Tuesday, 12 July 2016

Choi-Baisi classification for bronchoscopic findings in esophageal cancer

This classification allows to identify bronchoscopic findings that predict resectability of esophageal carcinoma [1-3].
Category I: No abnormalities [2].
Category II: Impingement and no mucosal changes [2].
Category IIa: "(...) slight compression on the posterior wall of the trachea or left bronchus and no tumorous infiltration of the tracheobronchial tree; normal mobility of the tracheobronchial wall; and parallel and regular longitudinal folds of the pars membranacea. (...) This group of patients can be identified because the compression on the involved tracheobronchial tree is usually slight and its mobility is normal. (...) The tracheobronchial tree is only compressed and not infiltrated by the tumor, thus making a radical resection possible" [1].
Category IIb: "(...) compression in which the fixation of the tracheobronchial tree suggests tumorous invasion; impingement or deviation of the trachea or left bronchus or widening of the carina, with or without narrowing, associated with a reduction in mobility during breathing and coughing (ie, fixation of the involved tracheobronchial segment). The mucosa is still normal, but the longitudinal folds of the pars membranacea may be widened. (...) There is a frank infiltration of the tracheobronchial tree and a radical resection is unlikely. These patients can be downstaged by appropriate neoadjuvant" treatment "that would then make radical resection feasible" [1].
Category III: Mucosal invasion [2]/irregularities or tracheoesophageal fistula [3].
Bibliographic references:
[1] Baisi A, Bonavina L, Peracchia A. Bronchoscopic staging of squamous cell carcinoma of the upper thoracic esophagus. Arch Surg. 1999;134(2):140-143. Available at: http://dx.doi.org/10.1001/archsurg.134.2.140.
[2] Choi  TKSiu  FSLam  KWong  J Bronchoscopy and carcinoma of the esophagus, I: findings of bronchoscopy in carcinoma of the esophagus. Am J Surg. 1984;147(6):757-759. Available at: http://dx.doi.org/10.1016/0002-9610(84)90194-6.
[3] Choi  TKSiu  FSLam  KWong  J Bronchoscopy and carcinoma of the esophagus, II: carcinoma of the esophagus with tracheobronchial involvement. Am J Surg. 1984;147(6):760-762. Available at: http://dx.doi.org/10.1016/0002-9610(84)90195-8.