虚拟支气管镜导航联合经支气管超声导向鞘引导技术与常规支气管镜诊断周围型肺癌的临床研究

目的探讨虚拟支气管镜导航(VBN)联合经支气管超声导向鞘引导(EBUS-GS)探查技术在,诊断周围型肺癌中的价值。方法随机将385例周围型肺癌(高分辨CT诊断,8 mm≤结节直径≤30mm)患者分为3组,一组为VBN联合EBUS-GS组,一组为EBUS-GS组,另一组为常规支气管镜组。在VBN联合EBUS-GS组,支气管镜经VBN引导到达靶支气管,并用超声探头探查;EBUS-GS组只有超声探头探查,无VBN辅助;常规支气管镜组,则既无VBN辅助,亦无超声探查,仅有胸部CT片作为参考。结果可供分析的研究对象为最后诊断为原发性周围型肺癌的294例患者。VBN联合EBUS-GS组与EBUS-GS组在诊断率方面无显著差异(82.5%/81.3%,P0.05)。而与常规支气管镜组相比,诊断率有显著差异(82.5%/81.3%/43.3%,P0.05)。亚组分析显示,影响VBN联合EBUS-GS组和EBUS-GS组诊断率的因素,可能为CT影像显示有支气管直通病变,病变直径大于20 mm,超声探头是否在病变内。结论 VBN联合EBUS-GS或EBUS-GS可提高周围型肺癌的诊断率;提高其诊断率的影响因素可能包括,CT影像显示有支气管直通病变,病变直径大于20 mm,超声探头是否在病变内。     

虚拟导航系统联合径向超声支气管镜在肺周围型病变中的诊断价值

目的 探讨径向超声支气管镜联合虚拟导航系统对肺周围型病变的诊断价值及安全性研究，为临床上选择PPLs的诊断方式提供依据。方法 收集本院经胸部CT检查提示肺周围型病变患者500例，根据操作方式不同分为常规支气管镜组、VBN-rEBUS组、CT-PTNB组。分析比较三种诊断方式对PPLs的诊断阳性率及安全性。结果 1.常规支气管镜组诊断率43.6%,其中恶性病变52例，良性病变共44例；VBN-rEBUS组诊断率60.8%,恶性病变55例，良性病变49例；CT-PTNB组诊断率76.1%,恶性病变60例，良性病变23例；VBN-rEBUS组、CT-PTNB组诊断率高于常规支气管镜组，CT-PTNB组诊断率高于VBN-rEBUS,差异有统计学意义(P均<0.05)。2.对于病灶直径≤3cm、距离胸壁<2cm、位于肺野中带的病灶，CT-PTNB诊断率高于常规支气管镜及VBN-rEBUS(P均<0.05),对于病灶直径>3cm、距离胸壁≥2cm、位于双肺上叶、下叶、右肺中叶及肺野内带及外带的病灶，VBN-rEBUS诊断率与CT-PTNB无显著差异。3. CT-PTNB并发...     

细支气管镜下超声引导联合测量技术诊断肺周围性病变

目的 评价使用细支气管镜行支气管内超声引导联合测量技术诊断肺周围病变的有效性、安全性和影响因素.方法 回顾性分析2013年10月至2014年9月在苏州大学附属第三医院进行支气管内超声引导联合测量技术经支气管活检的肺周围性病变117例患者临床资料.其中男67例,女50例,年龄(62.2±10.9)岁,病灶直径(22.9 ±9.5)mm.支气管内超声检查使用外径4 mm细支气管镜和外径1.4 mm超声小探头.测量技术是指超声发现病灶后测量病灶与目标支气管开口或者病灶与支气管镜活检通道入口的距离,根据所测距离在活检钳相应部位做标记,从而指导活检钳进入深度的方法.结果 支气管内超声小探头病灶发现率77.8％ (91/117),超声引导经支气管活检总诊断率65.0％ (76/117),恶性肿瘤诊断率75.0％(66/88),良性病变诊断率34.5％(10/29).直径＞2 cm的病灶诊断率(78.7％,48/61)高于直径≤2 cm者(50.0％,28/56),差异有统计学意义(x2=10.56,P=0.001).不同部位病灶诊断率分别为右上叶61.8％ (21/34),右中叶91.7％(11/12),右下叶59.1％ (13/22),左上固有支57.1％(12/21),左舌叶80％ (4/5),左下叶65.2％(15/23),差异无统计学意义(x2=5.31,P=0.38).贴近胸膜的病灶且直径≤2 cm者诊断率18.2％(2/11).超声探头能穿过的病灶诊断阳性率(63.0％,17/27)低于探头不能穿过者(92.2％,59/64),差异有统计学意义(x2=11.78,P=0.001).不良反应为出血和胸痛,无需特殊处理.结论 细支气管镜下超声引导联合测量技术经支气管活检可明确大部分肺周围病变的诊断,并发症少,费用低廉.病灶大小、是否贴近胸膜以及超声探头能否穿过病灶影响诊断率.     

