Diagnostic Accuracy of Cytological Sampling Techniques by Bronchoscopy in the Diagnosis of Lung Cancer
Keywords:
Bronchoscopy, Bronchial brushing, Broncho-alveolar lavage, Bronchial biopsy, cytology, histopathology
Abstract
Background: With advent of newer diagnostic modalities for obtaining small biopsies and cytologic samples by bronchoscopy it is important to assess the diagnostic accuracy of these techniques. Material and Methods: A Retrospective and Prospective study was conducted on 347 bronchoscopic specimens from 200 patients with clinical and / or radiological suspicion of carcinoma lung. To evaluate the role and relative diagnostic accuracies of bronchial washings, brushings and broncho-alveolar lavage in the diagnosis of lung cancer Results : 119/200 cases were diagnosed as positive for malignancy on cytology and 56/80 cases were confirmed positive on histopathological evaluation. Cytological materials included in the study were, 8 BW, 180 BAL and 159 BB constituting a total sample size of 347. The overall sensitivity of BW, BAL and BB was 25%, 72% and 94% respectively. Thus, BB provided a significantly superior sensitivity and improved the diagnostic yield. Squamous cell carcinoma was the most common histologic type of malignancy diagnosed on both cytology and histopathologic evaluation with accuracy of 78.8%. A specific diagnosis of malignancy was made in 124 cases (62%) by combination of cytology and biopsy. Conclusion : Cytologic samples and small biopsies obtained under bronchoscopic guidance are forming important samples for diagnosing and classifying lung tumours. Every technique has utility and limitation. However, combination of different methodologies on bronchoscopy increases the diagnostic accuracy.References
REFERENCES
1. Cagle PT, Allen TC , Dacic S, Beasley MB, Borczuk AC, Chirieac LR, Laucirica R ,et al. Revolution in Lung Cancer New Challenges for the Surgical Pathologist. Arch Pathol Lab Med. 2011;135:110–16.
2. Gilbert Schreiber G, McCrory DC. Performance Characteristics of different modalities for diagnosis of suspected lung cancer. Chest 2003; 123:115S–128S.
3. Linder J. Lung Cancer Cytology. Something Old, Something NewAm J ClinPathol 2000;114:169-171.
4. Kamath AV, Chhajed PN Role of Bronchoscopy in Early Diagnosis of Lung Cancer. Indian J Chest Dis Allied Sci 2006; 48: 265-9.
5. Sturgis CD, Nassar DL, D’Antonio JA, Raab SS. Cytologic features useful for distinguishing small cell from non–small cell carcinoma in bronchial brush and wash specimens. Am J ClinPathol 2000;114:197-202.
6. Bhatia A, Singh N, Arora VK.A Perspective on Cytology of Lung Cancer. Indian J Chest Dis Allied Sci 2004; 46: 81-3.
7. Sackett MK, Salomao DR, Donovan JL, Yi ES, Aubry MC, Diagnostic Concordance of Histologic Lung Cancer Type between Bronchial Biopsy and Cytology Specimens taken during the Same Bronchoscopic Procedure. Arch Pathol Lab Med. 2010;134:1504–12.
8. Gaur DS, Thapliyal NC, Kishore S, Pathak VP. Efficacy of Broncho-Alveolar Lavage and Bronchial brush cytology in diagnosing lung cancers. Journal of Cytology 2007; 24 (2): 73-77.
9. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 World Health Organization classification of lung tumors impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10: 1243–1260.
10. Kawaraya M, Gemba K, Ueoka H, Nishii K, Kiura K, Kodani T, et al.. Evaluation of various cytological examinations by bronchoscopy in the diagnosis of peripheral lung cancer. Br J Cancer. 2003; 89(10): 1885–8.
11. Roth K, Hardie1 JA, Andreassen AH, Leh F, Eagan TML.Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques.BMC Pulmonary Medicine 2008, 8:2 URL http://www.biomedcentral.com/1471-2466/8/2
12. Chaudhary BA, Yoneda K, Burki NK. Fiberoptic bronchoscopy. Comparison of procedures used in the diagnosis of lung cancer. J ThoracCardiovasc Surg. 1978 Jul;76(1):33-7.
