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Flexible Fiberoptic Bronchoscopy Its Place in the Search for Lung Cancer

The use of sputum cytology has demonstrated that conventional bronchoscopic equipment often fails to permit localization of earlier, more peripheral tumors. The flexible fiberbronchoscope now opens up new bronchial horizons but does not replace rigid instruments. Our experience in 300 fiberoptic studies has suggested certain guidelines for determining in which patients the flexible equipment should be used and in which conventional instruments are preferred. By means of a comprehensive endoscopic study, we successfully localized eight “sputum positive,” radiologically occult bronchogenic carcinomas. The fiberbronchoscope is essential in searching the segments for subtle changes of early cancer. These findings are documented by a color television system. A detailed pathological study demonstrates the importance of preoperative marginal biopsies in excluding carcinoma in situ which may extend some distance from even small tumors. In 94 patients with cancer we located 85 (90%) by direct visualization and/or bronchoscopic specimens. Sixty-eight (72%) involved primarily the segmental or more peripheral areas while main bronchus tumors were large and suggested spread from a more distal site of origin. The fiberbronchoscope has greatly extended our capabilities, allowing a better understanding of early lung cancer and greatly improved localization.