Value of rigid bronchoscopy and cytodiagnosis of bronchial washings in detecting bronchial carcinoma in the presence of a carcinoma of the upper aerodigestive tract.

OBJECTIVE

To assess the usefulness of rigid bronchoscopy and bronchial washings in detecting primary lung carcinomas.

SETTING

Department of Otolaryngology, University Hospital of Ghent, Belgium.

DESIGN

Prospective analysis of patient investigations.

METHOD

The results of 127 rigid bronchoscopies with bronchial washings in patients with a new, untreated head and neck tumour and a normal chest radiograph were analyzed for their usefulness in detecting simultaneous primary lung carcinomas. All patients were followed for a minimum of 2 years or till death.

RESULTS

We found positive bronchial washings in 19 cases (21%). Unilateral positive bronchial washings were found in 8 patients (9%). In only one patient was a simultaneous primary lung tumour found. One patient was found to have a pulmonary metastasis. The remaining 6 patients with positive unilateral cytology (6/8) had normal chest roentgenograms and/or CT scans, and did not develop a lung tumour in the course of follow up. Of the 19 positive bronchial washings, 10 patients had a carcinoma of the larynx and two had a large hypopharyngeal carcinoma.

CONCLUSIONS

Contamination of bronchial washings with tumour cells from head and neck neoplasms limited seriously the usefulness of positive bronchial cytology. The sensitivity and specificity of the rigid bronchoscopy with bronchial washing is too low to justify its cost.