Robert T. Fox

Transcarinal Bronchoscopic Needle Biopsy

KONCHOSCOPIC EXAMINATION has for years been one of the major aids in diagnosis and preoperative evaluation of B patients with all types of pulmonary disease, and especially cancer of the lung. In a significant number of patients in whom cancer is suspected, bronchoscopic examination reveals a broad, fixed carina, suggesting the presence of subcarinal lymphadenopathy. Not infrequently, despite exhaustive examination no positive histologic or cytologic proof can be obtained. In such patients the roentgenographic picture and the bronchoscopic demonstration of a broad, fixed cariiia provide the only evidence on which a clinical diagnosis can be based. Thus, a thoracotomy is necessary in order to establish a positive histologic diagnosis. Many surgeons consider that the presence of metastasis in the subcarinal nodes renders the pulmonary lesion “inoperable” (perhaps a better term is “nonresectable”), especially in a borderline case. Certainly, in the light of recent experience with preoperative irradiation, histologic proof of subcarinal node metastasis could constitute adequate indication for irradiation and subsequent reevaluation for exploration. Inasmuch as many roentgenologists are reluctant to administer radiation therapy without a histologic diagnosis, a simple method of biopsy of enlarged subcarinal nodes is desirable. In August, 1963, Versteegh and Swierenga [8] of Utrecht, the Netherlands, reported on a series of 150 patients with carcinoma of the lung. As part of the bronchoscopic examination they routinely performed transcarinal puncture with a long, thin needle. Only aspiration biopsy was possible with this technique, and they state that in many instances no material was obtained, but a positive histologic diagnosis was reported in 25 (16%) of the patients. Only half of these had a broad carina. Of these 25 patients, 14 were ex