Sputum cytology: a limited role.

Abstract

Aims-To determine the cost and sensitivity of sputum cytology in routine use and to determine when sputum cytology is most appropriate. Methods-A retrospective study, based on all sputum cytology requests received in five histopathology/cytopathology laboratories in Yorkshire from 1 January to 31 December 1993. Cytology findings were correlated with histological diagnosis or clinical outcome, and related to the speciality of the referring clinician. Results-Laboratory practice and performance was similar in all five centres. The average laboratory cost of sputum cytology was £26.93. The mean absolute sensitivity was 36% and the specificity was 99.6%. The majority of specimens was submitted by general physicians or geriatricians. The largest proportion of positive specimens were submitted by chest physicians. Conclusions-Often sputum cytology is used inappropriately as a screening investigation on, or soon after, admission. In addition, it is used inappropriately before bronchoscopy. Sputum cytology should be limited to individuals in whom a histological diagnosis is desired, but in whom bronchoscopy is inappropriate or unsuccessful. (i Clin Pathol 1997;50:566-568) Keywords: sputum cytology; sensitivity; cost; specificity; laboratory practice Sputum cytology is a common diagnostic test, forming much of the non-gynaecological cytology workload in many laboratories. Before the development of fibreoptic bronchoscopy, sputum cytology was the only alternative to thoracotomy for tissue diagnosis of many pulmonary neoplasms. It is regarded by clinicians as a simple, cheap, and non-invasive investigation.However, sputum cytology is relatively costly in terms of laboratory time, both during specimen preparation and screening; also, it has a low sensitivity. While there are individuals in whom it is the most appropriate means of investigation, there is an increasing recognition by cytopathologists and chest physicians that in many instances it is not a cost-effective investigation. This study examines the cost of sputum cytology and the laboratory practices of a selection of hospitals in Yorkshire. It also examines the sensitivity and specificity of sputum cytology requests from clinicians in different specialities to delineate better the appropriate role of sputum cytology. MethodsFive centres participated in the study, ranging from a relatively small district general hospital (350 beds) to a large general hospital with a significant teaching commitment (800 beds), and including one specialist cardiothoracic hospital. The participating pathologists were all consultants with a minimum of four years consultancy experience. All have a sizeable cytology workload, and one has a special interest in cardiothoracic pathology. All sputum cytology requests received from 1 January to 31 December 1993 were analysed with respect to age, sex, clinical details, requesting clinician, and cytology findings. Subsequent investigative procedures and final diagnosis were obtained either from the hospital's clinical information syst...

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