13. Hamilton W and Sharp D. Diagnosis of lung cancer in primary care: a structured review. Family Practice 2004; 21: 605–611.
14. Govert JA, Kopita JM, Matchar D, Kussin PS, Samuelson WM. Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumors. Chest. 1996;109:451–6.
15. Truong LD, Underwood RD, Greenberg SD, McLarty JW. Diagnosis and typing of lung carcinomas by cytopathologic methods. Acta Cytol 1985;29(3):379-84.
16. Poletti V, Poletti G, Murer B, Saragoni L, Chilosi M. Bronchoalveolar lavage in malignancy. Semin Respir Crit Care Med. 2007;28(5):534-45.
17. Poletti V, Romagna M, Allen KA, Gasponi A, Spiga L. Bronchoalveolar lavage in the diagnosis of disseminated lung tumors. ActaCytol. 1995;39(3):472-7.
18. Sigari N, Poor Anaraki Z, Salehian P, Safavi A, Ensani F, Accuracy of bronchial washing cytology before and after biopsy for lung cancer diagnosis Scientific Journal of Kurdistan University of Medical Sciences, 2006;10(4):1-5.
19. Flint A. Detection of pulmonary neoplasms by bronchial washings are cell blocks a diagnostic aid? Acta Cytol 1993;37;(1):21-3.
20. Mak VH, Johnston ID, Hetzel MR, Grubb C. Value of washings and brushings at fibreoptic bronchoscopy in the diagnosis of lung cancer. Thorax. 1990 May;45(5):373-6.
21. Chopra SK, Genovesi MG, Simmons DH, Gothe B. Fibreoptic bronchoscopy in the diagnosis of pre and post bronchoscopy sputa, washings, brushings and biopsies. ActaCytol 1977;21(4):524-7.
22. Saita S, Tanzillo A, Riscica C, Maresca A, Potenza E and D'Arrigo M. Bronchial brushing and biopsy: a comparative evaluation in diagnosing visible bronchial lesions.European Journal of Cardio-Thoracic Surgery1990;4:270-272.
23. Matsuda M, Horai T, Nakamura S, Nishio H, Sakuma T, Ikegami H, et al. Bronchial brushing and bronchial biopsy: comparison of diagnostic accuracy and cell typing reliability in lung cancer. Thorax 1986;41:475-8.
24. Ocque R, Tochigi N, Ohori NP, Dacic S Usefulness of Immunohistochemical and histochemical studies in the classification of lung adenocarcinoma and squamous cell carcinoma in cytologic specimens. Am J Clin Pathol 2011;136:81-7.
1. Cagle PT, Allen TC , Dacic S, Beasley MB, Borczuk AC, Chirieac LR, Laucirica R ,et al. Revolution in Lung Cancer New Challenges for the Surgical Pathologist. Arch Pathol Lab Med. 2011;135:110–16.
2. Gilbert Schreiber G, McCrory DC. Performance Characteristics of different modalities for diagnosis of suspected lung cancer. Chest 2003; 123:115S–128S.
3. Linder J. Lung Cancer Cytology. Something Old, Something NewAm J ClinPathol 2000;114:169-171.
4. Kamath AV, Chhajed PN Role of Bronchoscopy in Early Diagnosis of Lung Cancer. Indian J Chest Dis Allied Sci 2006; 48: 265-9.
5. Sturgis CD, Nassar DL, D’Antonio JA, Raab SS. Cytologic features useful for distinguishing small cell from non–small cell carcinoma in bronchial brush and wash specimens. Am J ClinPathol 2000;114:197-202.
