Preoperative Bronchoscopic Assessment of Airway Invasion by Esophageal Cancer
Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of bronchoscopy in pretherapeutic staging of esophageal cancer are lacking. To evaluate the diagnostic utility of fiberoptic bronchoscopy for the assessment...
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Published in | Chest Vol. 113; no. 3; pp. 687 - 695 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Elsevier Inc
01.03.1998
American College of Chest Physicians |
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Abstract | Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of bronchoscopy in pretherapeutic staging of esophageal cancer are lacking.
To evaluate the diagnostic utility of fiberoptic bronchoscopy for the assessment of airway involvement by esophageal carcinoma and its resectability.
In a prospective study, we analyzed 150 bronchoscopies in 116 consecutive patients with potentially operable esophageal carcinoma, and correlated the findings with other staging modalities, intraoperative evaluation, and histopathologic data.
One unknown additional bronchial cancer was found. In 32% of bronchoscopies performed in patients with esophageal cancer located above the tracheal bifurcation, some macroscopic abnormality was detected in the trachea and main bronchi, with mobile protrusion of the posterior tracheal wall being the most frequent abnormality (20.7%). When compared with histologic results, normal macroscopic appearance of the trachea and main bronchi had a negative predictive value of 98.5%, but the positive predictive value of all macroscopic abnormalities for the diagnosis of airway involvement was low, particularly after radiation therapy. The overall accuracy of bronchoscopy with multiple brush cytology and biopsy sampling in proving or excluding airway invasion in patients with otherwise operable conditions was 95.8% (95% confidence interval, 88.3 to 99.1%). Bronchoscopy was the sole decisive staging procedure, resulting in exclusion from surgery because of airway invasion, in 9.7% of patients with otherwise potentially operable conditions. The results of bronchoscopy and CT were discordant in 40% of the patients; the specificity and positive predictive value were higher for bronchoscopy than for CT.
When performed as the last investigation in the staging workup, bronchoscopy with biopsy and brush cytology is a very accurate procedure in evaluating possible airway invasion of esophageal cancer; macroscopic findings alone are not reliable. |
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AbstractList | Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of bronchoscopy in pretherapeutic staging of esophageal cancer are lacking.
To evaluate the diagnostic utility of fiberoptic bronchoscopy for the assessment of airway involvement by esophageal carcinoma and its resectability.
In a prospective study, we analyzed 150 bronchoscopies in 116 consecutive patients with potentially operable esophageal carcinoma, and correlated the findings with other staging modalities, intraoperative evaluation, and histopathologic data.
One unknown additional bronchial cancer was found. In 32% of bronchoscopies performed in patients with esophageal cancer located above the tracheal bifurcation, some macroscopic abnormality was detected in the trachea and main bronchi, with mobile protrusion of the posterior tracheal wall being the most frequent abnormality (20.7%). When compared with histologic results, normal macroscopic appearance of the trachea and main bronchi had a negative predictive value of 98.5%, but the positive predictive value of all macroscopic abnormalities for the diagnosis of airway involvement was low, particularly after radiation therapy. The overall accuracy of bronchoscopy with multiple brush cytology and biopsy sampling in proving or excluding airway invasion in patients with otherwise operable conditions was 95.8% (95% confidence interval, 88.3 to 99.1%). Bronchoscopy was the sole decisive staging procedure, resulting in exclusion from surgery because of airway invasion, in 9.7% of patients with otherwise potentially operable conditions. The results of bronchoscopy and CT were discordant in 40% of the patients; the specificity and positive predictive value were higher for bronchoscopy than for CT.
