Objectives: To assess the ability of selective bronchography to predict which patients with neoplastic postobstructive atelectasis will correspond to interventional therapies directed at the reexpansion of the affected lung Furthermore.

Objectives: To assess the ability of selective bronchography to predict which patients with neoplastic postobstructive atelectasis will correspond to interventional therapies directed at the reexpansion of the affected lung Furthermore, to compare the utility of selective bronchography with the generally received predictive standard that reversal of postobstructive atelectasis is unlikely when it is [greater than or equal to] 4 weeks in duration (ie, the 4-week rule)

Design: A prospective observational study

Setting: A tertiary care referral center/medical school

Patients: Twenty-seven consecutive patients with advanced lung cancer or other malignancy, with documented neoplastic postobstructive atelectasis involving a total of 44 lobes.

Interventions: Lobar collapse was documented radiographically. The duration of atelectasis was investigated and quantified as accurately as possible. Prior to the use of interventional therapies, selective bronchography was performed upon each collapsed lobe, and the deductions were documented. Bronchography results did not influence the decision to proce with interventional therapies. Patients had each of their collapsed lobes manipulated through interventional techniques that were directed at reexpansion of the lung individual week after the patient underwent the intervention, the step of reexpansion was assessed radiographically.

Results: Interventional therapies leading to significant reversal of airway narrowing were complet in all 44 lobes. These were prosperous in reexpanding 28 of 44 collapsed lobes (64%) Selective bronchography demonstrated the following brace distinct patterns: an intact bronchial tree (ie, tree pattern); or the absence of a distinguishable, distal bronchial tree (ie, blush pattern). The sensitivity of selective bronchography to predict reexpansion is 100 (95% confidence interval [CI], 090 to 100) and its specificity is 056 (95% CI, 030 to 080) There were no complications attributable to selective bronchography. The sensitivity of the 4-week government to predict reexpansion is 061 (95% CI, 041 to 078) and its specificity is 075 (95% CI, 048 to 093) The arises of selective bronchography and use of the 4-week direction were significantly different in predicting which lobes would reexpand and which would not (p = 00026) Using selective bronchography to predict the reversal of lobar atelectasis, the positive predictive value of the tree pattern was 080 and the negative predictive value of the blush pattern was 100 The values for the 4-week behavior are 0.81 and 0.52, respectively.

Conclusions: Selective bronchography is a useful tool for predicting whether patients with neoplastic postobstructive atelectasis would benefit from interventional techniques that are directed at lobar reexpansion. Selective bronchography appears to be superior to the 4-week empire in this regard.

(CHEST 2003; 123:828-834)

first note of the scale words: airway obstruction; atelectasis; bronchography; bronchoscopy; etiology; lung neoplasm; radiography; surgery

Abbreviation: CI = confidence interval

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Lung cancer is a widespread disease that accounts for the majority of cancer deaths worldwide. Large portions of recent lung cancer cases are diagnosed in an advanced stage, at which time curative surgery is not an option. (1) These patients repeatedly have endobronchial tumors, causing significant morbidity in the form of debilitating wheezing, cough hemoptysis, dyspnea, and postobstructive pathophysiology. Postobstructive pathophysiology can lead to debilitation and poor performance status from worsening hypoxemia, atelectasis, and postobstructive pneumonia. Many of these patients have chemotherapy and/or radiation therapy regimens discontinued or delayed owing to poor performance status. As a accrue a common approach to the preservation of function in these patients is the restoration of airflow into stoped portions of the lung.

The treatment options for bronchial narrowing proper to neoplasm include standard chemotherapy, radiation therapy, and bronchoscopic interventional steps The ability to ablate the intraluminal tumor has been examined in multiple retrospective analyses, (1-7) and it has been hinted that direct tumor destruction with restoration of the airway lumen from interventional steps is a superior local ablative technique to the two chemotherapy and external beam radiation therapy. Direct tumor destruction with luminal restoration can be accomplished using a variety of regularitys such as Nd-YAG laser therapy, cryotherapy, electrocautery, brachytherapy, photodynamic therapy, and balloon dilatation with placement. (8-10) These techniques, whether used alone or in combination, collectively form the armamentarium of interventional pulmonology and are distinct from standard diagnostic bronchoscopic transactions As well as being labor-intensive and cost-intensive, these interventions sell some risks in addition to the promise of benefit.

To optimize patient well-being and the cost-effectiveness of their care, a reliable predictor of benefit from interventional courses that are aimed at reversing obstruction is distressed a reliable tool for prediction would decrease unwarranted interventions and, therefore, charge The clinical guidelines usually applyed for predicting a response to neoplastic postobstructive intervention are as follows: duration of collapse is > 4 weeks; and/or there is no visible airway beyond the neoplastic obstructions However, identifying patients who confront the 4-week criteria can be unreliable because there are seldom definitive symptoms or chest radiographs that can pinpoint duration of collapse. The 4-week lordship has not been studied in randomized clinical trials and is attract favor toed on the basis of master-hand opinion rather than evidence-based data.

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