超细支气管镜肺活检并刷检结合经皮肺自动弹性活检对肺周边病灶的诊断

目的评价经X线引导超细支气管镜活检并刷检,结合B超引导经皮肺自动弹性穿刺活检在肺周围型病变诊断中的价值。方法89例肺外周病变患者先进行X线引导超细支气管镜肺活检并刷检共110次,对于经超细支气管镜检未获得诊断的26例患者,再进行B超引导经皮肺自动弹性穿刺活检共32次。结果经超细支气管镜肺活检并刷检获得诊断者63例,诊断率70.8%。经皮肺自动弹性穿刺活检获得诊断者21例,诊断率80.08%。二者结合后的诊断率明显提高为94.4%。结论经X线引导超细支气管镜肺活检并刷检,结合B超引导经皮肺自动弹性穿刺活检,可明显提高肺外周病变的诊断率,值得临床推广应用。     

虚拟支气管镜导航及快速现场细胞学评估对肺外周病变的诊断价值

目的探讨虚拟支气管镜导航(VBN)联合经支气管内超声及引导鞘管引导的肺活检术(EBUS-GS-TBLB)在肺外周病变(PPLs)中的应用价值,初步探讨快速现场细胞学(ROSE)的诊断价值。方法回顾性分析经EBUS-GS-TBLB诊断的PPLs患者88例,按有无虚拟导航分为VBN组46例和非VBN(NVBN)组42例,比较两组诊断率、操作时间,分析影响EBUS-GS-TBLB诊断率的因素。分析现场细胞学与刷检细胞学/组织病理诊断一致性。结果两组性别、年龄、病灶大小、病灶性质及肺叶分布差异无统计学意义(P0.05)。两组诊断率差异无统计学意义(χ~2=0.068,P=0.794);两组操作时间差异有统计学意义(t=-7.629,P=0.000)。两组均应用EBUS-GS-TBLB,恶性病变与良性病变诊断率差异有统计学意义(χ~2=4.926,P=0.026);病灶直径20 mm和≤20 mm诊断率差异有统计学意义(χ~2=13.071,P=0.000);EBUS图像显示病灶完全包绕探头者诊断率与靠近或远离探头者诊断率差异有统计学意义(χ~2=16.956,P=0.000),病灶上叶、中叶或舌叶及下叶诊断差异无统计学意义(χ~2=0.096,P=0.953)。ROSE诊断敏感性为65.9%(58/88),刷检细胞学或组织病理诊断敏感性为71.6%(63/88),两者一致性Kappa值为0.84,一致性较好(P=0.063)。结论 VBN联合EBUS-GS-TBLB对于PPLs有较高的诊断率,病灶性质、病灶大小、探头显示病灶情况等因素是影响诊断率的重要因素。结合VBN可以显著缩短操作时间,安全有效。ROSE与疾病最终诊断一致性好,可实时现场指导进一步操作情况。     

支气管肺泡灌洗液液基细胞学检查在周围型肺癌诊断中的价值

目的探讨支气管肺泡灌洗液(Bronchoalveolar lavage fluid,BALF)液基细胞学检查(Liquid based cytology test,LCT)在周围型肺癌诊断中的价值。方法选取同时进行了BALF传统涂片细胞学(Conventional smear,CS)、LCT、组织病理学检查的88例周围型肺癌和28例肺部良性病变患者,比较CS和LCT诊断周围型肺癌的敏感度、特异度及两者在肺鳞癌、腺癌中的阳性率。结果 BALF-CS和LCT诊断周围型肺癌的敏感度分别为51.14%、68.18%,差异存在统计学意义(χ2=3.972,P0.05);特异度分别为96.43%、100%,差异不存在统计学意义(χ2=0.168,P0.05);与CS相比较,LCT在肺腺癌中的阳性率更高(χ2=6.986,P0.01)。结论支气管肺泡灌洗液液基细胞学检查在周围型肺癌的诊断中可能具有较重要的价值。     

