Abstract
In order to predict the prognosis of a patient with bronchogenic carcinoma after a radical operation, the presence or absence of lymphnode metastasis in the intrathoracic space would seen very important.
Daniels's operation is employed to find subclavicular lymph nodemetastasesand mediastinoscopy may help demonstrating metastases lymph nodes.
Subcarinal lymph node metastasis used to be investigated by mediastinoscopy. However, we have been employing an aspiration biopsy smear technique using a long needle to the time of bronchoscopy under general anesthesia simultaneously with a brushing cytology for the diagnosis of bronchogenic carcinoma.
A bronchoscope was inserted into the trachea immediately after an intravenous of muscle relaxant and an aspiration biopsy was obtained with subsequent of the lesion. A small needle, I. I mm in outer diameter and 50mm in length, was inserted 5 to 10 mm in depth into the bifurcation tracher under direct vision with a rigid fiberscope and the aspirates with a syringe was submitted to the cytological diagnosis.
A total of 59 cases of bronchogenic carcinoma have been examined. Of 52 examined satisfactorily, 12 (23.1%) were positive for malignancy. With regard to the subcarinal angle the bifurcation tracher, a higher incidence of positive cytology was noted in cases with highly graded subcarinal angle. However, it would seem important to have noted some positive cases in those with normal or slightly dilated bifurcation. As for location, a positive rate tended to be higher in the lower lobes than anywhere else and to be somewhat higher in undifferentiated carcinomas. Eighteen of the 52 cases were resectable, in which only one was positive and the remaining seventeen were negative. Fifteen of the 17 cases with a negative result did not disclose the metastasis to the subcarinal lymphnodes and the remaining two cases were positive. The one with a positive cytological result demonstrated metastases in the histopathological surveys of the resected specimen.
No complications such as gross bleeding, mediastinitis and cardiac puncture were noted. It is concluded that a cytological method by means of aspirating from a subcarinal lymph node under bronchoscopy is of clinical worth in detecting metastases.
