Bronchoscopy in the preoperative staging of oesophageal cancer below the tracheal bifurcation: a prospective study.

Oesophageal cancer located above the level of the tracheal bifurcation is frequently complicated by its spread into the airways and by the simultaneous occurrence of malignant bronchial tumours. Although bronchoscopy is an essential procedure in identifying malignant tumoral invasion of the airways and detection of primary airway tumours in patients with suprabifurcal oesophageal cancer, its role in patients with infrabifurcal oesophageal cancer is not clear. This study aimed to assess the value of fibreoptic bronchoscopy in the preoperative staging of oesophageal cancer located below the level of the tracheal bifurcation. In a prospective protocol, bronchoscopic findings were correlated with the results of other staging procedures, operative results and survival in 51 patients with oesophageal cancer located below the level of the tracheal bifurcation. One unsuspected primary bronchial cancer in a patient with squamous cell oesophageal cancer and one case of lower lobe invasion of an oesophageal adenocarcinoma were found. By excluding from surgery these two patients in whom curative resection was not possible bronchoscopy was the sole decisive staging investigation in 6.5% of potentially operable and 3.9% of all patients. Suspect macroscopic abnormalities were shown in 15.7% of the patients at bronchoscopy. Taking bronchoscopic biopsy as the gold standard the positive predictive value for all macroscopic abnormalities was only 25% (95% confidence interval (CI) 3.2-65.1%). The overall accuracy of bronchoscopy with biopsy and brush and washing cytology in proving or excluding airway invasion in otherwise potentially operable patients was 100% (95% CI 89.4-100%). Bronchoscopy is useful in the preoperative staging of oesophageal carcinoma located below the level of the tracheal bifurcation, particularly if the oesophageal cancer is of the squamous cell type.