Bronchoscopy is one of the main methods for diagnosing lung cancer and estimating the prevalence of this disease. During bronchoscopy, it is possible to visually examine the larynx, trachea, main, lobar, segmental, and even subsegmental bronchi, to assess the state of the lumen of the respiratory tract, directly see the tumor in central cancer and get an idea of ​​its endobronchial spread. On the basis of indirect signs, bronchological research provides an opportunity to judge the increase in the lymatic nodes of the root of the lung and mediastinum.

During bronchoscopy, it is possible to take various types of biopsies for the purpose of morphological verification of the tumor. With central lung cancer and peripheral with the germination of the large bronchi — this is most often a pinch and scarification biopsy, and in the peripheral — directed aspiration of the washing water of the bronchi, as well as transbronchial aspiration, scarification or pinch biopsy, which should be carried out under x-ray control. In addition, during bronchoscopy, puncture of the intrathoracic lymph nodes can be made through the wall of the bifurcation of the trachea and the main bronchi.

Bronchoscopy is a mandatory method of instrumental examination of patients in whom lung cancer is suspected, regardless of the location of the tumor and its clinical and anatomical shape. Without detracting from the high diagnostic value of bronchological research, it should be noted that the true prevalence of a tumor according to the bronchus may differ significantly from the data obtained during endoscopic examination, especially with the peribronchial nature of its growth. Contraindications to surgery, obtained on the basis of bronchological studies, were considered: extensive damage to the trachea bifurcation involving the opposite lung or side wall of the main bronchus of more than four cartilaginous semirings in the mouth of the process.

Bronchoscopy was performed for each patient. In the first period of the clinic, for this purpose rigid models of respiratory bronchoscopes of domestic and

foreign designs widespread use of fiber optic
 
 
 the range of their diagnostic capabilities, especially in ambulatory practice, was achieved by developing and applying original techniques of local anesthesia and anesthesia. Each endoscopic examination included the taking of material for the morphological study: plucking biopsy was performed, scarification of the mucosal areas changed, targeted aspiration of bronchial wash water, trans-bronchial biopsy of the peripheral formations. In combination with the use of a transthoracic aspiration and puncture biopsy, performed in 248 patients with peripheral lung cancer under fluoroscopy and 52 patients under computer X-ray tomography, this allowed 95.6% of the morphological verification of the tumor before the operation.

However, determination of the cell structure of lung cancer before surgery often presents certain difficulties, especially with poorly differentiated and undifferentiated forms of the tumor. A comparative analysis of the results of morphological studies of biopsy and surgical materials showed that in 39.2% of observations with these forms of lung cancer there was a discrepancy in the interpretations of the histological form of the tumor. At the same time, discrepancies in the estimates were almost equally often expressed in the revision of the results of the preoperative study both towards the establishment of more differentiated forms of cellular structure (48.6%) and the diagnosis of undifferentiated lung cancer (51.4%). The complexity of the morphological verification of biopsy material seems to be due to the presence of paracancrosis inflammatory changes,polymorphism of the structure of tumors, the inability to assess the structure of its various sections due to the small amount of material obtained, and, in part, the deformation of the tissue in the process of taking a biopsy. Therefore, the histological structure of the tumor, established before the operation, should not be the only criterion when deciding on the treatment tactics.

Another most commonly used endoscopic method for patients with advanced stages of lung cancer is esophagoscopy. The performance of esophagoscopy was considered as indicated in the presence of clinical or radiological signs of a tumor lesion of the esophagus, as well as in all cases of a lesion of the posterior mediastinum, trachea and main bronchi. With the introduction of the method of fibroesophagoscopy into clinical practice, the indications for the study have expanded significantly. At present, prior to surgery, fibroesophagoscopy is performed for all patients with advanced stages of lung cancer. In our opinion, only the detection of tumor germination of the esophagus mucosa during esophagoscopy can be a sign of the patient’s inoperability.