Chest
Volume 105, Issue 2, February 1994, Pages 454-457
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Clinical Investigations
Oncology
Fiberoptic Bronchoscopy in the Evaluation of Carcinoma Metastatic to the Lung

https://doi.org/10.1378/chest.105.2.454Get rights and content

To determine the clinical presentation of patients with malignancies metastatic to the lung, the diagnostic utility of fiberoptic bronchoscopy (FB), and the primary site of malignancies metastasizing endobronchially, we retrospectively reviewed 1,853 FB records (1987 to 1991) and selected 111 cases for review. Cases were divided on the basis of FB findings into abnormal (44 patients) and normal (67 patients). Pulmonary symptoms (cough, hemoptysis, and chest pain) prompted referral significantly more often in the abnormal FB group (34/44) than in the normal FB group (24/67). The finding of atelectasis on chest radiograph occurred more frequently in patients with endobronchial abnormalities. The spectrum of extrapulmonary malignancies that metastasize endobronchially has changed during the AIDS epidemic. Our study shows the most frequent causes of endobronchial mass lesions were Kaposi's sarcoma and the lymphoma group (Hodgkin's disease, nonHodgldn's lymphoma, chronic lymphocytic leukemia) and the most common malignancies causing submucosal metastases were breast and the lymphoma group. In summary, the highest yield from FB can be expected in patients experiencing symptoms of cough or hemoptysis and/or having radiographic evidence of atelectasis. We propose a new mnemonic “KLAS” (Kaposi's sarcoma, Lymphoma, Adenocarcinoma, Sarcoma) to describe the malignancies most likely to metastasize endobronchially in the 1990s.

Section snippets

Methods

Since institution of FB at Walter Reed in 1970, duplicate bronchoscopy reports have been collected following every procedure. For this retrospective review, all FB reports for the 5-year period of 1987 to 1991 were evaluated.

Cases were selected for further review if the FB report indicated that the patient (1) had a history of extrapulmonary malignancy and presented with a new abnormality on chest radiograph or new pulmonary symptoms, (2) had a radiographic presentation suspicious for

Results

Between January 1, 1987 and December 31, 1991, 1,853 FBs were performed at Walter Reed (1,215 in men and 638 in women). One hundred sixty-six of the FBs (9 percent of the total) were performed in HIV-positive patients. One hundred eleven patients (6.0 percent) underwent FB for evaluation of extrathoracic malignancy metastatic to the thorax. Demographic information for this cohort is included in Table 1. These patients were divided into an abnormal FB group and a normal FB group. Bronchoscopic

Discussion

The lung is often involved when extrapulmonary malignancies metastasize, and FB is frequently performed as part of the patient's subsequent evaluation. We conducted this study to investigate which malignancies most commonly metastasize endobronchially, and what clinical and radiographic clues suggest abnormal endobronchial anatomy, so that a reasonable decision can be made as to when FB will be a potentially high-yield procedure. To our knowledge, this is the first study of this kind to be

References (15)

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Supported by Department of Clinical Investigation Protocol 1756. The findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents.

revision accepted May 14.

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