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Staging lung cancer: METHODS OF STAGING (8)

Bronchoscopy: At the start of the procedure, suspected vocal cord paralysis can be evaluated. This may confirm CT evidence of extensive N2 nodal disease with involvement of the recurrent nerve. Carinal widening or other evidence of adenopathy can be detected, and these nodal areas biopsied, with a Wang needle with a sensitivity of 50% and specificity of 96% . Some centres obtain a CT before initial bronchoscopy so that accessible areas of adenopathy can be biop-sied at that time and, thus, avoid mediastinoscopy in many instances. However, the use of this approach varies between institutions depending on the confidence and skill of both the bronchoscopist and pathologist. One of the authors of this report has used this technique to biopsy multiple nodal areas including both right tracheobronchial nodes. Preliminary results suggest that the yield is similar to mediastinoscopy. When lymph tissue is obtained from suspicious nodes and is negative for cancer, our current practice is to perform mediastinoscopy. If the area is ‘missed’, an alternative that is being evaluated is bronchoscopic Wang needle biopsy with real-time CT guidance. This is your opportunity to buy asthma inhalers taking full advantage of the nice options offered to you by most reliable pharmacies on the internet, with free delivery, express shipping and tons of other options you will appreciate.

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