Meanings and Indications of pretreatment assessment of esophageal carcinoma with bronchoscopy

Ahn, Kang Hyun; Park, Jae Min; Kim, Young Sam; Choi, Seung Won; Lee, Jun Gu; Chang, Yoon Soo; Yang, Dong Kyu; Kim, Se Kyu; Chang, Joon; Lee, Won Young; Kim, Choong Bae

Abstract

OBJECTIVES
To determine the yield of bronchoscopy for evaluating tracheobronchial spread in esophageal carcinoma and to identify the conditions for bronchoscopy in patients with newly diagnosed esophageal carcinoma, who planned to be operated.
METHODS
From March 1989 to June 1997, 115 patients with esophageal carcinoma had received bronchoscopy. Bronchoscopic findings were classified into three types: Type I: no definitive endobronchial lesion, Type II: indirect effects(hyperemia and compression), Type III: invasion. CT findings were classified into three classes: Class A: tumor separated from tracheobronchial tree, Class B: abutting tree, Class C: compressing tree. We investigated the correlations of clinical presentation and non-invasive tests (including esophagogram) with bronchoscopic findings.
RESULTS
1) Among 115 patients, bronchoscopic findings were Type I in 67(58.3%), Type II in 34(29.6%), Type III in 14(12.2%). 2) Abnormal bronchoscopic findings are related with length of lesion by esophagogram.(p < 0.05) 3) Class C lesion by chest CT scan were closely correlated with abnormal bronchoscopic findings. 4) Chest symptoms were frequently associated with type III lesion of bronchoscopy
CONCLUSION
We could recommend preoperative bronchoscopy in recently diagnosed as esophageal carcinoma who got more than 2 of 3 variables listed below: 1) patients who had chest symptoms, such as cough with sputum, hemoptysis, and dyspnea 2) length of tumor is long in esophagogram(above 5 cm in length), 3) tracheobronchial compressed lesion by chest CT scan. Bronchoscopy is not needed in cases with no chest symptom, short lesion length(below 5 cm) and normal chest CT finding for preoperative evaluation of esophageal carcinoma.