Diagnostic bronchoscopy for early detection of lung cancer with positive sputum cytology

In the Niigata. Prefecture Japan, high risk participants with a smoking index of 600 or higher have been screened by Sputum cytology as well as chest X-ray. From 1988 to 1999, 201,131 examinations were performed. Sputum samples were diagnosed as sputum D (markedly or borderline atypical squamous cells or suspicious cells) in 402 cases (0.20%), and sputum E (malignant cells) in 239 cases (0.12%). Of these, 314 primary lung cancers were detected. Of the 197 lung cancer cases diagnosed at our hospital. 137 tumors were centrally located, 157 were squamous cell carcinoma. and 114 were roentgenographically occult. Of these 114 roentgenographically occult cases. 18 exhibited no abnormal Findings at the initial bronchoscopy. and I I out of these 18 were found to have tumors localized beyond the range of view. Those cases which were located distal to segmental bronchi, with only minute findings and less than 10 mm in diameter, were difficult to localize. The bronchoscopic findings of early-stage lesions included thickening and paleness of the surface of bifurcation, and fine granular change of mucosal surface. When lesions are difficult to localize, serial selective brushing and autofluorescence bronchoscopy are useful. Finally, careful follow-up is necessary for cases in which localization has not yet been confirmed.