Bronchoscopy Health Article

Definition

Bronchoscopy is a procedure in which a hollow, flexible tube called a bronchoscope is inserted into the airways through the nose or mouth to provide a view of the tracheobronchial tree. It can also be used to collect bronchial and/or lung secretions and to perform tissue biopsy.

Purpose

During a bronchoscopy, the physician can visually examine the lower airways, including the larynx, trachea, bronchi, and bronchioles. The procedure is used to examine the mucosal surface of the airways for abnormalities that might be associated with a variety of lung diseases. Its use may be diagnostic or therapeutic.

Bronchoscopy may be used to examine and help diagnose:

• diseases of the lung, such as cancer or tuberculosis
• congenital deformity of the lungs
• suspected tumor, obstruction, secretion, bleeding, or foreign body in the airways
• airway abnormalities, such as tracheal stenoses
• persistent cough, or hemoptysis, that includes blood in the sputum

Bronchoscopy may also be used for the following therapeutic purposes:

• to remove a foreign body in the lungs
• to remove excessive secretions

Bronchoscopy can also be used to collect the following biopsy specimens:

• sputum
• tissue samples from the bronchi or bronchioles
• cells collected from washing the lining of the bronchi or bronchioles

If the purpose of the bronchoscopy is to take tissue samples or biopsy, a forceps or bronchial brush are used to obtain cells. Alternatively, if the purpose is to identify an infectious agent, a bronchoalveolar lavage can be performed to gather fluid for culture purposes. If any foreign matter is found in the airways, it can be removed as well.

The instrument used in bronchoscopy, a bronchoscope, is a slender, flexible tube less than 0.5 in (2.5 cm) wide and approximately 2 ft (0.3 m) long that uses fiberoptic technology (very fine filaments that can bend and carry light). There are two types of bronchoscopes, a standard tube that is more rigid and a fiberoptic tube that is more flexible. The rigid instrument does not bend, does not see as far down into the lungs as the flexible one, and may carry a greater risk of causing injury to nearby structures. Because it can cause more discomfort than the flexible bronchoscope, it usually requires general anesthesia. However, it is useful for taking large samples of tissue and for removing foreign bodies from the airways. During the procedure, the airway is never blocked since oxygen can be supplied through the bronchoscope.

Demographics

In 2000, the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery Reports outlined the following rates for bronchoscopy with or without biopsy at short-stay hospitals in the United States:

• Both sexes: 8.9 per 10,000 population
• Males: 10.6 per 10,000 population
• Females: 7.3 per 10,000 population

According to the National Cancer Institute, cancer of the lung and bronchi is the second most common cancer among both men and women and is the leading cause of cancer death in both sexes in the United States. Among men, lung cancer incidence rates per 100,000 people range from a low of approximately 14 among American Indians to a high of 117 among African Americans. Between these two extremes, rates fall into two groups ranging from 42 to 53 for Hispanics, Japanese, Chinese, Filipinos, and Koreans and from 71 to 89 for Vietnamese, Caucasians, Alaska natives, and Hawaiians. The range among women is much narrower, from a rate of about 15 among Japanese to nearly 51 among Alaska Natives, only a three-fold difference. Rates for the remaining female populations fall roughly into two groups with low rates of 16–25 for Korean, Filipino, Hispanic, and Chinese women, and rates of 31–44 among Vietnamese, Caucasian, Hawaiian, and African American women. The rates among men are about two to three times greater than the rates among women in each of the racial/ethnic groups.