6. Bhatia A, Singh N, Arora VK.A Perspective on Cytology of Lung Cancer. Indian J Chest Dis Allied Sci 2004; 46: 81-3.
7. Sackett MK, Salomao DR, Donovan JL, Yi ES, Aubry MC, Diagnostic Concordance of Histologic Lung Cancer Type between Bronchial Biopsy and Cytology Specimens taken during the Same Bronchoscopic Procedure. Arch Pathol Lab Med. 2010;134:1504–12.
8. Gaur DS, Thapliyal NC, Kishore S, Pathak VP. Efficacy of Broncho-Alveolar Lavage and Bronchial brush cytology in diagnosing lung cancers. Journal of Cytology 2007; 24 (2): 73-77.
9. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 World Health Organization classification of lung tumors impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10: 1243–1260.
10. Kawaraya M, Gemba K, Ueoka H, Nishii K, Kiura K, Kodani T, et al.. Evaluation of various cytological examinations by bronchoscopy in the diagnosis of peripheral lung cancer. Br J Cancer. 2003; 89(10): 1885–8.
11. Roth K, Hardie1 JA, Andreassen AH, Leh F, Eagan TML.Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques.BMC Pulmonary Medicine 2008, 8:2 URL http://www.biomedcentral.com/1471-2466/8/2
12. Chaudhary BA, Yoneda K, Burki NK. Fiberoptic bronchoscopy. Comparison of procedures used in the diagnosis of lung cancer. J ThoracCardiovasc Surg. 1978 Jul;76(1):33-7.
13. Hamilton W and Sharp D. Diagnosis of lung cancer in primary care: a structured review. Family Practice 2004; 21: 605–611.
14. Govert JA, Kopita JM, Matchar D, Kussin PS, Samuelson WM. Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumors. Chest. 1996;109:451–6.
15. Truong LD, Underwood RD, Greenberg SD, McLarty JW. Diagnosis and typing of lung carcinomas by cytopathologic methods. Acta Cytol 1985;29(3):379-84.
16. Poletti V, Poletti G, Murer B, Saragoni L, Chilosi M. Bronchoalveolar lavage in malignancy. Semin Respir Crit Care Med. 2007;28(5):534-45.
17. Poletti V, Romagna M, Allen KA, Gasponi A, Spiga L. Bronchoalveolar lavage in the diagnosis of disseminated lung tumors. ActaCytol. 1995;39(3):472-7.
18. Sigari N, Poor Anaraki Z, Salehian P, Safavi A, Ensani F, Accuracy of bronchial washing cytology before and after biopsy for lung cancer diagnosis Scientific Journal of Kurdistan University of Medical Sciences, 2006;10(4):1-5.
19. Flint A. Detection of pulmonary neoplasms by bronchial washings are cell blocks a diagnostic aid? Acta Cytol 1993;37;(1):21-3.
20. Mak VH, Johnston ID, Hetzel MR, Grubb C. Value of washings and brushings at fibreoptic bronchoscopy in the diagnosis of lung cancer. Thorax. 1990 May;45(5):373-6.
21. Chopra SK, Genovesi MG, Simmons DH, Gothe B. Fibreoptic bronchoscopy in the diagnosis of pre and post bronchoscopy sputa, washings, brushings and biopsies. ActaCytol 1977;21(4):524-7.
22. Saita S, Tanzillo A, Riscica C, Maresca A, Potenza E and D'Arrigo M. Bronchial brushing and biopsy: a comparative evaluation in diagnosing visible bronchial lesions.European Journal of Cardio-Thoracic Surgery1990;4:270-272.
23. Matsuda M, Horai T, Nakamura S, Nishio H, Sakuma T, Ikegami H, et al. Bronchial brushing and bronchial biopsy: comparison of diagnostic accuracy and cell typing reliability in lung cancer. Thorax 1986;41:475-8.
24. Ocque R, Tochigi N, Ohori NP, Dacic S Usefulness of Immunohistochemical and histochemical studies in the classification of lung adenocarcinoma and squamous cell carcinoma in cytologic specimens. Am J Clin Pathol 2011;136:81-7.
Published
2018-05-20
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