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Vol. 30. Issue 6.
Pages 291-296 (June - July 1994)
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Vol. 30. Issue 6.
Pages 291-296 (June - July 1994)
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Fibrobroncoscopia en el cáncer de pulmón: relación entre radiología, endoscopia, histología y rendimiento diagnóstico en una serie de 1.801 casos
Fibrobronchoscopy in lung cancer: associations among radiology, endoscopy, histology and diagnostic value in a series of 1,801 cases
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E. Martínez Moragón1, J. Sanchis Aldás, A. de Diego Damiá, M. Martínez Francés, E. Cases Viedma, F. Sanchis Moret
Servicio de Neumología. Hospital Universitario La Fe. Valencia
J. Aparicio Urtasun*
* Servicio de Oncología Médica. Hospital Universitario La Fe. Valencia
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Se ha realizado un análisis retrospectivo de 1.801 pacientes diagnosticados de neoplasia pulmonar primaria mediante fibrobroncoscopia entre 1977 y 1992; el objetivo fue investigar la relación entre la radiografía de tórax, los hallazgos endoscopicós y la histología, así como valorar el rendimiento diagnóstico de las diversas técnicas endoscópicas empleadas.

Había 1.598 tumores de localización central y 203 periféricos. El tipo histológico más frecuente fue el carcinoma escamoso (39%) y el patrón radiográfico más común, la masa pulmonar (40%). La endoscopia mostró infiltración neoplásica en el 49% de los casos y tumor endobronquial en el 27%. Los patrones radiológicos de masa pulmonar, afectación hiliar y atelectasia se asociaron más frecuentemente con la presencia de infiltración, tumor y necrosis, y con los tipos histológicos escamoso y de células pequeñas; en ellos la biopsia bronquial obtuvo el máximo rendimiento diagnóstico. Por el contrario, en el nódulo pulmonar solitario y en el derrame pleural predominaron la endoscopia normal, con alteraciones inespecíficas o compresión extrínseca, y los tipos celulares de adenocarcinoma y carcinoma de células grandes; el procedimiento con mayor valor diagnóstico en este grupo fue la biopsia transbronquial (especialmente bajo control radioscópico).

Se concluye que, en el cáncer de pulmón, la radiografía de tórax y el aspecto endoscópico pueden sugerir el tipo histológico más probable y orientar la elección de las técnicas diagnósticas.

A retrospective analysis of 1,801 patients with primary pulmonary neoplasm diagnosed by fibrobronchoscopy between 1977 and 1992 was carried out in order to determine the relation between chest X-rays and endoscopic and histological findings, as well as to assess the diagnostic usefullness of the various endoscopic techniques used.

Central tumors numbered 1,598 and peripheral ones 203. The largest tissue classification was squamous (39%) and the most common X-ray finding was pulmonary mass (40%). Endoscopy showed neoplasic infiltration in 49% of the cases and endobronchial tumor in 27%. X-rays showing pulmonary mass, hiliar involvement and atelectasis were more often associated with infiltration, tumor and necrosis and with a smallcell tissue type. Bronchial biopsy gave the best diagnostic results in these cases. In cases of solitary pulmonary nodule and pleural effusion, on the other hand, normal endoscopic results with non-specific changes or extrapulmonary involvement, predominated, with adenocarcinoma and non-small cell tissue types. Transbronchial biopsy, especially with radioscopio monitoring, was most useful in these cases.

We conclude that chest X-rays and endoscopic results can be used to predict the most likely tissue type in lung cancer and that they can serve as guides for the choice of diagnostic technique.

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Copyright © 1994. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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