The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule.
In order to assess the role of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN), we reviewed our experience in 33 SPNs identified among 1,269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989. All lesions were less than 4 cm in greatest diameter and were not associated with symptoms of weight loss, chest pain, hemoptysis, localized wheezing, or hoarseness. A tissue diagnosis was established in 25 patients, 23 of whom had a malignant SPN. This study failed to detect a single case in which a fiberoptic bronchoscopic examination of the airway discovered a lesion that would preclude surgery and potentially curative resection. We recommend the abandonment of a staging bronchoscopy in the evaluation of a patient with an indeterminant SPN in whom history, physical examination, laboratory, and imaging studies fail to document contraindications to surgery. No additional useful information is derived and a substantial cost savings to the patient can be realized if the procedure is eliminated.
Department of Medicine, Albert Einstein Medical Center, Philadelphia 19141.
S K
SK
Goldberg
M D
MD
Walkenstein
A
A
Steinbach
R
R
Aranson
D000230:Adenocarcinoma / Q000473:pathology; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000473:pathology*; D013908:Thoracotomy