Abstract

Despite increasing the number of peripheral-type adenocarcinoma of the lung, the diameter of daily-use bronchoscope is large to go through narrow bronchi. Fine needle fiberoptic bronchoscopy(FNFB)with 2.8 mm of outer diameter and 1.2 mm of biopsy channel was developed to reach small mass(BF-XP40, Olympus). To investigate the usefulness of FNFB, we compared the ability of BF-XP40 and usual-type videoscope(BF240 or BF-1T200, Olympus). From December 1998 to July 2000, we performed comparative bronchoscopic examinations in 49 patients suspected to have peripheral lung cancer. In the diagnostic approach to the lesion, we recorded the level of most distal bronchus reached, and the level of most distal bronchus observed by FNFB and videoscope respectively in the same examination. Median age was 60(range 36-80), and 37 were male. Diagnoses were adenocarcinoma in 24, squamous cell in 9, large cell in 3, small cell in 1, non-small cell in 1, metastases in 3, tuberculoma in 2, inflammation in 2, and unknown in 4. Right lung lesions were 23, and left 26. FNFB could reach more peripherally in all cases. Median difference of levels of bronchi to reach was 3(range 1-5)in the right side, and 2(range 1-5)in the left lung. In 15% of all cases, FNFB could reach 4 levels or more distally. In observations, median difference of levels of bronchi was 2(range 0-4)in the right, and 1(range 0-4)in the left. In 15% of the patients, FNFB could observe 3 levels or more distally. FNFB was easy to reach mediastinal-side lesions. We experienced less bleeding from the biopsied site. Final pathological diagnostic sensitivity was 80%. FNFB could reach more distally and more closely to the peripherally located mass and could obtain enough specimens.