This study aimed to assess the role of pleural fluid analysis in diagnosing pleural malignancy. Thoracentesis and closed needle biopsy of parietal pleura, using Cope's needle, were performed in 45 cases of pleural effusion coming to Department of Pulmonary Medicine. Samples were processed and studied as per standard methods. The male to female ratio was 4.6:1. Age range was 18-74 years. Two pleural effusions were transudates. Amongst the 43 exudates, 17 cases were malignant on pleural fluid analysis. Cytohistological correlation was 68.4% for malignancy. Adenocarcinoma was the most common malignancy. Pleural fluid showed good sensitivity, specificity and accuracy. In developing countries, where investigations and health facilities are inadequate and cost of treatment is un-affordable, careful analysis of pleural fluid still remains a very convenient, low-cost and safe investigation that helps in diagnosing cases of malignant pleural effusion. Its combination with pleural closed needle biopsy can further enhance its usefulness in diagnosing pleural malignant lesions.

Bronchial brushing (BB) and the more recent trans-bronchial needle aspiration (TBNA) are well established techniques performed using flexible fiberoptic bronchoscope, for sampling trachobronchial lesions suspected of malignancy. Our aim was to assess the efficacy of these two techniques in diagnosing carcinoma lung, when used individually as well as in combination, taking bronchial biopsy as the "Gold Standard" diagnostic test. Of all the cases of suspected lung cancer received between 1 st January 2003 to 30 th September 2004, 181 cases were selected where flexible bronchoscopic samples of BB, TBNA as well as bronchial biopsy were taken. Samples were processed as per standard procedures of cytology and histology. Squamous cell carcinoma was the most common lung cancer followed by small cell type. Sensitivity of BB was 81.5%; while that of TBNA was 62.5%. Specificity of BB and TBNA was 77.8% and 66.7%, respectively. Efficacy of BB was better than TBNA in diagnosing lung cancers. Combined use of BB and TBNA showed better sensitivity and accuracy than either techniques used individually. Bronchial brushing is a superior technique in the diagnosis of lung cancers than TBNA. Their combined use can further improve the chances of early detection of lung cancers.

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