reduced by stepwise performance of multiple and integrated bronchoscopic procedures [3,13,15,28]. In the current investigation, combining BMDPs with the guidance of presence and type of BS on 2-mm thick CT sections has provided a yield of 68% in PC, and 64% overall.…”

“…Routine BW, having low overall and no exclusive yield in the diagnosis of SPNMs, can be ignored if a population with very low incidence of infection is being examined. However, if tuberculosis and other infections are common in a study population like ours, BW for cultures may be a desirable adjuvant procedure [3,28]. Similarly, bronchoalveolar lavage performed when fluoroscopic guidance is unavailable and giving a cytologic diagnosis rate of only 19-28% in SPNMs, is beneficial for the microbiologic studies [29].…”

“…Accessibility of a SPNM [1,4], and the bronchus-SPNM relationship demonstrable macroscopically in the resected tissue [5], or radiographically by prebronchoscopic CT [2,3,7], determine the success of various bronchoscopic sampling methods: BW, BR, TBNA or TBB. In agreement with the reports above, the current investigation which, to our knowledge, includes the first prospective large series in the pertinent field, also has shown the significantly higher yield of FB in SPNMs with BS on thin-section CT scan, and verified that the diagnostic results can be obtained by BR or TBB more efficiently in type 1 (cut-off) and 2 (contained), and by TBNA in type 3 (compressed, mucosa intact) and 4 (narrowed/thickened) SPNMs.…”

“…A targeting zoom factor between 3 and 5 resulting in a pixel of 0.66-0.40 mm was chosen. According to the method previously described [3,4], 2-mm thick CT sections were obtained from the pulmonary hilum through the SPNM. SPNM-bronchi relationship was classified according to the system described by Tsuboi et al [5]: (1) bronchus patent up to the tumor exposed to the lumen (bronchus cut-off); (2) bronchus penetrating the tumor exposed to the lumen (bronchus contained within); (3) bronchus compressed and narrowed, mucosa intact (bronchus compressed), and (4) bronchus narrowed by peri-/submucosal tumor spread and lymphangitis (smooth or irregular narrowing and thickening).…”

Computer-Tomographically Guided Fiberbronchoscopic Transbronchial Biopsy of Small Pulmonary Lesions: A Feasibility Study

“…There are some studies comparing the diagnostic yield of each method in different bronchopulmonary diseases [1][2][3][4][5][6][7][8][9][10][11][12][13][14], Using X-ray-supported bronchoscopy for taking pe ripheral lung biopsies we often find that despite a fluoro scopic guidance of the biopsy forceps or needle a close contact with a lesion is not guaranteed although the instrument seems to touch the center. Therefore the aim of the present study was to develop a new method to over come these problems of incorrect positioning of the biop sy instruments (in cases where prior conventional biopsy had failed) by guiding them with the help of CT combined with fluoroscopy.…”