Riedel M, Hauck R W, Stein H J, Mounyam L, Schulz C, Schömig A, Siewert J R
Department of Internal Medicine I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Chest. 1998 Mar;113(3):687-95. doi: 10.1378/chest.113.3.687.
Bronchoscopy is frequently used to assess invasion of esophageal cancer into the tracheobronchial tree. Prospective studies evaluating the role of bronchoscopy in pretherapeutic staging of esophageal cancer are lacking.
To evaluate the diagnostic utility of fiberoptic bronchoscopy for the assessment of airway involvement by esophageal carcinoma and its resectability.
In a prospective study, we analyzed 150 bronchoscopies in 116 consecutive patients with potentially operable esophageal carcinoma, and correlated the findings with other staging modalities, intraoperative evaluation, and histopathologic data.
One unknown additional bronchial cancer was found. In 32% of bronchoscopies performed in patients with esophageal cancer located above the tracheal bifurcation, some macroscopic abnormality was detected in the trachea and main bronchi, with mobile protrusion of the posterior tracheal wall being the most frequent abnormality (20.7%). When compared with histologic results, normal macroscopic appearance of the trachea and main bronchi had a negative predictive value of 98.5%, but the positive predictive value of all macroscopic abnormalities for the diagnosis of airway involvement was low, particularly after radiation therapy. The overall accuracy of bronchoscopy with multiple brush cytology and biopsy sampling in proving or excluding airway invasion in patients with otherwise operable conditions was 95.8% (95% confidence interval, 88.3 to 99.1%). Bronchoscopy was the sole decisive staging procedure, resulting in exclusion from surgery because of airway invasion, in 9.7% of patients with otherwise potentially operable conditions. The results of bronchoscopy and CT were discordant in 40% of the patients; the specificity and positive predictive value were higher for bronchoscopy than for CT.
When performed as the last investigation in the staging workup, bronchoscopy with biopsy and brush cytology is a very accurate procedure in evaluating possible airway invasion of esophageal cancer; macroscopic findings alone are not reliable.
支气管镜检查常用于评估食管癌侵犯气管支气管树的情况。目前缺乏评估支气管镜检查在食管癌术前分期中作用的前瞻性研究。
评估纤维支气管镜检查在评估食管癌气道受累情况及其可切除性方面的诊断效用。
在一项前瞻性研究中，我们分析了116例连续的潜在可手术食管癌患者的150次支气管镜检查结果，并将这些结果与其他分期方法、术中评估及组织病理学数据进行关联分析。
发现1例额外的未知支气管癌。在气管隆突上方食管癌患者所进行的支气管镜检查中，32%在气管和主支气管中检测到一些宏观异常，气管后壁的可移动性突出是最常见的异常（20.7%）。与组织学结果相比，气管和主支气管正常的宏观表现阴性预测值为98.5%，但所有宏观异常对气道受累诊断的阳性预测值较低，尤其是在放疗后。对于证明或排除其他可手术患者的气道侵犯，支气管镜检查联合多次刷检细胞学和活检采样的总体准确率为95.8%（95%置信区间，88.3%至99.1%）。在其他方面可能可手术的患者中，9.7%的患者支气管镜检查是唯一决定性的分期检查，因气道侵犯而导致手术排除。40%的患者支气管镜检查和CT结果不一致；支气管镜检查的特异性和阳性预测值高于CT。
当作为分期检查的最后一项进行时，支气管镜检查联合活检和刷检细胞学在评估食管癌可能的气道侵犯方面是一种非常准确的方法；仅宏观发现不可靠。
