12 Bronchology – Past, Present and Future Diagnostic Procedures Fig. 10 Endobronchial medication for tuberculosis and other lung disease. Fig. 11 Specimen collected by using a flexible biopsy forceps through the fiberscope. (The pathologist prefers bigger specimen). Diagnostic Goals – aside from visual exploration – obtained with Combined Bronchoscopy: • Collection of bronchial aspirate, sputum and secretion samples. • Broncho-alveolar lavage. • Transbronchial biopsies at proper depth and desired site for subsequent examination. During the “3rd World Congress for Bronchology” held in March 1982 in San Diego, California, the author presented a study of 300 cases in which trans- bronchial biopsies were performed and bronchial aspirates collected. It was ob- served that 29% of the cases showed neoplastic disease, 51% inflammatory lung disease, and 20% miscellaneous and non-specific lung lesions. The bronchial aspirate results, based on a total of 300 cases were as follows (see pie charts, p. 13): Negative culture 62  (21%) Non-pathogenic bacteria 94  (31%) Pathogenic bacteria and fungi 144  (48%) and led to the following conclusion: The histopathological and bronchial aspirate observations show that more than half, i.e. 51% of the cases, need more precise diagnostic studies in which bronchoscopy would provide a most useful means. This conclusion has been confirmed during the last several decades when it has become clear that cancer detected by radiology does not represent an early stage of disease. In  the  1950s,  screening  for  cancer  in  the  United  States  (Philadelphia)  and Europe (London) with large scale miniature radiography at 6-month intervals fell short of the expectations that this method might enhance the chance of identifying resectable tissue, e.g. tissue capable of being subjected to radical treat- ment. The results were not much different from unscreened patients. New Dimensions Back –––––––Table of Contents–––––––Next Back –––––––Table of Contents–––––––Next