Needle lung biopsy, bronchial brushing and mediastinoscopy in management of chest diseases.

Ways to know when not to operate and having guidelines for the extent and direction of intrathoracic operations are recurring needs of thoracic surgeons. History, chest film, pulmonary function tests and bronchoscopy have been useful, but inadequate, solutions to these problems in the past. Needle lung biopsy, bronchial brushing and mediastinoscopy have been used to supplement these conventional diagnostic methods. The result has been that patients with acid-fast and fungal disease, sarcoidosis, and endobronchial inflammatory disorders have been identified for appropriate medical treatment without thoracotomy. In addition, patients with lung cancer in whom the quality of life or survival cannot be aided by surgical operation have been spared thoracotomy. Where co-existing major, systemic illness increases the risk of operation, these additional diagnostic methods have been used to either eliminate the need for thoracotomy or to limit the operation performed to the minimal procedure permitting a satisfactory surgical result. Needle lung biopsy, bronchial brushing and mediastinoscopy are safe and they do not add to the cost or length of stay in hospital.