To determine the clinical presentation of patients with malignancies metastatic to the lung the diagnostic utility of fiberoptic bronchoscopy (FB) and the primary site of malignancies metastasizing endobronchially.

To determine the clinical presentation of patients with malignancies metastatic to the lung the diagnostic utility of fiberoptic bronchoscopy (FB) and the primary site of malignancies metastasizing endobronchially, we retrospectively reviewed 1853 FB records (1987 to 1991) and selecteded 111 cases for review. Cases were divided forward the basis of FB findings into abnormal (44 patients) and normal (67 patients). Pulmonary symptoms (cough hemoptysis, and chest pain) apted referral significantly more often in the abnormal FB collection (34/44) than in the normal FB cluster (24/67). The finding of atelectasis forward chest radiograph occurred more not rarely in patients with endobronchial abnormalities. The image of extrapulmonary malignancies that metastasize endobronchially has changed during the AIDS epidemic. Our research shows the most frequent causes of endobronchial mass lesions were Kaposi's sarcoma and the lymphoma collection (Hodgkin's disease, nonHodgkin's lymphoma, chronic lymphocytic leukemia) and the greatest in quantity common malignancies causing submucosal metastases were breast and the lymphoma cluster In summary, the highest yield from FB can be rely uponed in patients experiencing symptoms of cough or hemoptysis and/or having radiographic evidence of atelectasis. We have the intention a new mnemonic "KLAS" (Kaposi's sarcoma, Lymphoma, Adenocarcinoma, Sarcoma) to describe the malignancies mostly likely to metastasize endobronchially in the 1990s

The introduction of flexible fiberoptic bronchoscopy (FB) in 1968[1] has riseed in major advances in the diagnosis of pulmonary disease. Patients are as a common thing [i]or[/i] matter referred for evaluation of clinical illnesses suspicious for malignancy metastatic to the lung Whereas the yield diagnosing primary bronchogenic carcinoma is a high as 85 percent[2] it has been lower in evaluating cancer metastatic to the lung For example, in the series reported by dint of Zavala,[2] overall yield of diagnosing carcinoma metastatic to the lung using cytology brush and transbronchial biopsy specimen was 38 percent Mohsenifar et al[3] used brush, wash, and biopsy specimens to diagnose suspected intrathoracic metastases in 54 percent of patients. Using the same courses as Mohsenifar et al, Poe et al[4] were able to diagnose conditions in 67 percent

single of the earliest and greatest in quantity quoted articles concerning endobronchial metastases was published from our institution in 1975 when Braman and Whitcomb[5] retrospectively reviewed 4 years of consecutive autopsies and described 5 patients with endobronchial metastases. More newly other investigators have studied patients with carcinoma metastatic to the lung however their reports are incomplete because they exclud cases of endobronchial metastases,[6] failed to identify which tumors were greatest in number likely to metastasize endobronchially,[3,4] or evaluated patients using rigid bronchoscopy[7] Additionally, these studies all antedated the AIDS epidemic, which has produc a large form into groups of individuals predisposed to developing pulmonary metastases from previously strange malignancies.[8-11] We undertook this 5-year retrospective review to describe the origin of neoplasms that metastasize to the lung and to evaluate our diagnostic capabilities.

METHODS

Since institution of FB at Walter Re in 1970 duplicate bronchoscopy reports have been mustered following every procedure. For this retrospective review, all FB reports for the 5-year period of 1987 to 1991 were evaluated.

Cases were chosened for further review if the FB report indicated that the patient (1) had a history of extrapulmonary malignancy and instanted with a new abnormality in succession chest radiograph or new pulmonary symptoms, (2) had a radiographic presentation suspicious for metastatic disease, or (3) had a diagnosis of esophageal carcinoma and the diagnosis of tracheoesophageal fistula was being investigated.

single in kind hundred ninety-six cases met at least undivided of the criteria. We evaluated hospital records, files in pulmonary, oncology and infectious disease clinics, and pathology reports to determine the precise indication for each action as well as to learn each patient's medical history and following diagnosis. Records were available for 194 of the 196 cases (99 percent) chooseed Of this group, 83 were exclud because the patient did not actually have an extrapulmonary malignancy, metastatic bronchogenic carcinoma was establish or FB was actually performed to evaluate infection.

Of the 111 remaining cases, we identified sex HIV status, lonely dwelling type of the primary malignancy, reason for referral, air and type of pulmonary symptoms, chest radiographic findings, bronchoscopic findings, diagnostic specimens obtained, and yield of each technique. Patients were separated forward the basis of FB findings (normal v abnormal) and the disposes were compared statistically by Pearson's [[chi].sup.2]analysis. Statistical significance was assumed for p [les than or equal to] 1005

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RESULTS

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