In order to assess the part of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN) we reviewed our experience in 33 SPN identified among 1269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989 All lesions were les than 4 cm in greatest diameter and were not associated with symptoms of weight los chest pain.

In order to assess the part of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN) we reviewed our experience in 33 SPN identified among 1269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989 All lesions were les than 4 cm in greatest diameter and were not associated with symptoms of weight los chest pain, hemoptysis, localized wheezing, or hoarseness. A tissue diagnosis was established in 25 patients, 23 of whom had a malignant SPN This application of mind failed to detect a single case in which a fiberoptic bronchoscopic examination of the airway discovered a lesion that would prevent surgery and potentially curative resection. We commend 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 preciousness savings to the patient can be realized if the manner of proceeding is eliminated. (Chest 1993; 104:94-97)

The evaluation of a solitary pulmonary nodule (SPN) is a habitual problem confronting the respiratory disease specialist. There are established radiographic and clinical features that hint either a benign or malignant cause. In general, a lesion that has been not past nor future for at least two years with no evidence of pullulation or is associated with diffuse, laminated, stippled, or central calcification (granuloma) or "popcorn ball" calcification (hamartoma) is accepted as benign and no further evaluation is necessary. reciprocally noncalcified nodules or nodules in which pullulation patterns cannot be determined must be considered malignant especially in cigarette smoker above the age of 35 years. disputation remains regarding the necessity of establishing a preoperative tissue diagnosis in these lesions having a high likelihood of malignancy, or whether surgery should be performed directly in the absence of a tissue diagnosis if the staging workup is negative for metastatic disease in an otherwise operable candidate.

In the staging of an SPN similar to the evaluation of mass lesions, a thorough history and physical examination is performed focusing forward risk factors for carcinoma (such as smoking history and asbestos exposure) as well as signs and symptoms suggestive of metastatic disease of the like kind as lymphadenopathy, organomegaly, subcutaneous masses, weight los and anorexia. Laboratory studies of liver function and bone chemistries are obtained to omit carcinomatous involvement. If either the physical examination findings or laboratory assessment indicates abnormalities, then further imaging studies are ordered.

In our experience, a bronchoscopic examination is performed as part of the staging evaluation of an SPN for couple reasons. First, the finding of proximal airway involvement with tumor may alter or restrain surgery. Second, a bronchoscopic inspection may lay open mediastinal lymph node involvement through tumor with resultant airway compression that would require further evaluation before subjecting the patient to a potentially curative resection. The value of a staging bronchoscopic examination in the evaluation of an asymptomatic patient with SPN however, has received little attention in the literature.[1,2] For this reason, we sought to review our experience with airway inspection in patients with an SPN to (1) assess the common occurrence of detecting occult endobronchial disease and (2) the ne for similar a practice to continue in the staging of solitary nodules.

METHODS

The objective of this investigation was to assess the part of staging bronchoscopy in the preoperative assessment of the asymptomatic SPN A lesion was considered an SPN if it measured 4 cm or les in greatest diameter in succession posteroanterior chest radiograph, was fence abouted by normal lung tissue without evidence of pleural or mediastinal extension, and was not cavitary. No patients were immunocompromised and patients with weight los chest pain, hemotysis, localized wheezing, or hoarseness were exclud from the study

A retrospective research of 1,269 bronchoscopies performed at the Albert Einstein Medical Center between 1984 and 1989 identified 33 patients who satisfied the above criteria for an asymptomatic SPN All patients with SPN were evaluated with comput tomographic studies of the lung and mediastinum. Screening laboratory studies, including entire blood cell count, urinalysis, pulmonary function ordeals bone and liver chemistries were obtained. Additional radiographic or radionuclide studies were ordered based onward history, physical findings, or abnormal laboratory results

The 33 SPN patients were examined with a bronchoscope (Olympus B4) in the standard manner. make submissives were premedicated with atropine, meperidine, and hydroxyzine. The bronchoscope was introduced transnasally following the application of topical lidocaine anesthesia. one time the bronchoscope was introduced, the airways were inspected for endobronchial lesions or compression. If an abnormal area was finded appropriate brushings and biopsy specimens were obtained and submitted for pathologic examination.

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