气道内超声模型在预测肺外周病变恶性概率中的探索性应用

目的 ①分析周围型肺癌的气道内超声图像特点;②筛选出周围型肺癌的气道内超声诊断指标,建立肺外周病变恶性概率估算模型,并评价其临床诊断价值.方法 2010年9月1日至2011年10月30日,150例患者入选试验.分析135例气道内超声检查清晰显示病灶图象,明确患者病变病理结果,记录、分析超声图像内部结构特征,观察特征包括:①病灶外形;②病灶边缘连续与否;③病灶边界清晰与否;④病灶内部回声强弱;⑤病变内部回声同质或异质;⑥病灶内支气管充气征;⑦同心圆有无;⑧病灶内血管影;⑨病灶内不规则无回声区.结果 ①单因素分析发现:病灶外形、病灶边界清晰与否、病变内部回声同质或异质、病灶内支气管充气征、同心圆有无、病灶内不规则无回声区6种特征在周围型肺癌良恶性鉴别中差异有统计学意义;②经二分类多因素Logistic回归分析,最终5个超声特征纳入回归方程,恶性概率预测模型P=1/[l+e-(1.272+1.271病灶彤状+1.452边界+1.645异质回声1687支气管充气征+1.899无回声区)]其中,病灶呈圆形或类圆形、边界清晰、内部同声异质、支气管充气征、不规则无回声区存在者记为1,否则为0;绘制ROC曲线,计算曲线下面积,正确度为86.3％.结论 ①气道内超声在肺周围型病灶的良恶性鉴别诊断方面,具有较高的应用价值,是一种安全、无刨、价廉的影像学检查方法.②多变量联合应用,建立二分类Logistic回归模型,能提高肺周围型病灶的恶性概率辨别的准确性.     

荧光支气管镜在中央型肺癌诊断中的价值

目的评价荧光支气管镜在中央型肺癌诊断中的价值。方法将患者随机分为白光组和荧光组,对可疑病变部位进行活检和/或刷检,比较两组检查结果的差异。结果入组患者86例,白光组和荧光组分别为44例和42例,肺癌一次性检出率分别为52.3%和78.6%,有统计学差异(χ2=6.54,P=0.038)。镜下呈增生型病变的肺癌检出率两组无统计学差异(χ2=0.34,P=0.84)。对于镜下呈非增生型病变,白光组检出率15.4%,荧光组为77.8%,两组有统计学差异(P=0.0138)。对中、重度不典型增生和原位癌检出率,白光组和荧光组分别为8.7%和24.2%,两组无统计学差异。结论荧光气管镜在中央型肺癌的诊断中具有重要的作用。     

CT、MRI及CYFRA21-1联合检测在周围型肺癌诊断中的价值

目的探讨CT、磁共振成像(MRI)及细胞角蛋白19片段抗原(CYFRA21-1)联合检测对周围型肺癌的诊断价值。方法分析83例周围型肺癌患者的临床资料,比较CT、MRI检测周围型肺癌患者肿瘤内部结构及周围特征的影像学结果及CT影像学特征下CYFRA21-1水平改变,分析CT、MRI、CYFRA21-1对周围型肺癌的诊断价值。结果 CT、MRI对周围型肺癌患者肿瘤边缘形态、血管断面、侵袭情况、淋巴结转移、积液、钙化及胸膜凹陷征影像学特征比较差异均具有统计学意义(均P<0.05);CT、MRI对周围型肺癌患者病灶大小、病灶形态检测比较差异无统计学意义(均P>0.05)。周围型肺癌患者在不同血管断面、积液、钙化、胸膜凹陷征等CT表现下CYFRA21-1水平比较差异无统计学意义(均P<0.05);在不同病灶大小、分叶形态、肿瘤边缘、侵袭、淋巴结转移CT表现下CYFRA21-1水平比较差异有统计学意义(均P<0.05)。CT、MRI、CYFRA21-1对周围型肺癌诊断准确性比较上差异均无统计学意义(χ~2=2.949,P=0.229);诊断准确性依次为54.22%、48.19%、61.45%,误诊率依次为45.78%、51.81%、38.55%;采用CT、MRI、CYFRA21-1联合诊断准确性明显高于单一方法诊断,误诊率也明显降低(χ2=18.55,25.17,11.17;P<0.001)。结论CT、MRI、CYFRA21-1联合诊断可以进一步提高周围型肺癌患者的诊断准确性,降低误诊率。     

