Relationship of radiologic position to the diagnostic yield of fiberoptic bronchoscopy in bronchial carcinoma.

The radiologic position of tumors in 100 patients with bronchial carcinoma was compared with the diagnostic yield from fiberoptic bronchoscopy. A new method for dividing the chest x-ray film into three areas (hilar, perihilar, and peripheral) was based upon the expected range of vision of the fiberoptic bronchoscope. At bronchoscopy without fluoroscopy, only eight (36 percent) of 22 radiologically peripheral tumors were diagnosed, compared with 31 (94 percent) out of 33 hilar tumors (p less than 0.001) and 34 (76 percent) out of 45 perihilar tumors (p less than 0.01). The results show that in hilar and perihilar tumors, fiberoptic bronchoscopy gives a high diagnostic yield, whereas in peripheral tumors the yield is poor. This method allows the clinician to judge from the chest x-ray film whether a tumor is likely to be visible bronchoscopically. Thus, in radiologically peripheral tumors, as defined by our method, fluoroscopy at the time of fiberoptic bronchoscopy should be available to the clinician, or alternative diagnostic methods should be considered.