الفهرس 
BRONCHOGENIC CARCINOMAOnly 14 pages are availabe for public view
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Abstract
L
ung cancer is the most commonly diagnosed cancer worldwide and its incidence continues to grow. Among all cancers, lung cancer now has the highest mortality rate in most countries (Ridge et al., 2013).
Determination of histopathological cell type and stage of primary lung carcinoma is crucial in immediate planning of appropriate treatment modality and prognosis (Porter et al., 2002).
Factors that affect the success of diagnostic modality are diameter and localization of the mass, and visibility at endobronchial tree with bronchoscope. The most prevalent diagnostic tool in central and exophytic endobronchial lesion is bronchoscopy (Rivera et al., 2003).
Bronchoscopy has become an essential tool for the respiratory physician. The modern fiberoptic video bronchoscopes provide high-definition images of the airways so that even subtle lesions are recognized (Grange et al., 2006).
The use of the cryotherapy probe allows sampling of endobronchial tumors, producing well-preserved tissue, which tends to be of superior quality to that obtained by flexible forceps biopsy (FB). Recent studies demonstrate that cryobiopsy (CB) samples are devoid of the crush artifact commonly seen in biopsies obtained with traditional forceps. CB also yields much larger samples than FB (Moeller et al., 2008).
This study was performed between May 2016 and June 2017 in the bronchoscopy unit of Chest hospital of Military Kobri Al-Kobba medical Complex It was a randomized prospective controlled comparative study upon 40 male patients with suspected endobronchial malignant lesions, based on:
1. Clinical Diagnosis (Full history and clinical examination)
2. Radiological imaging (chest X-ray and enhanced C.T chest)
3. Exophytic endobronchial tumor (endoscopically visible lesion).
4. Sufficient respiratory function (oxygen saturation >90% with 2 liters of supplementary oxygen).
5. Signed informed consent form.
6. Vitally stable patient (pulse rate, blood pressure, temperature and Oxygen saturation)
Patients with endoscopically visible lesion were randomized into 2 groups:
• group I: Included 20 patients in whom biopsies were carried out using forceps biopsy (2 samples).
• group II: Included 20 patients in whom biopsies were carried out using cryobiopsy (one sample).
All patients were undergone bronchoscopy under local anesthesia with 10% xylocaine solution. Before biopsy sampling, a bronchoscopic assessment of patients’ bronchial systems was performed.
All samples were fixed in 10% formalin for at least 24 h before pathological analysis. Using centimeters (cm), biopsies were measured in the largest diameter prior to sectioning for microscopic evaluation.
The following results were obtained:
In the current study, there was a highly statistically significant diagnostic yield of bronchoscopic CB (100%) upon conventional bronchoscopic FB (85%) in cases of bronchogenic carcinoma (BGC). Among diagnosed cases via FB, there were 55.0% diagnosed from first procedure, 30% diagnosed from the second trial, while 15% failed to be diagnosed.
In the present study, largest diameter of tissue biopsy (in cm) was highly significant between both groups. In cases of CB was in range of 0.9 – 1.6 cm (mean 1.18 ± 0.20) while in cases of FB it was in range of 0.2 – 0.5 cm (mean 0.36 ± 0.09). (p<0.001)
In our study, all endobronchial lesion located in different bronchial segments were successfully diagnosed by CB (n = 20), while 3 lesions located in left upper lobe, left lower lobe and left lingular segment– one in each site respectively- were not diagnosed by FB (n = 20).
Results revealed that the only detected complication during both procedures was bleeding. There was no significance in bleeding intensity between two groups. Therefore difference in haemostatic maneuver in both procedures was insignificant.
All patients in the study were males (n = 40) with mean age of 60.25 ± 6.48 that showed male predominance in relationship with BGC.
Regarding histopathological examination for tissue biopsies (n = 37), 94.5% were diagnosed non small cell lung cancer (NSCLC). 40.5% by FB and 54.0% by CB. Squamous cell carcinoma (SCC) 57.1%, Adenocarcinoma 42.8% and 5.5% were diagnosed as lung small cell carcinoma (SCLC) and both of them by FB.
In the current study, there was a highly significant relationship between smoking and lung cancer. 85.0% were attributed to smoking, while 15.0% were non smokers (n = 40).