Situation
How do you manage the
following situations?
1 Negative biopsies
2 Query PV involvement by tumour
3 Dysplastic cells but no malignant cells from all lobes on bronchoscopy.
4 Poor PFTs in a
patient with a blocked left main bronchus that needs a left pneumonectomy on CT
scanning.
1 Negative biopsies
If the biopsy reveals
a specific diagnosis such as hamartoma then the diagnosis is correct, but the
failure to demonstrate malignancy does not exclude carcinoma. So follow up with
repeat CT scanning every 3 months initially. Occasionally the patient will just
want it out which will make decision making easier.
2 Query PV involvement by tumour
A trans esophageal echo can help here.
3 Dysplastic cells but no malignant cells from all lobes on bronchoscopy.
You need to repeat a few times to make sure no malignancy present. The
patient must stop smoking as they obviously have an unstable epithelium. The
role of Vitamin A is unproven. Chemotherapy would be highly controversial,
although not such a silly idea.
4 Poor PFTs in a
patient with a blocked left main bronchus that needs a left pneumonectomy on CT
scanning.
The PFTs are
unimportant with a blocked LMS bronchus in a patient needing a pneumonectomy; it
is their current performance status. You can actually make them better as you
will be reducing their intra pulmonary shunt through the hypoxic left lung.
5 Query met or second primary
Tissue biopsy is
usually key to solve this conundrum.