Diagnosis of early bronchogenic carcinoma.

C ytologic examination of sputum has long been used in the diagnosis of bronchogenic carcinoma. Tumors of the segmental and larger bronchi may shed cells detectable in the sputum for many months prior to becoming symptomatic or radiographically apparent.’ During this period of their development, standard endoscopic techniques have frequently proven inadequate to localize the lesion with sufficient accuracy to permit definitive therapy.2 As increasing emphasis is being placed on early diagnosis and as sputum cytology becomes more widely used, we can expect an increasing need to evaluate patients whose diagnosis of cancer is based solely on sputum cytology. It is the purpose of this paper to summarize the endoscopic techniques and observations we have found useful in discovering the source of malignant cells found in the sputum of patients whose tumor site cannot otherwise be located. This work was performed at The Johns Hopkins Hospital as one aspect of a screening study designed to identify, localize and treat lung cancer discovered in a working population of cigarette smoking men over age 45 years.