Rather advanced lung cancer detectorflexible bronchofiberscope with pathological endorsement is an important direct tool for discovering cancer lesion and differentiating it from inflammatory lesion as well.
The results of endoscopic findings are summarized as follows;
1) Inflammatory lesions can be seen diffusely over the very wide area, while cancer infiltrating lesions are localized and complicated. But it will be very difficult to diagnose when the cancer lesion is combined with inflammatory findings.
2) Tuberculous granulations are smooth in surface, homogenous in size and characterized by severe reddish swelling; while cancer granulations are surrounded by rigid and rough mucosa or small nodulation, and do not always show redness.
3) It is very difficult to judge the uneven mucosa surface in the In situ lesion, especially on the rather smooth mucosa surface with very limited granulation. In this situation, the mucosa surface is localized, rigid, hypertrophic and ill-defined. But it is easy to realize the In situ lesion when the mucosa becomes rough and thick.
4) The narrowed lumen due to epidermoid cancer or adenocarcinoma will be easily differentiated from inflammatory edematous swelling, but it may not be true for small cell carcinoma.
5) The protruded tumor appears more frequently in epidermoid cancer, while the infiltrated lesion more often in adenocarcinoma.
6) In epidermoid cancer, the overlying epithelium shows desquamated, necrotic and very rough in surface. Sometimes, some parts of involved lumen show deep infiltration, while the other parts are covered by normal epithelium. In general, adenocarcinoma has a tendency of circular invasion over the whole lumen.
7) Usually, the involved proximal bronchial mucosa is covered by the epithelium in adenocarcinoma and undifferentiated cancer.
8) The mucosa surface causes whitish scar contraction resulting in deformed lumen, if the deep portion of bronchial wall is involved.
Even though the differentiation between cancer infiltrating findings and inflammatory findings is very difficult. But if endoscopy is conducted with careful observation and experienced technique, the problem of difficulty in differentiation can be solved.
For the purpose of high probability of positive result in pathological examination, it is recommended to use an adequate size of brush wire combined with the good technique to get enough and adequate specimen.
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