Evaluation of various cytological examinations by bronchoscopy in the diagnosis of peripheral lung cancer

Abstract

To improve the efficacy of fibreoptic bronchoscopy in the diagnosis of peripheral lung cancer, we evaluated the effectiveness of various techniques for obtaining samples for cytological examination. Between January 1984 and December 2000, flexible fibreoptic bronchoscopy under fluoroscopic guidance was performed in 1372 patients with lung cancer having no visible endoscopic findings. Histological examination of specimens obtained by forceps biopsy and cytological examinations on imprints of biopsy specimens, brushing, selective bronchial lavage, curettage, transbronchial needle aspiration, rinse fluids of the forceps, brush, curette, and aspiration needle, and all fluids aspirated during the bronchoscopic examinations were evaluated for diagnostic power. Using these techniques, the overall diagnostic rate with bronchoscopy was 93.4%. The sensitivity of the histological examination was 76.9%; additional imprint cytology increased the sensitivity to 84.8% (Po0.0001), while additional cytology on the rinse fluid of the forceps increased the sensitivity to 83.7% (Po0.0001). The addition of both imprint cytology and cytology on the rinse fluid of the forceps increased the diagnostic rate to 86.2% (Po0.0001). Our results indicate that cytological examinations of the imprints of biopsy samples and the rinse fluids of the forceps and the brush improve the efficacy of fibreoptic bronchoscopy in the diagnosis of peripheral lung cancer. British Journal of Cancer (2003) Fibreoptic bronchoscopy is now routinely used for obtaining specimens from which to diagnose various respiratory diseases. Bronchoscopic techniques for the diagnosis of lung cancer consist of histological examination of specimens obtained by transbronchial biopsy and cytological examination procedures such as bronchial washing, brushing, and needle aspiration. Some combinations of these techniques have been reported to increase the diagnostic sensitivity for lung cancer compared with that of transbronchial biopsy alone. Harvesting the cells shed from the tumour during bronchoscopic needle aspiration or brushing, by rinsing the needle or brush, has already been reported to be useful (Steinmann and Creul, 1978;Smith et al, 1980). The cytological examination of the brushing samples or bronchial washing fluid in addition to the histological examination of specimens obtained by forceps biopsy has been shown to increase sensitivity in the diagnosis of peripheral lung tumour, by an estimated 12 -30% (Chaudhary et al, 1978;Mak et al, 1990;Govert et al, 1996). Furthermore, cytology on the rinse fluids has been previously reported to elevate the diagnostic sensitivity from 65.8 to 70.7% (Zavala, 1975;Rosell et al, 1998). On the basis of these results, we planned to evaluate the effects of a histological examination combined with cytological techniques such as imprints of biopsy specimens and cytology on the rinse fluids of the forceps and brush; the effects of such combinations have not been previously reported. The primary objective in this study was to evaluate the...

Fiber-optic bronchoscope and detection of lung cancer: A five year study

“…Lung cancer was more frequently found in male subjects (77.2%), which is consistent with earlier findings [9][10][11]. Our results showed that there was a 3.39 times higher possibility of lung cancer in male subjects than in female subjects when they had WLB examination (Table1).…”

“…Moreover, the incidence of squamous cell carcinoma was 54.5% in male and 15.6% in females. One possible explanation to this tendency is that men have much higher prevalence of smoking than women in China [10][11][12][13][14][15][16][17] . Chinese National Tobacco Prevalence Survey in 2002 reported current smoking prevalence of 57.4% for men and 2.6% for women [14].…”

Epidemiologic trends in lung cancer over two decades in Northern Greece: an analysis of bronchoscopic data

“…Unfortunately only a small part of the lungs can be inspected by FOB, and the diagnostic yield of bronchoscopy for peripheral lung tumours ranges between 36 and 52 per cent. Recent data from bronchoscopic examination for peripheral lesions under simultaneous fluoroscopic guidance for cytological or histological sampling, revealed an overall diagnostic yield of 93.4% [11]. Most of the lung tumours referred for surgical resection or other therapy have bronchoscopic evidence of malignancy, and so this procedure is believed to be the most successful method in the diagnosis of lung cancer [9,10].…”

Correlation of bronchial brushing cytology with bronchial biopsy in diagnosis of lung cancer

“…Bronchoscopy has a diagnosti c yield of more than 90% when combined with bronchial cytology and biopsy. 6,8 In this study, the most common tumor was squamous cell carcinoma 64.2%, followed by adenocarcinoma 18.8%, small cell carcinoma 13.2%, large cell carcinoma 1.9% carcinoid tumor 1.9% In 46 cases, brushing cytology were well correlated with biopsy which was taken as a gold standard. There were no cytologically false positi ve cases.…”