Usefulness of Various Diagnostic Techniques during Fiberoptic Bronchoscopy for Endoscopically Visible Lung Cancer: Should Cytologic Examinations Be Performed Routinely?

Abstract

Background: The question of which combination of procedures gives the best diagnostic yield following fiberoptic bronchoscopy is controversial. Objectives: To evaluate the value of various diagnostic techniques following fiberoptic bronchoscopy in the diagnosis of endoscopically visible lung cancer. Methods: The study included 98 patients found to have endobronchially visible tumor during routine daily bronchoscopy. Endobronchial lesions were classified as mass, submucosal lesion and infiltration. Washings, brushings and forceps biopsies were obtained in all subjects. Transbronchial needle aspirations were performed in 67 of 76 cases with mass or submucosal lesions. Results: Bronchoscopy was diagnostic for cancer in 88 (89.8%) of the 98 patients. Forceps biopsy specimens gave positive result in 82.7% of cases, transbronchial needle aspirates in 68.6%, brushings in 68.4%, and washings in 31.6%. Combination of forceps biopsy and brushing cytology yielded a positive result for lung cancer in 87 patients. The addition of brushings increased the diagnostic yield of bronchoscopy from 82.7% to 88.8% (p < 0.05). Collection of washing specimens in addition to forceps biopsy did not increase the yield of forceps biopsy. Transbronchial needle aspiration gave an additional yield of 1%. Conclusions: Routine cytological examination of bronchial washings does not increase the yield of forceps biopsy specimens. Transbronchial needle aspiration may give an additional positive yield to forceps biopsy. We conclude that a combination of forceps biopsy and brushing is the best strategy in the diagnosis of bronchoscopically visible lung cancer.

A Correlational Study of Bronchial Brushing With Bronchoscopic Biopsy in Diagnosis of Malignant Lung Neoplasms

“…It is not possible to perform all techniques in each patient because each has specific advantages and disadvantages. However their combined use yields the best results [4,5,6]. Some combinations of techniques like transbronchial biopsy and cytological examination procedures such as bronchial washing, brushing and needle aspiration have been reported to increase the diagnostic sensitivity for lung cancer compared with that of transbronchial biopsy alone [2].…”

“…It is not possible to perform all techniques in each patient because each has specific advantages and disadvantages. However their combined use yields the best results [4,5,6]. Some combinations of techniques like…”

Utility of VEGF and sVEGFR-1 in Bronchoalveolar Lavage Fluid for Differential Diagnosis of Primary Lung Cancer

“…However, lung cancer screening by chest X-ray and sputum cytology have proven ineffective in increasing patient survival (Ellis et al, 2001;Marcus, 2011), leading to the search for more sensitive and specific tests. Nowadays, fiberoptic bronchoscopy is the most commonly used method for diagnosing lung cancer (Karahalli et al, 2001;Mazzone et al, 2002). Patients suspected of having lung cancer often undergo fiberscopic examination and bronchoalveolar lavage fluid (BALF) was used as a clinical marker for lung cancer diagnosis has been described (Charalabopoulos et al, 2007;Emad et al, 2008).…”

Clinical application of the SurePath liquid-based Pap test in cytological screening of bronchial brushing for the diagnosis of lung cancer

“…Brushings, washings and forceps biopsies are often combined to increase the diagnostic yield (Saltzstein et al 1977;Mak et al 1990). Brushing complements forceps biopsy alone in the diagnostic workup of lung cancer and can be useful in the identification of lung carcinoma, a combination of brushing and forceps biopsy is the best strategy in the diagnosis of bronchoscopically visible lung cancer (Matsuda et al 1986;Karahalli et al 2001). However, the literature differs regarding both the sensitivities of the diagnoses and the conclusions for the utility value of flexible bronchoscopy (Karahalli et al 2001;Lam et al 2000;Roth et al 2008), the major limitation of the preparation method has been variable quality due to contamination with blood, cellular debris and mucus hiding the tumor cells (Motherby et al 1999).…”