Flexible Fiberoptic Bronchoscopy and Pulmonary Cytology in the Evaluation of Patients with Head and Neck Malignancies

Abstract

In a study involving 107 patients with new primary tumors of the head and neck and normal chest roentgenograms, the information gained from flexible fiberoptic bronchoscopy and pulmonary cytology was analyzed. A small but significant proportion of the patients (14%) had positive cytologies. Contrary to previous reports, contamination of bronchial washings with tumor cells from head and neck neoplasms did take place. In most patients, the source of contamination appeared to be the passage of the bronchoscope adjacent to the endotracheal tube. Two patients with normal chest radiographs and positive cytologic studies were discovered to have pulmonary metastases within one year of bronchoscopy. It is concluded that malignant involvement of the lungs is unlikely in patients with a normal chest radiograph, normal bronchoscopy, and negative bronchial washings. This informaion appears to be of value in staging patients with head and neck cancer. Positive bronchial washings are always associated with malignancy, either in the head and neck or the lungs, and should be considered an indication for further evaluation. Recommendations are made regarding the technique of bronchoscopy as part of panendoscopy in head and neck cancer patients, and diagnostic strategies are proposed for patients with positive bronchial washings and negative chest radiographs.