Diagnostic yield of bronchoscopic sampling methods in bronchial carcinoma

Comparative assessment of the diagnostic value of transbronchial lung biopsy and bronchoalveolar lavage fluid cytology in lung cancer

BACKGROUND

This study was designed to determine the accuracy of bronchoalveolar lavage fluid cytology (BAL) using histopathologic examination of transbronchial biopsy specimens as the gold standard in diagnosis of lung carcinoma at our center.

MATERIALS AND METHODS

A retrospective study was conducted to investigate a total of 388 patients who were suspected of having lung cancer and had undergone fiberoptic bronchoscopy in Shahid Sadoughi hospital from 2006 to 2011. Lung masses were proven to be malignant by histology.

RESULTS

Transbronchial lung biopsy (TBLB) identified malignancy in 183 of the 388 cases, including 48 cases (26.2%) with adenocarcinoma, 4(2.1%) with bronchioloalveolar carcinoma, 47(25.6%)with squamous cell carcinoma, 34(18.5%) with well-diffentiated neuroendocrine carcinoma, 35(19.1%) with small cell carcinoma, 14 (7.6%) with non-small cell carcinoma, and 1 (0.54%) with large cell carcinoma. A total of 205 cases were correctly classified as negative. BAL was also performed in 388 patients; 86/103 cases were consistent with the final diagnosis of lung cancer and 188/285 cases were correctly classified as negative. The sensitivity of BAL was 46.9%(CI:41.9%, 51.8%)) and its specificity was 91.6%(CI:88.8%, 94.3%). BAL had a positive predictive value (PPV) of 83.4%(CI:79.7%, 87.1%) and a negative predictive value (NPV) of 65.8%(CI:61%, 70.5%). The overall accuracy of BAL was 70.5% and the exact concordance was 39%.

CONCLUSIONS

Our findings suggest that BAL cytology is not sensitive but is a specific test for diagnosis of lung carcinoma. If transbronchial lung biopsy is combined with bronchoalveolar lavage, the positive diagnostic rate will be further elevated.

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

The SurePath liquid-based Pap test (LPT) is successfully and widely used to assess sputum cytology. This study aimed to compare the cytological findings and diagnostic sensitivity of LPT with those of the conventional Pap smear (CPS) method for diagnosing lung cancer. Bronchial brushing specimens from 204 patients diagnosed with lung cancer were studied. LPT slides showed decreased areas of cell monolayers, a clearer background and distinct, stereoscopic cytological features. The LPT had a significantly higher diagnostic sensitivity for lung cancer (71.6%) than the CPS method (57.8%, p < 0.05), particularly for small cell lung carcinoma and >2 cm lesions (p < 0.05). Combination of the LPT with the CPS method showed obviously higher diagnostic sensitivity for the detection of adenocarcinoma (63.6%), central lesions (85.0%) and >2 cm lesions (81.4%) compared with the CPS method alone (p < 0.05, p < 0.01). Thus, LPT is a useful and easily performed technique that can be widely applied, and is suitable for the early diagnosis of lung cancer.

[Preoperative procedures in diagnosis of central and peripheral lung cancer]

BACKGROUND

Actual problem in diagnostics and therapy of lung cancer is early diagnostic and choice of diagnostic procedure. The AIM of this work was to assess the sensitivity of various histocytologic methods in diagnosis of central and peripheral lung cancer lesions.

MATERIAL AND METHODS

During 2003-2004, 348 patients with lung infiltrates suspect for malignancy were treated in University of Kragujevac Clinical Center. For the preoperative diagnostics, their sputum, bronchoaspirate, aspirate obtained by fine needle percutaneous biopsy and specimens obtained by forceps biopsy during fiber-bronchoscopy were analyzed using standard cytohistology methods.

RESULTS

Lung cancer was diagnozed in 155 out of 348 patients. The malignant lesions were centrally located in 123 patients (79,4%), while peripheral localization was found in 32 patients (20,6%). In the former patients, forceps biopsy was positive in 89,4%, and when combined with bronchoaspirate analysis, positive results were obtained in 91,9% of patients. In patients with peripherally located lesions, fine needly biopsy was positive in 68,8%, while citological analysis of sputum and bronchoalveolar aspirate were positive in only three (9,4%) patients. When all three methods were combined, positive results were found in 25 (78,1%) patients.

CONCLUSION

The central localization of tumors was four times greater than the peripheral one. In the patients with central tumour site, the best results were obtained when forceps biopsy specimens and sputum were analysed cytologically. The combination of transcutaneous fine-needle biopsy, bronchoscopy and sputum gave the best results in the group of patients whose lesions were located peripherally.

Cytologic approach to tumors of the tracheobronchial tree

Cytologic testing is an integral part of the workup of patients suspected of having lung cancer. These tests are less invasive than other tissue procurement methods, with minimal risk of complications. In experienced hands, the tests are highly accurate and reliable. To achieve good results and avoid diagnostic errors, clinicians must be educated in proper collection and fixation methods and the pathologist should be cognizant of clinical and radiologic data. Close communication between the clinician and pathologist should be encouraged.