The Role of Flexible Bronchoscopy in Diagnosis of Bronchogenic Carcinoma


  • Ossama I. Rahiem m ( MBChB, FICMS Cardiothoracic and Vascular Surgery ) / Alfalluja Teaching Hospital
  • Nazar B. Elhassani FRCS, FACS


Fibroptic bronchoscopy, wash, CXR, biopsies, invisible and visible intrabronchial tumors, Olympus,


Aim: the use of outpatient instrument (flexible bronchoscopy) to improve cancer diagnosis earlier
with no hospital stay giving much time to early diagnosis and early management and follow up of
bronchogenic cancer patients and to rule out which patient need further intervention or management.
Patients and Methods: A retrospective study of 160 patients where a flexible bronchoscopy is done
in suspected cases of malignant lung lesion in relation to history, examination, chest x-ray and refer
them to their age, sex , location and social status and habits including smoking, and sampling of
sputum, lymph nodes and pleural fluid cytopathological exam and comparing the results with the
transnasal or transoral fibroptic bronchoscopic procedures whether they were wash (brushing not
done), biopsies and postbronchoscopic sputum cytological exam using Olympus fibroptic
Results: The patients arranged in two groups according to bronchscopic findings into visible and
invisible tumors and central tumors and peripheral tumors groups according to radiologic findings.
Best results in visible and central tumors, with the squamous cell carcinoma was the highest yield


- Iraqi cancer registry center; MOH, 2002, Iraq Baghdad.

- Miller Y., Respiratory diseases , Cecil textbook of medicine ,edited by JC BENNET and F.

Plum , 20th edition , 1996 , p 436 , WB saunders company philadilphia.

- T. Coleman; smoking cessation; recent advances into clinical practice, thorax, 2001; 50: 579-

- Braunwald E. et al; Harrison’s principles of int. Medicine , 16th ed. ,2003 , McGraw , ch. 88 ;

Minna , J . D.; Neoplasm of the lung, p 562-571.

- R.C.G. Russel, Norman S. & Chritopher J. K. Bulstrode; carcinoma of bronchus; Bailey &

Love’s short practice of surgery, Ed. By CV Mann, RCG, 23rd ed. 2000, p 563.

- Christopher Haslett et al: Davidson's principles and prac. Of medicine, 19th ed. 1999,

respiratory disease. Primary tumor of lung, bronchial carcinoma, p 360.

- F. Charles Brunicardi et al: Schwartz’s principles of surgery, lung neoplasms;8th ed, 2005,p


- Sackner M.A. :Bronchofibroscopy, Am.Rev. Respi. Dis., 1975,111:68-88.

- Mark Tedder & Ross Munqerleider : Bronchoscopy, David C. Sabiston, Jr.,Textbook of

Surgery, 15th ed. W.b.Saunders Company, 1997.

- Richard B. & McElvein :Bronchoscopy, Arthur E. Bane, Glenn’s Thoracic Surgery, vol.1, 5th

ed.Prentice Hall International Inc. 1992, 147.

- Kassab. A. k : The role of fibroptic bronchoscopy in the diagnosis of bronchogenic ca. J. Fac.

Med. Baghdad, 1996,1:24-26.

- Frank W.Sellke et al :Sabiston & Spencer surgery of the chest; lung cancer workup &

Staging edited by Bernard J. Park & Valerei W. Rusch, diagnosis & staging; 2005, 1: 242-249,250.

- Kennedy TC, Lam S, Hirsch FR : Review of recent advances in fluorescence bronchoscopy

in early localization of central airway lung cancer. Oncologist 6:257,2001.

- Elhassani NB; the scope of resection in bronchogenic car. ,J . Fac. Med., Baghdad, 1982, 24,


- Frank W. Sellke, Pedro J. Dell, Scott J. Swanson; Sabiston and Spencer Surgery of the

Chest; Lung Cancer: Multimodal Treatment; 7th ed. 2005, 1, 285-287.

- Abdul-hamed Al-qassir; bronch. Car. , presentation, radiological finding & operability. A

thesis for Iraqi commision for medical spec. ,1993.

- Wells, CK, et al: presenting manifestations, cigarette smoking & detection bias in age at

diagnosis of LC, Ann. Epidemio. , May 2001, vol. II, no. 6, p239-247.

- Al-alusi & Al-Azawi MM; the trends in incidence & prognosis of lung cancer in Iraq (1996-

.J. Fac. Med. Baghdad .2002.

- Eman J. Abdullah; the role of spiral CT in the evaluation of bron. Car. ; A dissertation of

diploma, Baghdad Univ. 2002.

- Al-khafaji Abdul Redah K., LC in Iraq (2001-2003) a dissertation submitted to the college of

med. /Baghdad Univ. 2004 : 65.

- Hirmiz NH & Al-Anni M.Subhi,; surgical aspects of bronch. Car. .A thesis submitted to Iraqi

comm. For med. Spec. , 1998:26-37

- Elhassani NB ; APUDoma of the lung , J. Fac. Med. , Baghdad ,1992 , 34 , no. 3 :313- 319 .

- Jamel, A. et al; cancer statistics, 2002, cancer journal for clinicians, vol. 52, Jan., 2002: 23-

- Murry J. F. And Nadel J. A.; Textbook of respiratory medicine, vol. I –IV .3rd ed., 2000, W.

B, Sauders, Ch. 44-45, p 1375-1451.

- American Thoracic Society /European respiratory society: pretreatment evaluation of

NSCLC , vol .156 , April 1997 ,p320-332.

- Elhassani NB; bronchial carcinoma in Iraq .J. Fac. Med., Baghdad, 1987, vol, 29, no. 1, 37-46.

- Ahmed AH Al-Azawi; lung cancer in Iraqi young patients under the age of 40, a thesis

submitted to Iaqi com. For med. Spec. , 1995.

- Ost D. et al; the solitory pulmonery nodule, New Engl. J. M. 348; 25 June 2003, p25 -38.

- Gene L. Colice et al :Detecting lung cancer as a cause of hemoptysis with normal CXR

;bronchoscopy vs CT scan, Cardiopulmonary and Critical CareJournal; Chest. Vol.111/ no.4/April,1997;p880-

- Juan J. Soler Cataluna et al: Cell type accuracy of bronchial biopsy specimens in primary

lung cancer; Cardiopulmonary and Critical Care J.; Chest, vol.109/no.5/ MAY 1996/p. 1200.

- Driesin R. B., Albert R. K. and Tallegy P.A.: Flexible fibroptic bronchoscope in the teaching

hospital, yield and complications, Chest, 1974,74:144.

- Richardson R. H., Zavla D.C., Mukerjie P. k. et al: the use of fibroptic bronchoscope and

brush biopsy in diagnosis of suspected pulmonary malignancy, Am. Rev. Respiratory Disease, 1974, 109:63-

- Ikeda S.: Flexible bronchoscope. Ann Otel Rh Nd laryngol.,1970,79:912.

- Chaudhary B. A. Yoneda K. and Burki N. B.: Fibroptic bronchoscope, comparison of

procedure used in the diagnosis of lung cancer,J. thoracic & cardiovascular surgery, 1978, 76:33-37.

- Kvale P. A., Bod F.R., Kinis, diagnostic accuracy in lung cancer. Chest, 1976, 69:752-757