When performed as the last investigation in the staging workup, bronchoscopy with biopsy and brush cytology is a very accurate procedure in evaluating possible airway invasion of esophageal cancer; macroscopic findings alone are not reliable. Background: Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of bronchoscopy in pretherapeutic staging of esophageal cancer are lacking. Study objectives: To evaluate the diagnostic utility of fiberoptic bronchoscopy for the assessment of airway involvement by esophageal carcinoma and its resectability. Patients and methods: In a prospective study, we analyzed 150 bronchoscopies in 116 consecutive patients with potentially operable esophageal carcinoma, and correlated the findings with other staging modalities, intraoperative evaluation, and histopathologic data. Results: One unknown additional bronchial cancer was found. In 32% of bronchoscopies performed in patients with esophageal cancer located above the tracheal bifurcation, some macroscopic abnormality was detected in the trachea and main bronchi, with mobile protrusion of the posterior tracheal wall being the most frequent abnormality (20.7%). When compared with histologic results, normal macroscopic appearance of the trachea and main bronchi had a negative predictive value of 98.5%, but the positive predictive value of all macroscopic abnormalities for the diagnosis of airway involvement was low, particularly after radiation therapy. The overall accuracy of bronchoscopy with multiple brush cytology and biopsy sampling in proving or excluding airway invasion in patients with otherwise operable conditions was 95.8% (95% confidence interval, 88.3 to 99.1%). Bronchoscopy was the sole decisive staging procedure, resulting in exclusion from surgery because of airway invasion, in 9.7% of patients with otherwise potentially operable conditions. The results of bronchoscopy and CT were discordant in 40% of the patients; the specificity and positive predictive value were higher for bronchoscopy than for CT. Conclusions: When performed as the last investigation in the staging workup, bronchoscopy with biopsy and brush cytology is a very accurate procedure in evaluating possible airway invasion of esophageal cancer; macroscopic findings alone are not reliable. bronchial neoplasms bronchoscopy esophageal neoplasms esophagectomy staging trachea |
Author | Mounyam, Leonard Stein, Hubert J. Siewert, Jörg R. Schulz, Christian Riedel, Martin Schömig, Albert Hauck, Rainer W. |
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Cites_doi | 10.1016/S0003-4975(10)60349-9 10.1378/chest.107.5.1447 10.1002/1097-0142(19810715)48:2<329::AID-CNCR2820480219>3.0.CO;2-V 10.1055/s-2007-1010275 10.1007/BF00185212 10.1016/0003-4975(94)90763-3 10.1055/s-2007-1012869 10.1007/BF00185213 10.1007/BF00316809 10.1055/s-2007-1010263 10.1155/DTE.1.9 10.1016/0002-9610(84)90194-6 10.1016/0002-9610(84)90195-8 10.1007/BF00308626 |
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publication-title: Langenbecks Arch Chir doi: 10.1007/BF00185213 contributor: fullname: Imdahl – volume: 103 start-page: 344 year: 1988 ident: 10.1378/chest.113.3.687_bib20 article-title: Assessment of resectability of esophageal cancer by computed tomography and magnetic resonance imaging publication-title: Surgery contributor: fullname: Lehr – start-page: 776 year: 1993 ident: 10.1378/chest.113.3.687_bib1 article-title: Cancer of the esophagus contributor: fullname: Roth – volume: 18 start-page: 312 year: 1994 ident: 10.1378/chest.113.3.687_bib6 article-title: Staging of squamous esophageal cancer: accuracy and value publication-title: World J Surg doi: 10.1007/BF00316809 contributor: fullname: Hölscher – volume: 25 start-page: 28 year: 1993 ident: 10.1378/chest.113.3.687_bib5 article-title: Esophageal carcinoma: impact of staging on treatment publication-title: Endoscopy doi: 10.1055/s-2007-1010263 contributor: fullname: Siewert – start-page: 44 year: 1992 ident: 10.1378/chest.113.3.687_bib3 article-title: Ösophagus – volume: 1 start-page: 9 year: 1994 ident: 10.1378/chest.113.3.687_bib16 article-title: Bronchoscopy of lung cancer publication-title: Diagn Ther Endosc doi: 10.1155/DTE.1.9 contributor: fullname: Hauck – volume: 147 start-page: 757 year: 1984 ident: 10.1378/chest.113.3.687_bib9 article-title: Bronchoscopy and carcinoma of the esophagus: I. Findings of bronchoscopy in carcinoma of the esophagus publication-title: Am J Surg doi: 10.1016/0002-9610(84)90194-6 contributor: fullname: Choi – volume: 147 start-page: 760 year: 1984 ident: 10.1378/chest.113.3.687_bib10 article-title: Bronchoscopy and carcinoma of the esophagus: II. Carcinoma of the esophagus with tracheobronchial involvement publication-title: Am J Surg doi: 10.1016/0002-9610(84)90195-8 contributor: fullname: Choi – volume: 19 start-page: 198 year: 1995 ident: 10.1378/chest.113.3.687_bib7 article-title: Multimodal treatment for squamous cell esophageal cancer publication-title: World J Surg doi: 10.1007/BF00308626 contributor: fullname: Fink |
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Snippet | Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of bronchoscopy... Background: Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of... |
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SubjectTerms | bronchial neoplasms bronchoscopy esophageal neoplasms esophagectomy staging trachea |
Title | Preoperative Bronchoscopic Assessment of Airway Invasion by Esophageal Cancer |
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