孤立性肺结节116例良恶性高危因素分析

目的 探讨孤立性肺结节良恶性的高危因素.方法 根据良、恶性将116例孤立性肺结节分为两组,应用多因素分析强制进入法进行二分类Logistic回归分析,诊断结果为应变量(良性疾病=0,恶性疾病=1),自变量:年龄,结节直径,结节形态,结节内部特征,磨玻璃征,毛刺分叶,周边特征,结节钙化,结节界面,吸烟史,咯血.结果 经Logistic回归分析,孤立性肺结节恶性诊断的高危因素中,年龄≥60岁的OR值为28.098,P=0.004;结节直径＞1 cm的OR值为41.886,P=0.016;毛刺或分叶征的OR值为138.386,P=0.001;空泡征,支气管充气征的OR值为57.602,P=0.003.结论 年龄(≥60岁)、结节大小(直径＞1 cm)、毛刺分叶、结节内部特征(空泡征,支气管充气征)是恶性孤立性肺结节的高危因素.     

电磁导航支气管镜联合径向超声对肺外周病变的诊断价值

目的 探讨电磁导航支气管镜(ENB)联合径向超声(EBUS)对肺外周病变的诊断价值.方法 纳入2018年1月至2019年7月就诊唐都医院呼吸科的肺外周病变32例,筛除最终诊断不明确的和未探及活检的6例,对比入选26例诊断率及确诊病例临床特征分层关系和未确诊病例临床特征.结果 ENB+EBUS确诊17例,诊断率65.4％...     

Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations

Objective

Radial endobronchial ultrasound with a guide sheath (EBUS-GS) has improved the diagnostic accuracy of transbronchial biopsy (TBB) for malignant peripheral pulmonary nodules (PPNs). Many underscore the importance of tumor localization but reproducible results on other aspects that affect yield are few. We aimed to analyze the diagnostic performance of TBB with EBUS-GS and to know what group of patients can benefit most.

Methods

The database of patients with malignant PPNs (≤30 mm) who underwent EBUS-GS TBB at the National Cancer Center Hospital, Tokyo, Japan from April 2012 to March 2013 was retrospectively reviewed and analysed based on lesion and procedural characteristics.

Results

Most PPNs (N=212) were adenocarcinoma, measuring 20 mm [mean, standard deviation (SD) 5.45]. Overall diagnostic accuracy was 67.5% (143 of 212 cases). Factors that significantly affected and predicted diagnostic success were EBUS probe within (P=0.001) and parenchymal location that was not adjacent to the costal visceral pleura (P=0.001). When combined, these variables achieved an 87% (59 of 68 lesions) diagnostic yield. CT scan characteristic, lesion size, lobe location, and GS size were non-contributory.

Conclusions

EBUS-GS TBB is an acceptable diagnostic method for small peripheral lung cancer. It can be maximized for PPNs that are away from the pleura and when the EBUS probe can be placed within the lesion.     

Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible fiberoptic bronchoscopy.

Ninety-seven consecutive peripheral lung lesions were evaluated by biplane fluoroscopically guided flexible fiberoptic bronchoscopy and analyzed to define features that predict diagnostic yield. The overall diagnostic accuracy was 56 percent (63 percent for malignant and 38 percent for benign lesions). The most important characteristic associated with a positive cyto- or histopathologic diagnosis was size of the lesion; the yield was 28 percent when the diameter was less than 2.0 cm compared to 64 percent if the diameter was greater than or equal to 2.0 cm (P = 0.0035). The diagnostic yield was similar for lesions located in the outer and middle third of the lung if the diameter was greater than 2.0 cm; inner one-third lesions were correctly diagnosed more frequently, related in part to the larger size of these lesions. There was no significant difference in diagnostic yield for the following: segmental location, greatest distance from carcina on either the posteroanterior or lateral radiograph, or radiographic characteristics of the lesion. We conclude that biplane fluoroscopically guided flexible fiberoptic bronchoscopy is a reasonable diagnostic procedure for peripheral lesions greater than or equal to 2.0 cm in diameter, but that alternative procedures should be used for lesions under 2.0 cm in diameter.     

Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules

STUDY OBJECTIVES: To evaluate factors affecting the diagnostic yield of flexible fiberoptic bronchoscopy in evaluating solitary pulmonary nodules (SPNs). DESIGN: Retrospective analysis of bronchoscopies performed over a 4-year period. SETTING: A tertiary teaching hospital. PATIENTS: One hundred seventy-seven patients with pulmonary nodules without endobronchial lesions who underwent bronchoscopy with brushing, washing, and transbronchial biopsy. RESULTS: There were 151 malignant and 26 benign lesions. The diagnostic accuracy of bronchoscopy in malignant and benign lesions were 64% (97 of 151) and 35% (9 of 26), respectively. The yield of bronchoscopy was directly related to lesion size (p < 0.001, chi(2)). When lesions were grouped according to distance from the hilum, yields of bronchoscopy in central, intermediate, and peripherally located lesions were 82, 61, and 53%, respectively (p = 0.05, chi(2)). When we stratified distance from the hilum by lesion size, the difference in yield was not significant. However, lesions 相似文献   

纤维支气管镜对孤立性肺肿块的诊断价值

目的　评价纤维支气管镜 (纤支镜)检查对原因不明孤立性肺肿块诊断价值。方法 回顾性分析行纤支管镜检查54例孤立性肺肿块。结果 54例经纤支镜检确诊37例 (68.5%)，其中23例恶性 (42.6%)，纤支镜诊断孤立肿块阳性直接与病灶大小相关 (P＜0.025)如果按病灶大小及所处部位看，无显著差异，而病灶＜2cm时位于肺部外带1/3时阳性率3.4% (1/29)，对比病灶位于肺部内2/3占68.0% (17/25)，中叶和下叶基底段的诊断阳性率更高些。结论 纤支镜能提高肺内肿块病灶诊断阳性率，刷片，灌洗，检查后痰检可互相补充以提高诊断的阳性率。纤支镜检查阳性率主要取决病灶大小及部位，当肿块＜2cm，位于肺部外围1/3时阳性率低的，可采用其它方法提高其阳性率。     

A randomized trial of CT fluoroscopic-guided bronchoscopy vs conventional bronchoscopy in patients with suspected lung cancer

BACKGROUND: Prior case series have shown promising diagnostic sensitivity for CT scan-guided bronchoscopy. METHODS: This was a prospective randomized trial comparing CT scan-guided bronchoscopy vs conventional bronchoscopy for the diagnosis of lung cancer in peripheral lesions and mediastinal lymph nodes. All procedures were performed using a protocolized number of passes for forceps, transbronchial needles, and brushes. Cytologists and pathologists were blinded as to bronchoscopy type. Patients with negative results underwent open surgical biopsy (for nodules or lymph nodes) or were observed for >/= 2 years if they had a nodule < 1 cm in size. RESULTS: Fifty patients were enrolled into the study (CT scan-guided bronchoscopy, 26 patients; conventional bronchoscopy, 24 patients). Two patients, one from each arm, dropped out of the study. Ultimately, 36 patients were proven to have cancer, and 27 of these patients (75%) had their diagnosis made by bronchoscopy. The sensitivity for malignancy of CT scan-guided bronchoscopy vs conventional bronchoscopy for peripheral lesions was similar (71% vs 76%, respectively; p = 1.0). The sensitivity for malignancy of CT guided bronchoscopy vs conventional bronchoscopy for mediastinal lymph nodes was higher (100% vs 67%, respectively) but did not reach statistical significance (p = 0.26). On a per-lymph-node basis, there was a trend toward higher diagnostic accuracy with CT scan guidance (p = 0.09). The diagnostic yield was higher in larger lesions (p = 0.004) and when CT scanning confirmed target entry (p = 0.001). CONCLUSION: We failed to demonstrate a significant difference between CT scan-guided bronchoscopy and conventional bronchoscopy for the diagnosis of lung cancer in peripheral lesions and mediastinal lymph nodes. Further study of improved steering methods combined with CT scan guidance for the diagnosis of lung cancer in peripheral lesions is warranted.     

Ultrathin bronchoscopy as an adjunct to standard bronchoscopy in the diagnosis of peripheral lung lesions. A preliminary report

