| Popis: |
Any patient presenting to a respiratory physician with a possible diagnosis of lung cancer requires a rapid and accurate histological diagnosis, together with enough staging information to enable a correct management plan to be arranged. Standards for these processes have been suggested.1 In practice it is incumbent upon physicians to assess each case and to determine the optimum combination of sampling and imaging tests that will be likely to achieve a firm diagnosis and staging at the minimum inconvenience to his or her patients, and with a minimum of delay which is known to be very distressing to them.2 Since the advent of fibreoptic bronchoscopy (FOB) in 1974, and with its current very wide availability, most physicians would consider this as their first investigation after a clinical assessment and plain radiology. Selection would be influenced by the latter, so that lesions clearly falling into the category of small solitary pulmonary nodules would be far more likely to be investigated by computed tomographic (CT) scanning and fine needle aspiration biopsy (FNA). For lesions of less than 2 cm in diameter FNA is superior to bronchoscopy even if imaging is used to guide the transbronchial biopsy or transbronchial needle aspiration.3 4 The probability that a lesion, thought by a physician to be accessible to bronchoscopy, can actually be diagnosed in this way is not easy to ascertain. However, a recent UK multicentre prospective study of 1660 consecutive cases investigated by FOB because of a prior likelihood of lung cancer showed that a definite tumour was seen in 57%. … |
