The Impact of Cytology on the Bronchoscopic Diagnosis of Lung Cancer

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Given uncertainties in the literature regarding the diagnostic yield of cytologic sampling in bronchial cancer, we decided to investigate this issue using conventional bronchoscopic instrumentation.


The purpose of the study was to validate bronchoscopy-guided cytology sampling against forceps and surgical resection biopsies in central and peripheral bronchial cancer.


All patients presenting with potentially malignant pulmonary or mediastinal lesions on a chest x-ray or a chest computed tomography scan were investigated prospectively from July 1999 through July 2000. A total of 156 patients underwent flexible bronchoscopy and conscious sedation and local anesthesia. Samples were obtained using transbronchial or endobronchial biopsies (TBB/EBB = histology) and needle aspiration or endobronchial brushing (TBNA/SBB = cytology).


Central lesions were found in 95 and peripheral lesions in 61 patients. Altogether, there were 154 malignancies and 2 benign lesions. Malignancy was confirmed by TBB/EBB alone in 98 of 156 patients (sensitivity 62.8%), and by TBNA/SBB alone in 108 of 156 patients (sensitivity 69.2%). Both methods combined assessed tumor tissue in 136 of 156 patients (sensitivity 87.2%). Forty-four of 156 patients underwent surgical resection. The sensitivities for tumor detection in this subgroup were comparable to the entire group. However, as a result of the frequently necessary postoperative adjustment of preoperative cell typing, the preoperative diagnosis was only 60% specific for tumor cell types.


In case of suspected lung cancer, bronchoscopic samples must be obtained for both histologic and cytologic analysis to achieve optimal diagnostic yield. The bronchoscopic diagnosis reliably distinguishes small-cell (SCLC) from nonsmall-cell lung cancer (NSCLC), and therefore determines the conventional therapeutic procedure (chemotherapy vs. surgery). On the other hand, given a low specificity for the particular tumor cell types as confirmed from the resected material, bronchoscopic biopsies or aspirates are unsuitable for database for tumor-cell-type incidence in the population at risk.

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