Need for Bronchoscopy in Coin Lesion
Arguments in favor of routine bronchoscopy:
- Surgeon needs to evaluate the road map of the bronchial tree before he
considers a patient for resectional surgery.
- Rarely, one can see a proximal endobronchial lesion, not anticipated by
chest x-ray appearance.
Arguments against routine bronchoscopy:
- One would not anticipate seeing an endobronchial lesion in solitary
pulmonary nodule. Goldbergg et all in 1993 report from Albert Einstein medical center,
that in 1269 patients, not a single case in which a feberoptic bronchoscopy discovered a
lesion that would preclude surgery.
- Even with fluoroscopic control, solitary pulmonary nodules are hard to
reach with biopsy or brush for establishing the diagnosis.
My Recommendation:
I do not routinely perform preoperative bronchoscopy for solitary
pulmonary nodule in whom a decision has been made for surgical resction. The surgeon can
do the bronchoscopy once the patient is under anesthesia, prior to surgery if he so
desires. He can take care of the surprises.
Ref:
- Chest 104(1):94-7,1993.
- Chest 104(4):1021-4,1993.
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