Background: The utility of fiberoptic
bronchoscopy in the preoperative assessment of patients with esophageal
cancer has not been thoroughly investigated. More accurate staging
could improve the design of clinical trials and avoid inappropriate
surgical decisions in individual patients.
objective: To evaluate the utility of bronchoscopy in the
preoperative assessment of airway invasion by supracarinal esophageal
Design: We prospectively analyzed 220
bronchoscopies in 166 consecutive patients with supracarinal esophageal
cancer and correlated the findings with operative results and
Results: In 126 bronchoscopies (57.3%), no
abnormal findings could be seen in the airways. Compared with
histologic and cytologic results, the normal macroscopic appearance of
the airways had a negative predictive value of 94.4%, but the positive
predictive value of all macroscopic abnormalities for the diagnosis of
airway invasion was low, particularly after radiation therapy.
Endoluminal tumor mass, protrusion of the posterior tracheal wall, and
signs of mucosal invasion were visible in 5.9%, 28.6%, and 4.1% of
the bronchoscopies, respectively. However, in only 8.6% of the 220
bronchoscopies, cancer invasion was proved by biopsy or cytology.
Bronchoscopy with biopsies and brush and washing cytology examinations
was the sole decisive staging procedure, enabling the exclusion from
surgery because of airway invasion in 18.1% of otherwise potentially
operable patients, with an overall accuracy of 93.3% (95% confidence
interval, 86.7 to 97.3%). The results of bronchoscopy were falsely
negative in six patients, who all underwent surgery after neoadjuvant
Conclusions: Fiberoptic bronchoscopy
with systematic multiple biopsies and brush and washing cytology
examinations is an accurate procedure in evaluating the possible
invasion of supracarinal esophageal cancer into the airways.
Macroscopic findings alone are not reliable; errors in sole
bronchoscopic inspection would have resulted in operations that would
be unlikely to help the patients or would have inappropriately excluded
patients from surgery.