BACKGROUND: The role of the standard bronchoscope as a method of diagnosis of peripheral lung lesions is limited. OBJECTIVES: To evaluate the role of the ultrathin bronchoscope as an adjunct to standard bronchoscopy in the diagnosis of peripheral lung lesions. METHODS: Seventeen consecutive patients with a peripheral lung lesion on chest radiography or chest CT. All patients underwent a bronchoscopic examination with a standard size bronchoscope, and if there was no evidence of endobronchial lesion, these patients were subsequently examined with an Olympus 3C40 ultrathin bronchoscope (external diameter of 3.6 mm). Under fluoroscopic guidance, cytological brushing samples were taken with the ultrathin bronchoscope followed by a reexamination with the standard bronchoscope which followed the same 'pathway' to the lesion established by the 3C40 ultrathin bronchoscope. Transbronchial biopsies (TBB) and cytological samples were taken with the standard bronchoscope. RESULTS: The size of the lesions ranged from 1.5 to 7.0 cm. A positive bronchoscopic diagnosis by TBB was obtained in 11 out of 17 patients (64.7%) and a diagnosis of atypical cells suspicious for malignancy noted in a further 3 patients. For lesions less than 3 cm in size, a positive diagnosis by TBB was achieved in 7 out of 10 of these cases. The lesion was directly visualized with the ultrathin bronchoscope in 4 cases. CONCLUSIONS: Ultrathin bronchoscopy appears to be a useful adjunct to standard bronchoscopy by providing an accurate pathway to the lesion in question. However, further studies with larger patient groups are warranted.     

The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions.

BACKGROUND: Transbronchial needle aspiration (TBNA) is a bronchoscopic sampling technique used for the diagnostic workup of mediastinal lymph nodes, but the value of its routine use in evaluating peripheral pulmonary lesions is not yet firmly established. DESIGN: Retrospective analysis of routine diagnostic bronchoscopies. SETTING: University teaching hospital. PATIENTS AND METHODS: One hundred seventy-two consecutive patients (126 with malignant and 46 with nonmalignant disease) who underwent bronchoscopy for a peripheral pulmonary lesion. RESULTS: In 87 patients (51%), a final diagnosis was established by bronchoscopy; diagnoses included 81 malignant lesions (69 lung cancer and 12 pulmonary metastases) and 6 benign lesions (all tuberculosis). TBNA was used in 152 of the 172 patients (89%). Other endoscopic techniques included bronchial washing (100%), bronchial brushing (45%), and transbronchial biopsy (TBB) (27%). Concerning the different bronchoscopic sampling techniques, TBNA showed a positive result in 35% of cases, in comparison to 17% for TBB, 22% for bronchial washing, and 30% for bronchial brushing. While TBNA was diagnostic in 27.5% of the malignant lesions < 3 cm in diameter, the success rate in lesions > 3 cm was 65.5% (p = 0.03). Endoscopy-related complications included pneumothorax (n = 1), self-limiting bleeding (n = 12), prolonged coughing (n = 2), and vasovagal reactions (n = 2). None of these complications required further treatment. CONCLUSION: TBNA is an effective bronchoscopic sampling technique in the diagnosis of peripheral pulmonary lesions. In our study, the use of TBNA increased the diagnostic yield of bronchoscopy from 35 to 51% without additional risk. The use of TBNA in the clinical routine should be encouraged.     

Induced sputum in the diagnosis of peripheral lung cancer not visible endoscopically

The diagnosis of small peripheral lung cancer is difficult to achieve by non-invasive methods. We hypothesized that in these patients induced sputum might ncrease the diagnostic yield over spontaneous sputum, representing a good diagnostic alternative in selected patients. We prospectively evaluated 60 patients with peripheral lung lesions and normal bronchoscopic evaluation. Six samples of sputum (three spontaneous and three induced with nebulization of hypertonic saline) before bronchoscopy and six samples of sputum after bronchoscopy (three spontaneous and three induced) were obtained in each subject. Forty-two out of the 60 patients included were finally diagnosed with lung cancer. Eighteen patients were diagnosed with different benign conditions of the lung. Overall, malignant cells in sputum were observed in 21 patients and in all but one, the final diagnosis of lung cancer was achieved. Only one patient with a pseudoinflammatory tumour of the lung had a false-positive result in one spontaneous sputum sample. The diagnosis of lung cancer was obtained in 18 patients with the induced sputum (43%) and in 14 patients with spontaneous sputum (31%) (P=NS). Samples of induced sputum were more adequate for cytological analysis than samples of spontaneous sputum (P < 0.001). Of 13 patients with peripheral lung neoplasms of 2 cm or less in diameter, five were diagnosed using induced sputum (38%) and only one using spontaneous sputum (8%) (P<0.05). In conclusion, induced sputum is a valuable technique for the diagnosis of peripheral lung cancer. Induced sputum gives better quality specimens and better diagnostic yield in small lesions than the spontaneous sputum and may be indicated in selected patients with disseminated disease, inoperability or severe co-morbities.