16 Bronchology – Past, Present and Future Diagnostic Procedures Blind Segmental Brush Biopsie In this procedure, segments B10 to B1 were brushed with the fiberscope under local anesthesia. The method proved to be time-consuming, taking between 1 and 2 hours on average. There is also a contamination problem if reusable brushes are used. A meticulous examination of a very large number of samples by an experienced cytopathologist is required. A repeat bronchoscopy for local- izing the exact site of brush biopsies is difficult if no lesions can be identified unambiguously. On the location of these sites can only be speculated. However, this has directed us towards a procedure to visualize lesions. Basic Facts Significant in the Detection of Early Stage Malignancy. 1. Biopsy for histopathological examination is the ”Gold Standard“. 2. The normal respiratory epithelium undergoes cellular changes, progressing to dysplasia and in-situ carcinoma a few cell layers thick (0 .1 – 1 mm) and ultimately leading to invasive carcinoma. 3. Dysplasia and in-situ carcinoma are not detected in white light broncho- scopy, as increased redness, granularity, and slight thickening of the mucosa are associated with a variety of diseases. 4. Lung cancer occurs after a prolonged latency period (of up to several years). 5. Invasive lung cancer cure rates are below 15%. 6. Potential for curing in-situ carcinoma or micro-invasive cancer is 100%. 7. Local therapeutic measures, photodynamic therapy, cryotherapy or surgery can be used. 8. Chemical agents can be used to prevent or revert the progression of the carcinogenic process. 9. Retinol was found to be effective in reducing the cancer incidence. In conclusion: Pre-invasive  lung  cancer  is  like  poisonous  seeds  lying  just  under  the surface of the ground. They lie there for a long time and sprout when conditions suit them and then they get out of control. Back –––––––Table of Contents–––––––Next Back –––––––Table of Contents–––––––Next